OK, I am getting sick of this growing group of drug seekers I have been seeing. Most notably, those with recurrent shoulder dislocators.
Of course this is not an new thing. Dislocating your shoulder is a great way to get drugs. After all, you now have an objective physical (and radiographic) finding that IS painful. However, once you have popped it out a dozen or more times, the pain is not nearly as bad but you can easily exaggerate it.
In the past, we had few options. People would fuss and scream until they got multiple doses of Narcs and Benzos and then because they were so habituated to it, they would be able to fight your efforts to pull the damn thing back in. By the time you were done, they would get 6 of Dilaudid and 4 of Versed. And of course go home with an Rx for Percs.
But now, we have the solution. The Michael Jackson Death Drug ™, Propofol. No one can resist it. They are powerless. They simply go limp within 15 seconds and you can pop the shoulder back in so easily you don’t even need anyone to apply counter traction. Then, they wake up all nice and lucid and ready to be dischareged. With an Rx for Naprosyn of course. The main problem with it is that patients have to wait 6 hours after eating or drinking anything but water before they can get it. That means that for several hours you have have to sit there with them and endure their demands for nacs. I of course refuse this and have had a few people sign out AMA before their shoulder is back in. Big deal. Hit the road. You can probably pop it back in yourself if you really wanted to.
As someone who put up with a lot of shoulder dislocations from a torn labrum (before we learned it was a torn labrum) these people make me extra extra disgusted, as if drug-seekers don’t already make me disgusted.
From my own experience, there is a way to replace it with 0 drugs and almost no pain, but that also ONLY works on someone who is compliant and definitely NOT a crazy drug-seeker…..
If it was up to me, I’d strap them down and fix it without ANY meds…(which I’ve also done before in the ER, minus the straps).
All that time, pain and trouble!! Why don’t these people find someone that sells pot and use that? I couldn’t take having to harm myself, going to the ER and then not even getting what I wanted because the docs and nurses aren’t stupid.
What bothers me the most is what is happening with the people that really need to be in the ER. They have to wait while you all have to mess around with these losers.
@ Susan. They have to pay for their pot, so they don’t smoke it. They get their percs essentially for free, at at least on an endless stream of “credit”.
@ Susan You obviuosly don’t understand self injury and that it is a real problem and the guilt that follows, because one was there taking up space that the “real patients” needed.
Grow some compassion!
Susan. i apologize. We are talking about two different things entirely.
@tracy :)
Cripes, I forgot these losers don’t even pay! It pisses me off that the rest of us have to pay outrageous insurance premiums. If all that crap was cut out, I really wonder if there would be a healthcare crisis in this country.
I was doing clinicals when we had a shoulder dislocation come in to the ER. The patient was opioid dependent due to this shoulder injury. (fentanyl patches, etc). We ended up giving him 50mg of morphine and 10mg of versed IV and he was still able to buck the attempt by ortho to put it back in. They also had anesthesia come and try blocks, etc. Lo and behold, when they propofol’d him, it went right in. After the post reduction film, he popped it back out and he needed to be propofol’d again. Around the point of the propofol, we started to suspect the drug seeking.
6 hours? Really?
So…. If someone pops their shoulder out a few times (too many for you) they get no pain meds while waiting for the 6 hours to pass???? Why?
@ Almost Jesus there is a huge difference between dependence and addiction.
If they are a regular dislocator that is here all the time, yes. I make them wait. You’ll find that regular dislocators are very comfortable sitting there if they don’t move. So I advise they sit still or offer them some Toradol.
Oh ok :) Just wondering, I use to be a seeker, the person the Doctors would cringe to see. I faked everything, and 99% of the time I would walk out with an opiate. (Vicodin, Percs, Norcies, Lortab) I haven’t done any seeking in years tho, I learned my lesson when I went to the ER for real rightside abdominal pain, and they didn’t believe me, but the doc decided to do a CT anyways and found appendicitis. Never again did I seek, next time I go to the ER I am gonna be sick! For real!
How cruel. My son has Elhers Danlos Syndrome Hypermobility and has many dislocations an hour including shoulder. He now has chronic pain. I have found in life that Gods revenge is the best revenge.
I, as well as anyone with Ehlers Danlos Syndrome, find this article offensive.
With distasteful comments such as, “OK, I am getting sick of this growing group of drug seekers I have been seeing. Most notably, those with recurrent shoulder dislocators.” and “You can probably pop it back in yourself if you really wanted to.”
Here’s a few issues with his offensive and slanderous comments:
1. Some people, such as people with Ehlers Danlos Syndrome, have subluxations (partial/incomplete dislocations) as well as full blown joint dislocations.
2. Most people (over 80-90%) with Ehlers Danlos Syndrome – The Hypermobility Type has, or will have, severe pain from these joint dislocations/subluxations. It is not a laughing matter when the severe chronic pain from these joint dislocations/subluxations drives us to suicide.
3. Everyone with Ehlers Danlos Syndrome, not just those of us with the Hypermobility Type, have had physicians mistreat us in one fashion or another. Primarily, they believe this genetic disorder is “all in our heads.”
I spent 30 years in a busy ER. A good plan can deal effectively with the drug seekers-and still keep a level of empathy for those who have a legit complaint like Ehlers Danlos.
First, the docs must cooperate with the social worker to detect and intervene early with the ID of the seekers. Good documentation helps and a check of demographics does too. If the patient passed a few other ER’s to get to yours, be suspicious. If he has no insurance, be suspicious. If he has no regular doctor, be suspicious. If he names the drugs he wants, be suspicious. If his pain level is self defined as high and his vitals are normal, be suspicious.
In CA we can call/use the website set up by the state and see if a patient is doctor shopping. Amazing how many of the ones we check on had been to several ER’s and doctors recently.
Our practice was to treat an injured person once with narcotics and if they had a chronic problem they would have to return to us with a note from their doctor or they would receive NO narcotics. They would be treated with non-narcotic meds. If we suspected they were addicted, we referred them to the local pain management clinic and if they returned they would have to have a letter from that clinic. We cut down our drug seekers by about 80% the first year. We are pretty sure we didn’t cut down on their drug seeking but we are sure we cut it down at our facility.
Consistency and collaboration with the mental health professional on duty is what made it work.
One of us would tell them directly-You have a chronic medical problem and we are not your doctor for that. You need to have a regular relationship with a physician in order to get consistent treatment. That isn’t us.