A hilarious must read for anyone who has been frustrated by drug seekers . . .
3. If you’ve ever paused the show Trauma: Life in the ER at the exact moment that a doctor is writing a prescription for vicodin to see if you can decipher his DEA number, then you might be a drug seeker.15. If you are asked to rate your pain on a scale of 1 to 10 and you answer 23, then not only are you incapable of following simple directions, but you also may be a drug seeker.
Related posts:
- What to do if your name is trashed on the web
- Drug seekers in the ER: "A denial of narcotics is just a temporary setback"
- Drug seeking, without finesse
- How to spot a drug seeker
- Has drug seeking behavior reached the tipping point?
- Hospital administration supporting drug seekers?
- Drug-seekers, again
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{ 18 comments }
I never got why drug seekers didn’t just write down someone’s DEA when they got a legit script and save it for future reference. Is there a reason this wouldn’t work?
You might think EVERYONE’S a drug seeker if:
You are a physician working in the ER and are 31 years old, with no history of chronic pain yourself and no understanding of the patients who suffer from it.
“You are a physician working in the ER and are 31 years old, with no history of chronic pain yourself and no understanding of the patients who suffer from it.”
Or you’ve been threatened with Death or Lawsuits by someone you know stole narcotics from their dying mother, and still has the nerve to physically or legally threaten you despite their past. Chronic pain sufferers won’t tell you they are allergic to Ultram and TOradol, they may tell you it doesn’t help their pain. Abusers tell you they are allergic.
“I never got why drug seekers didn’t just write down someone’s DEA when they got a legit script and save it for future reference. Is there a reason this wouldn’t work?”
It could work. Of course it has been tried. You can also go to jail.
“You are a physician working in the ER and are 31 years old, with no history of chronic pain yourself and no understanding of the patients who suffer from it.”
1. If you have chronic pain why are you in the ER?
2. Why not just say you need vicodin to live rather than make up convoluted complaints and subject yourself to tests and workups just to score some vicodin?
3. Why do some people with the same injuries, illnesses learn to live with pain without distress while others need to make up imagined conditions to justify their need to live a life on drugs?
“You are a physician working in the ER and are 31 years old, with no history of chronic pain yourself and no understanding of the patients who suffer from it.”
I have multilevel disc prolapse thanks to a rugby scholarship and underground mining job to get me through med school and take only NSAIDs for it and do you know why ?
I am an ER/OB/Family rural physician and I could not in good conscience take narcotics and risk other peoples lives because I have sciatica – if you suck it up a bit and keep healthy and exercise , like with many conditions , you learn to live with it without becoming a drug seeking , whining asswipe.
PS I am NOT allergic to ketorolac and few people are!
Chronic pain should never be treated in the ER. There should be a fall back plan arranged by the primary physician for such an occasion as a flare-up. And as far as “flare-ups” go, I’m not even sure they are part of the chronic pain “syndrome”. Afterall, isn’t chronic pain just that? Chronic? Unwavering? Steady? Continuous? Free of peaks and valleys?
This debate won’t get cleared up in our lifetime.
I too suffer from an old and recurring disc herniation-which when florid makes me unable to concentrate on much else other than the extreme pain which usually runs it’s course in about 4-7 days. I also have a frontal sinus polyp – which, when infected, makes me physically sick from the radiating pain – to the point that I have to just sit for several days until it subsides.
I don’t take much in the way of medication because I get nauseous from opioids.
My high tolerance for physical pain doesn’t mean that people who can’t tolerate it as well are “Drug-seeking asswipes” as described by someone on this blog with a medical degree.
There are reasons why differences in tolerance occur. Descending pain inhibitory pathways are now known to be related to the pain experienced by fibromyalgia sufferer’s. There is a lot we still don’t understand.
Don’t be so quick or condescending to label all pain sufferer’s as drug-seeking protoplasmically deficient members of society. They can’t help who they are or what they have in the way of physiological responses to pain and suffering.
By calling them names and thinking you are tougher or superior to them you disenfranchise them as a group.
Just don’t prescribe for them – the same way most doctors turn their collective backs on them .
Refer them to pain groups and specialists. If you don’t like who they are just be good to them and get them a pain consultation.
By calling them names you place them in the same category of people who go to and follow rugby matches.
I couldn’t agree more – but they (the drug seeking asswipes) have threatened me with lawsuits , threatened me physically and tried to steal prescription pads etc in my ER. As someone with a medical degree , I draw the line at this behaviour from any patient – if that is condescending , then cry me a friggin river and bring me a violin!
PS I think your treatment by the authorities has been despicable and I applaud your courage.
“If you don’t like who they are just be good to them and get them a pain consultation”
Dr. M: I am not trying to paint you all with the same brush but the fact is I have found most “pain specialists” to be anywhere from unhelpful to worthless. They do have their use in procedures. That stated, I long ago stopped referring patient’s for oral narcotic management frankly because I did a better job and was much more attentive than they were. Sorry but my professional experience.
PS:
I agree with above. The DEA is part of the problem.
Dear ANON’S 12:30 and 12:40–
Your frustrations and concerns are valid. I essentially agree that pain specialists often don’t connect and I meant no disrespect to your rugby fondness-my son played also.
I am going off this site and will no longer be reading Kevin-MD or joining in.
As far as my situation is concerned-it has been more than destructive. Too complicated to discuss here. Except to say that I practiced my specialty to the best of my ability – never ever wrote a prescription that wasn’t medically indicated – examined everyone fully – treated everyone with dignity – no one died or overdosed – no one became addicted from my prescribing – nobody was subjected to injections that weren’t designed to effect long term improvement – all my patients had legitimate pain syndromes – all were counselled extensively about all potential treatment options – if they didn’t have money they still got seen – if they were hungry or broke I helped them – none were selling prescriptions – none were ever accused of or proven to be addicted.
I got a killer-deal from the attorney general.
They killed me.
It would have been less painful if they had marched me into a field and shot me.
The things they say about me – through press releases – in no way closely approximate the truth.
Some people have said – on this website – that I am irritatingly pompous and arrogant.
I do it by design.
I hate The Pennsylvania Attorney General’s Office-and everyone in it. They are scoundrels.
There are two general categories of drug-seekers that we all encounter.
Those who are ‘on the make.’ Just trying to score. They are either addicted or are selling. They don’t have legitimate chronic pain conditions and should be referred for counselling.
Those who are ‘pseudoaddicts.’ Scared people who for some reason have developed neurotic type fears about suddenly losing their ability to get proper medications. To be in this category they must have a legitimate pain condition.
Some of my patients exhibited pseudo-addictive behavior. They still got treated.
Had I not followed them closely it would have been difficult for me to determine just who was who.
I think if you practice due diligence you can usually figure out where they stand.
Prescribing laws are vaguely constructed. Most were passed prior to our understanding of opioid physiology. None of the statutes have built-in dosage prohibitions.
You must examine every patient [ focused exam ] on everey visit. You must be practicing in good faith. It nust be a typical doctor-patient encounter. You must believe that the patient has an actual pain condition-and not just be an addict [ they use the term "Drug dependent" ]
In addition you must not have aforethought that the patient is not really in pain. It is called a “Specific-intent” crime.
These are the “Criminal standards” for conviction.
Under these standards I am not convictable. For I obeyed all of the requirements in the statute.
But thats not how they come after doctors.
They come after YOU by using “Civil standards.”
Too many patients. Too many pills. High dosages. Not having big bulky exam tables in the office [ they love that one. ]- Name one neuro finding that requires an exam table to elicit. -Violating some imaginary Workd Health Organizatrion limit on prescribing [ there isn't any. ]These are but a few examples. Most of them wouldn’t qualify as a malpractice standard much less a criminal reason to convict.
They don’t have separate jail cells for doctors – but they could never bring a case against a street dealer with this kind of bullshit circumstancial nonsensense-unfounded upon scientific principole – and expect to gain a conviction.
I was offered a plea agreement to serve six months by pleading guilty. I said no. If convicted I’ll do a long long time.
I’m going forward with this because I need to show the courts that there are issues which need to be addressed. They may find me guilty. It won’t be based on any evidence of wrongdoing or violation of the statutes which I outlined above.
If they find me guilty it will be based on myth and prejudice against the use of opioids.
So thats why i get nasty sometimes. I’m angry.
The very best to all of you.
“So it was that they brought air and cheer into the sickroom…and often…though not so often as they wished… brought healing.”
Mangino,
Good luck. No need to leave this website though — you have said that before. Do you have a website following and outlining your ordeal?
“I have multilevel disc prolapse thanks to a rugby scholarship and underground mining job to get me through med school and take only NSAIDs for it and do you know why ?”
Because your pain isn’t that bad. Your pain wouldn’t rate a “2” on most chronic pain patient’s scales; if was any worse, you wouldn’t be getting much relief from NSAIDs. When your pain can’t be relieved by 225mcg a day of Fentanyl, come and give us a lecture on how bad your pain is; I’ll believe you then. If I could get relief from NSAIDS, I wouldn’t go within a mile of one of you white-coated barbarians.
There is very little scientific correlation between prolapsed discs and chronic back pain. Plenty of people have all manner of disc and spinal problems and have no pain at all. Others have no observable defects and are in excruciating pain. This is not a question of tolerance, but of the fact that medical science isn’t very good at detecting the real causes of pain. Treating people with no observable physical abnormalities as if they are all just a bunch of fakers and whiners displays not only a high degree of callousness and arrogance, but a fundamental ignorance of how chronic pain actually works. The latest theories sugggest that chronic pain is in fact a neurological disorder, and should be regarded as a disease in itself. Like any other disease, some people have it worse than others. Your ignorant macho posturing doesn’t alter the fact.
“I am an ER/OB/Family rural physician and I could not in good conscience take narcotics and risk other peoples lives because I have sciatica – if you suck it up a bit and keep healthy and exercise , like with many conditions , you learn to live with it without becoming a drug seeking , whining asswipe.”
The majority of people with pain can function reasonably well as far as cognition is concerned while taking narcotics. Most find their concentration is improved when they no longer have severe pain screaming in their faces like a drill sergeant all day. You wouldn’t know what “good conscience” was if it gave you a well-derserved kick in the ass.
“PS I am NOT allergic to ketorolac and few people are!”
Depends on how you define “allergy.” Few doctors would regard a GI bleed as the result of chronic NSAID usage as an “allergic” reaction, but adverse reactions are hardly rare with this class of drug. On the other hand, few people are allergic to narcotics, and most people can, in fact, tolerate them a lot better than NSAIDs and other drugs as they are similar to the body’s own endorphins. With over 100,000 deaths and 1.5 million injuries being caused every year by prescription drugs, the idea that a lot of people have problems tolerating a lot of drugs shouldn’t be news to any doctor. Treating people who are allergic to drugs other than narcotics as ‘drug seekers” by default is pretty ignorant.
I can only hope for your sake you never have to find out what chronic pain is really like, or what it’s like to have a lifetime sentence of torture hanging over your head in a system where you’re guilty until proven innocent, and the guy who serves as your judge, jury, executioner and court stenographer regards any attempts by you to prove your innocence as evidence that you’re in fact guilty as charged, and will happily brand you a “drug seeker” in your medical records. Read Kafka’s “The Trial” sometime for a fictional story that is identical to what people with pain go through in reality thanks to “doctors” like you.
Okay, I’ve never been here before and I realize that this is a rather old post, but on the off chance that someone else stumbles across it like I just did or someone re-visits it, I’ve got to respond to a rather ignorant comment…
Anonymous’ 1:01 (I think) statment which reads…
“Chronic pain sufferers won’t tell you they are allergic to Ultram and TOradol, they may tell you it doesn’t help their pain. Abusers tell you they are allergic.”
I can tell you for a fact that Chronic Pain sufferers do indeed say they’re allergic to Ultram. I’m allergic to Ultram and suffer from not only a wide-spread hyper-mobility syndrome (possibly EDS) that includes sternoclavicular dislocation, but Thoracic Outlet Syndrome (due to a cervical rib on both sides that resulted in having to have my right first rib removed) which further complicates not only my severely unstable shoulder (*TWO* capsular shifts – one open and one arthroscopic – failed within six months) but the dislocating clavicle as well and caused a *third* problem… brachial plexis neropothy. (don’t even think of comparing me to a rugby injury… I’m 32 and can’t even cut my own food!)
In the course of things I was at one time given Ultram, but that was rather disastrous and resulted in a rather nasty course of prednisone (which I tell my drs I will *never* take again) to rid me of the massive rash… a later “mistake” at a hospital ratcheted my allergic response up to an asthma attack that sent the nurses scrambling for syringes of benedryl and an epi pen .
While I admit that treatment for me is a bit complicated due to a laundry list of medications (aspirin, ibuprofen, keflex, Sulfa, Tequin, Ultram, and many derivatives thereof) those with chronic pain have, do, and will tell a dr they are allergic to Ultram.
I know this is getting lengthy, but I would like to address a couple other comments before I go…
First…
“If you have chronic pain why are you in the ER?” … Because a) there’s such a thing as breakthrough pain and b) some with chronic pain can also further injure themselves. If my back goes out (the disc subluxes) in the middle of the night because I leaned over too far to get a glass of soda (which thankfully is not often), I have to go to the e.r… or if my shoulder’s out and I can’t seem to get it back in for a couple of days… sorry… that’s just the way it is.
The second is really an after-thought, actually and not really attributed to a comment as much as it is aimed at a concept or way of thinking. Why on earth do Drs prescribe NSAIDS when there is absolutely no inflammation whatsoever? (the tissue surrounding my shoulders, knees, hips, etc are no different after a routine dislocation / subluxation than when they’re ’stable’… granted, one shoulder pretty much spends most of its time outside of the socket to varying degrees which may cloud the results in such a comparison, but the others don’t)
And lastly…
“Afterall, isn’t chronic pain just that? Chronic? Unwavering? Steady? Continuous? Free of peaks and valleys?” NO.
Chronic Pain is a blanket term. It can refer to a constant “baseline” of pain but it can also refer to pain that comes and goes on a long term basis. Those with Chronic Pain can also suffer “breakthrough pain” which goes well beyond the level of pain they deal with most of the time. (For me, I have a continuous pain in several joints that sits at about the – 4-5 level usually, though depending on weather, stress, etc can rise to about a 7 – but the breakthrough pain can be caused by a movement as simple as rinsing a soda can and ratchet the pain up to 9 and last anywhere from 30 seconds to 3 hours and feels like someone is trying to stick a large screw into my shoulder with a power screwdriver… usually when people ask what happened (after I scream and start to tear up) I usually try to lighten the mood by saying “I forgot I’m not supposed to blink”)
So you see… we’re not all drug seekers… and stated allergies don’t always equal drug seeking behavior.
It’s attitudes like these that prevent me from getting any kind of lasting relief from my constant (and breakthrough) pain. Oh, I do have one good medication and I am grateful for it (I could just *kiss* the one who invented Lyrica), but it only works on the nerve pain and I still have breakthrough pain. Try laughing with a massively unstable and wholly un-fixable collar bone that rubs against and pinches damaged nerves, an equally unstable shoulder and ankle, knees that can be walked *on* but not *with* (one has to be “locked” when I step, the other has to be bent at a particular angle), major arteries that are constantly being pinched off in your shoulder area and restricting blood flow to *both* of your arms, a disc in your back that plays the hokey pokey, knee caps that don’t like to stay put, a jaw that subluxes when you yawn, hips that sublux when you sit down because you forgot your wallet was in your back pocket, fingers that can’t always hold a pen because of pain and hands that constantly drop what you’re carrying with absolutely no warning (one minute you’re holding it, then next – it’s on the floor) and the constant degeneration of all of these symptoms … then come talk to me about “drug seeking behavior” and tell me that I shouldn’t have the vicodin that I asked for. (and don’t even get me started on lidoderm patches!!!)
Yikes…
Where it says…
“…laundry list of medications…”
It should say “…allergies to a laundry list of medications…”
Interstitial Cystitis is one of many conditions where NSAIDS are contraindicated. Many IC patients will state they have “allergies” to them b/c they know they exacerbate their condition and they have been instructed by their Uros not to take it. However, they are unsure of how to verbalize this, therefore they state they are “allergic”.
Please do not assume that everyone who states they cannot take NSAIDs are all catagorically lying. There are always exceptions to every rule.
Incidently, in the event an IC patient turns up in your ER in acute pain due to a flare, a rescue instillation of Sodium Bicarb, Heparin, Marcaine and Kennalog will work wonders! (Most ICers will be better within 5 min of the solution hitting their bladders!)
I enjoy your blog! Keep up the great posts!
Love love love Toradol. If I’m in a lot of pain, I can get a shot, drive home and not look like a drug seeker. Problem solved. I don’t think I’ve come across one Dr. who complains about giving a shot of Toradol to someone in obvious pain.
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