Drug Seeking 101

The running joke whenever we get a patient who asks for something that the rest of the staff knows I'm not willing to give is that I look like Boo Boo The Fool.

Most of the time, the nursing staff can always give me a heads up on a patient who seems to sniffing out a controlled substance.  Over the years, I have kind of learned to spot them from a mile away.

Taking a cue from Mr. Letterman, for your education, I give you:

The Top 10 Signs that You are Dealing With a Drug Seeker

10. They have no income or insurance, but swear they have an appointment with their "regular" provider coming up and just need some pain medication until their appointment...next month.

9. Before you even give them an idea of what you are going to give them for pain, they make the point of telling you that they have taken Tramadol before and "its not strong enough."

8. They are a brand new patient complaining of knee pain, and as soon as they sit on the exam table, they ask you if you need a urine sample from them.

7. They tell you that they have been in severe and chronic pain for years. But when you ask them what they have been taking for it, they tell you, "Nothing. I have just been dealing with it."

6. They answer in the affirmative to every sign or symptom that you ask them about. I mean, if your foot is "completely numb", how can you also describe the pain as "sharp"?

5. We provide them with their blood pressure medicine at no cost because they can't afford to pay $4.00 a month for the prescription, but they can afford to regularly see a psychiatrist and pay for monthly Adderall prescriptions with no problem.

4. They walk into the exam room holding whatever body part and make it a point to breath heavily and go "ooh" and "aah" over and over again for dramatic effect.

3. They threaten to go to the emergency room when you refuse to give them what they want. (*dials 911*) #kanyeshrug

2. Every other week they come in telling you that their medication was "stolen" out of a "locked" drawer to which only they have a key.

And the #1 sign that you are dealing with a drug seeker:

1. You can sit down and have discussion with me on the difference between natural and synthetic opiates and which ones will or won't show up on a routine urine drug screen.

Drug seekers, especially the obvious ones, annoy me. Not because I don't think there might be some level of  legitimacy to their pain, but more because my intelligence feels insulted whenever I encounter a patient asking for an unreasonable level of pain management. I very often must explain to them that I get at least 5 people with similar stories asking for controlled substances every day. I mean, sometimes I wish they were more creative in their tactics just to break up the monotony of having me saying, "No."

Especially in the clinic environments where I work, a large part of the homeless population struggle with substance abuse and mental illness. I don't intend to help them self-medicate by becoming a pill factory. I've been threatened with physical harm and called out of my name more times than I can count by patients upset with me for not giving them Lortab or Xanax or Soma. Just let's me know that I am doing the right thing.

Towanna