"Being Treated Like a Drug Addict"

Being an RN, I see a lot of patients coming in to the hospital who love their pain medication and are clearly addicted, but the doctors keep prescribing large amounts of drugs for them just to keep them pacified (not all docs but many with whom I have worked). Also, I have witnessed my son, who was seriously injured about 1 1/2 years ago, who went into the hospital clean, and came out a junkie, not being able to get off the stuff, even to this day.

I have to admit, that sometimes when I deal with drug seeking behavior from a patient, I at times, become judgemental, especially when I know they are not in pain and they just want the buzz. When someone is in pain, you will see an increase in blood pressure and heart rate. What bothers me the most is when drug dependents come into the hospital and push the call bell the MINUTE their pain medicine is due. They actually watch the clock. It is quite irritating when you have 5 other patients and they are demanding drugs every 1 or 2 hours. The funny thing is, when you see the patients an hour before the dose is due you see them talking on the phone, laughing, playing cards, etc. But, once that second hand reaches 12 boy, they call and suddenly, are in excruciating pain. The bottom line, I know I should treat every patient with compassion, but it gets really hard when you see the junkies come in with abscesses all over their arms from skin popping and get out of the hospital to do it all over again. Yes, we should have compassion for drug addicts but we should never condone the behavior.

Once last thing, prescription medication can lead to serious addiction problems if they are taken long term. I have seen many patients come into the hospital addicted to prescription drugs. Prescription medication is one of the worse types of medication to become addicted to, because psychologically, you justify your drug use because the meds are prescribed and not some street drug, therefore you are not an addict.

Well, I am rambling now. So, these are my thoughts and good topic to

I certainly appreciate Deborah’s comment as a health care professional myself.

What sets addiction to prescription medications apart in my mind – is the recipients of the damage. Yes, illegal drugs cause people to commit hideous crimes, often to innocent people to pay for their habit. But the crimes can sometimes be much more subtle, yet no less – and even more “painful” with prescription medication addictions.

I don’t know how many colleagues of mine fear prescribing pain medications – even for cancer patients – because they don’t want to end up in front of a state medical board defending their position. I have seen many patients, including those in the last weeks of terminal cancer go vastly undertreated for pain, because physicians were afraid to prescribe narcotics. To save face (and possibly their license and financial security), they have to rule-out everyone as being a possible “professional patient,” someone who knows the symptoms to complain of to get the drugs they want.

No – I am not blaming those who are addicted to prescription medications for hurting those with terminal pain, nor am I blaming the health care providers that truly want to relieve pain.

What is happening in the middle? Those who are given prescriptions that become addicted are abandoned by the medical profession, meanwhile those same professionals are scrutinized when they prescribe pain medications appropriately for patients who really need them.

Our current practice reminds me of a bunch of teenagers given drugs and allowed to use them until the police need to step in. Where is the guidance and education in the middle? Where are the teachers and coaches? Why aren’t we using nurses enough – those angels who can use their intuition to know who the “fake” pain patients are, and guide them to resources where they can get the help they need, and understand those with truly horrible pain, and guide the physicians they work with to treat them adequately.

Another rambling comment, but a little more about what it looks like from the “inside.”

What I note in your post is that no responsibility is expected of the addict him/herself to seek that healthy behavior. We certainly can’t assume that all of them do seek it, or don’t.

I’m not a health professional, but I was married to an alcoholic for many years. To the day he died (and yes, he died from his alcoholism, although it was many years after we were divorced)he denied he was alcoholic. He never took any ownership of his drinking.

There was no “support on his path to healthy living” because he wasn’t interested. He didn’t think he had strayed from that path to begin with.

I wonder how much this rings true for the professionals above? They see no attempt on the part of the “addict” to get healthier. They see only that the person is desperate, in denial, and wreaking havoc for everyone around them, taking no responsibility for improving the situation for him/herself or anyone else.

You can’t help someone who is unwilling to help him or herself. And in that case, compassion is really hard to come by, too.

It’s hard, because there is always a stigma associated with disease that is related to mental health or behavior, or is erroneously viewed as willful.

Even some health professionals find it harder to deal with an addict or alcoholic, or a smoker who has gotten lung cancer, than someone who has another disease, it seems.

I’m not saying it’s right, but it definitely seems that even with all the science and knowledge we have of addiction, even medical professionals sometimes maintain the idea — at least in part — that the person with the addiction is in part to blame for their own illness.

This is a tough one. I think perhaps the commenter meant that they were being treated with suspicion – suspicion that they might be abusing the system to get drugs for a non-medical purpose. Nobody likes to be eyed with suspicion.

I understand and agree your point that addicts should be treated with compassion. After all, addiction is a disease. However, noone wants to be responsible for providing an addict with drugs they will abuse, thereby enabling the addiction and possibly being indirectly responsible for harm coming to that person.

I’ve actually been there. I was once being treated for a little-known condition and the treatment happened to entail taking a very minimal dose of a drug that was classified as a narcotic. (way too small a dose to ever get “high”, by the way) I was still treated with suspicion, even chastised, at some pharmacies when filling my prescription.

So, while I do get your point, I also get the point of the commenter. People who have legitimate prescribed uses for controlled subtances are quite often treated under a “presumption of abuse” just as those who ARE abusing drugs. It’s just the way it is, yet it’s very disconcerting for someone who has to explain and defend their own legitimate medical treatment.

I don’t feel that any patient should be treated differently from another regardless of their “addiction status”.

One thing I have noticed and upsets me is that because we have addicts, because certain individuals have made a conscious decision to try illegal drugs (and subsequently become addicted to them) many people who are in legitimate pain do not get the pain relief they need because the doctor is either afraid he will be prosecuted for prescribing, or that he will turn a patient who is not an addict into an addict.

I remember sitting in a team meeting a few years ago, and during a case presentation the patient was described as an “XXXXX addict”, and not as a person who has an XXXX addiction. It may seem like a subtle difference, but the implication is that the person has become their addiction, instead of a person who has an addiction. Many times patients *do* become their addiction, but as professionals it is important that we validate who they are in addition to their addiction. The way in which we talk makes a difference, even if it is with support staff and peripheral team members, as it sets a tone for treatment.

I understand your points, but I think you read a lot into that comment that wasn’t there. It’s true that there is a certain way our society/medical community treat drug addicts. Recognizing that fact doesn’t condone the views or actions behind the treatment.

There are two different problems at work – one is that people with addictions are sometimes treated suspiciously, like criminals, or as if they are at fault for developing an addiction. The other problem is that those attitudes and actions also impact people who are being treated for pain.

If the medical community would treat addiction with caring and compasion, pain patients wouldn’t (wrongly) have to endure the stigma (wrongly) attached to addiction.

Societally, people need to understand that drug use – prescription or not – doesn’t guarantee addiction; that addiction is a disease and not a character flaw; and that most people with addictions are not going to engage in criminal or inappropriate behavior just because they have an addiction.

I know a woman who takes narcotics for chronic pain, and her son will not allow her to be around his children because he sees her as a “druggie.” First, she’s not addicted, and second, why would it even matter if she WAS? The drugs don’t make her dangerous or unstable, and she certainly doesn’t leave them laying around where the kids could get into them. And yet her son treats her as if she’s some kind of criminal. Because of the social stigma attached to addiction, she now feels shame for taking the drugs she needs in order to function. It’s wrong on many levels.

Hospital nurses see a lot of patients who have chronic pain, and it’s easy to label them as “drug seekers” and write them off as difficult patients. It’s not easy to distinguish a pain sufferer’s need from an addict’s need – both cause increased vital signs, agitation, etc. Instead of diagnosing addicts, nurses serve their patients better by treating pain and referring patients to pain clinics where appropriate.

And remember – the number 1 inappropriate drug seeking behavior isn’t addicts seeking narcotics! It’s people with colds seeking antibiotics.

I am in no way an expert in pain (I’m a pediatric NP and never got a DEA number so I didn’t prescribe anything stronger than 600mg ibuprofen!), but I worry about the way we treat those who have chronic pain. I think I’ve commented on this issue before, but if we give a pain med and the patient has an increase in quality of life, then it’s not addition. If the continuation of pain meds leads to a decrease in quality of life, you have to consider addiction.

For example, my mom has had many back issues over the years. She did a microdiskectomy (sp?) and had some relief. She’s had epidurals with varied results. She does have some narcotic pain relievers that she will take when the pain gets too bad. Sometimes, those are days that she can get more accomplished (housework, her job, spending time with family). She truly takes it as needed and can get pain relief so that she can function on bad days.

I think that we need to be able to evaluate pain medication use over the long term to see if it helps or hurts a patient’s quality of life – which is so hard to do in a fragmented health care system like we have.

It’s all so tangled up. On the one hand, it makes sense that health professionals need to be on the look out for addicts searching for a buzz. On the other hand, there are many people suffering legitimately with chronic pain who can’t get the relief they need because doctors are afraid of losing their license. I heard one story of a compassionate pain doctor who is now serving time in jail for giving patients the doses they needed to be able to manage their pain and function in their lives.

And there are cases where people DO get their drugs, and the drug companies mess up, resulting in lives lost. I have read too many stories to count of people who lost loved ones to manufacturing mistakes with the Fentanyl patch. Although there were some recalls, I guess the doctors weren’t pro-active in notifying their patients in time to save their lives. Or maybe they just didn’t keep up with the FDA alerts. This turn my stomach. But the fact remains there’s no one right or wrong way to look at this issue.

I just wish pharmaceutical companies would be genuinely accountable and responsible for the effects they have on people, rather than hiring their lawyers and PR firms.

I see this from both sides. I am a pharmacist…and I’m also a recovering drug addict- clean/sober for over 8 years.
From the pharmacist standpoint, even as a recovering addict myself, I get frustrated with patients that we see month after month doing the same ole manipulative crap. My dog ate my Lortab. Somebody broke in and stole my Oxycontin. Or the guy that calls everyday trying to get his prescription filled early when we’ve told him each time exactly when it is fillable. With the stress of a busy day thrown in, I can see how someone might get treated a certain way. I hope I don’t treat anyone differently, especially since I’ve been in their shoes. However, I do get frustrated. My frustration is more towards the disease of addiction and how I observe it stealing their lives away. Many pharmacy staff folks dispise the addicted persons and relish the opportunity to tell them that they cannot have their prescription filled.
On a side note, I hate the word junkie. It’s demeaning, arrogant, and judgemental. I’m not gonna go any further here.
Addicts should not be treated as a lower class of human. They need guidance, compassion, and respect. We don’t do that very well. The doctors keep prescribing. We pharmacists keep filling. The addict keeps using. That’s how it goes in my neck of the woods. I work very little in the retail world where prescriptions are filled. When I do, it pains me to fill about a third of the prescriptions that cross my counter. I hurt for these people. I want to throw them a life preserver and say, “Hey! Here’s a better way of life. Let me show you.” For fear of not being asked back to work at that pharmacy or rejection or whatever…I don’t much of the time. For that I am just as much a part of the problem I suppose.
In recent years I have spent a great deal of time and effort educating pharmacists, pharmacy students, and the general public about the dangers of addiction. I hope that my experience can persuade at least one person to not take that first drug off the shelf and pop it in their mouth to relieve the stresses of our profession. I’ve written my account into a personal memoir titled Incomprehensible Demoralization- An Addict Pharmacist’s Journey to Recovery. I walk the reader through my own personal hell and into a better way of life.
One day I hope to make it my sole vocation to guide people towards hope in their struggles with addiction. I hope to teach students not to treat their patients with disdain when they present with drug-seeking behaviors. Addiction is a terrible, painful, and lonely place to reside. I’m happy to be clean and sober today.

Following reading Dr. Hartney’s blog “Being Treated Like an Addict”, I read with interest and a fair amount of chagrin the 12 comments that followed.

Not only is the “addict” blamed, but chronic pain patients are assumed to be manipulative, prescribers assumed to be frustrated, deceived and manipulative, pharmacists assumed to be frustrated and manipulative, corporate scientists and marketers, policymakers, lawyers, etc…are also all blamed. The root cause of all this dysfunction is, of course, the ADDICT. Or as Mexico is saying loudly and clearly to the USA these days, “There is only supply when there is demand”.

I noticed this topic discussion somehow morphed into a collective treatise critical of the awkward and unwieldy ways in which society tries to manage the use and abuse of controlled pharmaceuticals by groups labeled abusers. Clearly everyone is uncomfortable when manipulation is involved in getting control drugs into the hands of patients (who might then sell them, get high on them, overdose with them or, God forbid, let them be eaten by the dog).

The comments posted point out that all people mentioned are lumped into groups defined by labels (pharmacists, nurses, recovering people…). When we identify as a label (whatever the label) we lose our individuality.

A few years back, I worked at a medical school. Students and residents, given the curricula of the times, did not know how to work in multidisciplinary, (much less transdisciplinary) teams. As a result patients often benefited only from a fourth or fifth of the knowledge base they could have received from a team assessment, diagnosis and treatment plan.

Today, in addressing complex individualized medical conditions such as cancers and addictions, we see the application of diagnostic and treatment protocols applied with minimally modified-by-type “one size fits most” approaches whether what is being treated is breast cancer or alcohol dependency. Protocols, for the most part, can be implemented by technicians. Physician (or Addiction Specialist) time is reserved for researching experimental treatments, seeing people seriously at risk of dying, collecting the proceeds from thrice weekly colonoscopy clinics and attending professional conferences or reading journals for CME’s. (JOKE)

For example in medicine, protocol implementation becomes the territory of technicians such as nurse practitioners while individualized rational treatment plans are relegated (in theory) to physicians with M.D. after their names. However, technicians have lots of time to spend with patients. Physicians not so much. Pharmaceutical reps, you are on your own (and shouldn’t be).

Please don’t let my comments be rained down upon by every highly qualified and well- credentialled healthcare person out there, this was meant as an example.

My more pointed and topically relevant point is that there is a need to stop diagnosing people into labeled and stigmatized groups and viewing people involved with pain pills as killer tomato-like blights to be shunned from society lest we be overrun and lose all moral decency.

I believe it is time to evolve medically and socially so that every patient has an accurate diagnosis and an individually effective treatment plan rather than a “protocol” driving their care. If so, fewer blunders will occur all around.

After a lifetime of working in human services and healthcare fields, I detect a new trend in addressing addiction individually and societally: we may finally be on the brink, thanks to the Recovery Movement (not bound by 12 step traditions of anonymity and restraint from public/political activity), of writing the term “addict” out of the collectively blameful social consciousness.

Please support legislation, policies and diagnostic terms that define and utilize “Substance Use Disorder (specified)” language.

As Dr. Hartney’s Addiction Site has demonstrated, our society applies the term “addiction” to the bondage and suffering that arguably accompanies every human behavior in which one can inextricably and often inexplicably over-indulge.

The related question of when and how “addiction” is differentiated considering physiological dependency and withdrawal should be well considered under substance use disorder classification systems.

Dr. Hartney’s ambitious and timely exploration of the whole addiction enchilada is much appreciated and admired.

Here are some final thoughts regarding the topic “being treated like an addict”. In my experience, being treated like an addict involves being “helped”, forgotten, ignored, lied to, helped some more, manipulated, blamed, punished (although never as brutally as the self-inflicted punishment of which an addict is capable) and eventually shunned.

In my experience being treated like an addict is much like being treated like a person with a hard to diagnose, chronically and visibly disabling and chronically painful medical condition.

I can’t help but believe that in both cases we must all try harder to keep ourselves and each other safer and free of hatred as all our cultural and societal efforts toward fostering happy healthy lives carry on to doing better.

It’s easy for the “health care providers” to only worry about covering their asses because at the end of the day the ONLY thing a majority of them care about is collecting their money and sending the patient out the door, regardless of whether they really feel better or not, just set up a follow up appointment, be told the same things, no clear results. The medical profession is a cloud of defensive mysticism, and by that I mean Vague, groundless speculation and scared “professionals” worrying more about their fancy cars outside their giant, conglomerate offices than the well being of their patients, it’s all just one big monopoly. In the last year I have had 6 surgeries, five to reverse a colostomy and one 4 weeks ago, for a fractured elbow. As a result of the colostomy surgeries I have 3 or 4 hernias throughout my abdomen, my arm is still so sore I haven’t slept more than 3 or 4 hours a day since the operation. I’ve tried taking 800mg Ibuprofen, no results, the pain does not subside. I try taking night time pain medicine to try to help me sleep, no results. I call and get jerked around by receptionists who give me nothing but a self righteous attitude and the same, lame excuses. Animals get treated better by veterinarians and they can’t talk! Am I to be blamed, looked at with judgmental, careless eyes because of junkies and liars? Should I continue to feel pain and lose sleep at their expense?! It’s wrong. At the end of the day the rich will get richer and the people suffering will continue to suffer, no matter how many junkies die.

Some studies show that only 3 to 16 percent of chronic pain patients become addicted to narcotic pain medications. Yet most people seem to believe that 100 percent of those who take opiates on a long-term basis become addicted to them. Personally, I resent this.

Please note that not everybody who takes these drugs “abuses” them, desires to get “high” from them, or is addicted to them. Many of those addicted to pain medications do seek euphoria and often take a higher dose than prescribed, or use other drugs such as marijuana or alcohol while taking pain pills. But some of us take opiates just to have a near-normal quality of life.

I have severe and near-constant pain from bone, disk, and nerve problems that persist despite two major spine surgeries, and I’ve taken opiates every day for a year or two, though I avoided them prior to that time despite having severe pain. They don’t make me “high” and I don’t take them for that purpose.

I take these drugs so that I can do everyday activities — clean my house, shop for groceries, walk my dog, wash clothes, sit at the computer, etc. Without the drugs, I’m practically bed-ridden.

I could tolerate a higher dose than I take and would get more pain relief from a higher dose, but I’m satisfied with the amount of pain relief I get from the dosage I’ve taken for the past several months. When it’s not enough to control my pain, I resort to a moist heating pad and bed rest.

Despite the length of time I’ve taken these drugs, I do not think I’ve developed an addiction to them. I don’t want to stop using them, though, because it greatly reduces my quality of life.

I can go for long periods of time without these drugs, and my main “withdrawal symptom” is worsening pain that becomes hard to control even when I begin taking the pills again. My blood pressure also rises to life-threatening levels when my pain increases from not taking the pain pills on schedule, and the worse the pain gets, the more fatigued I feel.

I do not have chronic pain. I lost my job about four months ago. I went to the doctor to get a check up before I was laid off. I was experienceing anxiety attacts due to not knowing where the money was going to come from or if I could keep the roof over my head, keep my cobra etc with my unemployment benefits. I asked my doctor for valume or something to help my anxiety and was quickly told “I do not do valume”. She did write me a 10 count lowest dose prescription for larasapham. When I asked for a refill I was treated like how dare I ask for more and I got the impression that my doctor felt I was a drug addict. I went to this doctor for three years and never asked her for any medication for stress or pain.

Since then my anxiety has caused alopecia and I have also started grinding my teeth at night. The teeth grinding has caused tooth and jaw pain. I went to urgent care and the doctor there gave me 10 count of vicoden for pain. I also expressed to this doctor that I have been having anxiety attacks and received no medication or forwarding. I have made a appointment with the dentist but I had run out of the vicoden (this was 21 days later and the reason for the length of time is pay rent or get my tooth fixed). I asked this doctor if I could get a refill of the 10 vicoden and was told “no” and that she would not be a good doctor to prescribe pain medication becuase I have not received a reason for the tooth pain from the dentist.

I am 40 years old my prescription drug history is: I was prescribed Xanax for 90 days when I was 28 and going through a divorce, I received pain medication for a broken arm that I never refilled and did not finish and the two prescriptions above. I realize there a addicts out there that abuse prescription medication but when doctors are to afraid to prescribe over a 10 count of any pain or stress medication it is a sad day for all of us. Asking for a refill of another 10 count 21 days later does not make me an addict. Have you ever watched intervention those people take 5-10 pills at a time. Having panic attacks are bad for my overall health and has caused my blood pressure to now be high and neither of the two doctors I have been to will even consider putting me on high blood pressure meds. None of the doctors in my area care and I have been branded a problem now because I asked for a refill. This is what the original comment meant to me.

I am currently looking into natural remidies to help my anxiety becuase I do not think there are doctors that will give me prescribed medication under there care. I am not sure why they can not look into my prescription history becuase there is nothing that would cause any alarm bells that I have any history of prescribed or non prescribed narcotic abuse.

Suffering in Incline Village, Nevada

I have trigeminal neuralgia. I am 28, and I take hardcore narcotics to control my pain. Thankfully, I have a great relationship with my pcp.

Despite being on a long acting pain med, and having another available for breakthrough pain, my b/p will go as high as 212/180 when I have the worst attacks. The same thing happens to me. If I let that attack go, it is significatly more difficult to get my pain under control again. The truth is that I HATE taking meds of any kind, and I’d love to wake up in the morning, and not have to think about the bottles of meds sitting on my dresser. However, that is not my life.

I suffer from one of the most painful disorders known to man. It is known as the “suicide disorder”. I clearly understand why. My pain is real, and I lothe being treated like a drug seeker when I have to go to the ER. If the pain isn’t bad enough, the emotional fight is enough to put anyone over the edge, alone.