Dr. Grumpy is always looking for junkies. I try not to deny pain meds to those who need them, but at the same time I hate people who abuse them. They make it harder for those who need them to get them.
Every doctor has been taken by a junkie at some point.
A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.
She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.
She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.
I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.
Then her "regular neurologist" called. They'd never heard of this patient.
Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.
I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.
And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.
Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.
I had a sweet little old lady patient when I was a resident. She had horrible rheumatoid arthritis with bilateral shoulder dislocations and a host of other problems. She was on Valium and Darvocet chronically. She died and about six months later the pharmacy faxed over a refill request or her meds. Turns out her daughter was filling them and taking them. Makes me wonder if her poor old mom ever got her meds!
ReplyDeleteDr. Grumpy, I am a recovering opiate addict and have been clean now for many years. Her story brings me crashing back to the reality of who I was and the demon I still fight every day. We are ingenious when it comes to getting our fix, and unless you walk in our shoes, you cannot fathom the thoughts that we devise to rationalize our use. You weren't "taken", you were a compassionate doctor who tried to help their patient and failed. Trust me, her use will eventually lead her to a dark place, and hopefully she'll be one of the fortunate ones and get help. Don't be surprised if she returns to make amends one day. It's something I did with my doctor some time ago.
ReplyDeleteI'm sorry you got taken, but I know the other side. I sprained my ankle really, really bad once. I went to the minor emergency place. They would not write me a script since the X-ray showed it wasn't broken. I was in a lot of pain! And the swelling and purple color were impressive. They said to just take Tylenol. Two days later I hobbled into my scheduled GYN appt and that doc felt sorry for me and wrote a script for Tylenol with codeine. I guess the minor emergency doc thought I sprained my ankle on purpose to get drugs?
ReplyDeleteI feel sorry for those for whom a good anti-depressant would be helpful along with cognitive behavioral therapy, but for the others-- a flying leap off a dung hill, for this very reason.
ReplyDeleteWhy should all those that do a real good job be given any advantage over the sad sacks that are calling me for the third time today if their script of such and such is ready, yet?
Thanks for sharing this Dr. G.
In my state, we have a program called INSPECT. You should see if your state has anything like this... basically whenever I get a patient coming in with a script for a controlled substance, especially a patient that is new to my pharmacy, I pull up this website, type in their name and birthdate, and I can see every controlled substance they have filled in the past 5 years, which doctor wrote each script, and which pharmacy filled it. It is been extremely helpful in many situations. Of course, when I refuse to fill the script, I write at the top of the script where they filled last, how many they got, and when they filled it, and ususally highlight it before giving the script back to the patient :)
ReplyDeleteStories like this leave me fuming mad. Its junkies like this who make it ten-times harder for people in very severe pain to get appropriate pain treatment.
ReplyDeleteI am British but from my time spent on a US patient forum I know many people in the US who are in constant, severe pain and yet have terrible problems accessing pain management because virtually no doctors except for Pain Management Specialists are willing to treat their chronic pain.
Often this is the case even when there is strong radiographic proof of damage.
Between the Junkies, and the DEA harrassing doctors, often people in the US are left needlessly suffering. I dread the day when the UK ends up in the same boat.
Gotta give that ole girl some credit for creativity though.
What if her regular neurologist hadn't been at lunch? Wouldn't that have blown her story? Did she schedule an appointment during a time she KNEW that no one would be there to answer? I supervise a switchboard for a large hospital and my operators know the seekers. One night, the doctor was complaining about one of his seekers calling again and the operator, notoriously outspoken, said, "Doctor, you have no one to blame but yourself for creating this monster." She was right, too. This issue works both ways.
ReplyDeleteI've had clients ask me for narcotics, including Oxycontin for "cancer pain". One has to be desperate to ask the veterinarian for drugs.
ReplyDeleteDoc - you've got a good heart and you got burned. Sorry to hear it.
ReplyDeleteI've never had a problem getting pain relief when I've needed it.
For example:
Lower back pain is NOT a chronic problem for me. 99.99% of the time, ibuprofen and ice resolve the problem in short order.
However, in 2002, I had a problem with it and after 5 days, no relief. It started on a Monday, and by Saturday at about 1 a.m. I was in the ER (how's that for typical drug-seeking timing?!?).
The ER doc examines me and runs me through all sorts of tests, "bend this way, reach for the ceiling, hop around on 1 foot while singing the National Anthem," all that jazz.
The doc finishes up and says, "Everything is normal, just perfectly fine. JUST EXACTLY WHAT IS IT YOU WOULD LIKE ME TO DO FOR YOU?" (he wasn't shouting, I just wanted to put that sentence in caps).
I stared at him incredulously and said, "I want you to give me something to make my back stop spasming and to relieve my pain!"
I didn't ask for anything by name because I was ignorant about drugs at the time - hell, I thought Vicodin was just the newest NSAID.
So the ER doc gave me enough Vicodin and Soma to get me through the weekend with instructions to see my GP come Monday. Which I did. End of (long) story.
I'm glad that at present I get all my controlled substances filled at a self-contained clinic/pharmacy (no, not a Pain Clinic).
That way, no bullshit, no suspicious pharmacists, no nuthin'. MD writes the scripts, nurse walks them to the on-site pharmacy, I pick them up. No muss, no fuss.
When I first started practicing, I was on call for several docs and I get an after-hours call from the (alleged) daughter of a lung cancer patient of a doctor in the call group, who had accidentally left his pain meds while visiting family. This person had all the right info, including cell type. I called in enough for the weekend.
ReplyDeleteI happened to have to go in to the office shortly thereafter and decided to check the patient's medical record to write a note-there was none. I called the pharmacy and found she had come in minutes after I called it in. I called her phone number, and found it was a pay phone outside the pharmacy!
These drug seekers know who's on call, especially young naive docs, and plan their scam carefully.
That link was a pretty sobering story. I'm sorry you have to spend your days in defense mode.
ReplyDeleteMy sweet mam, now 82 talks fondly of the Salvation Army back in England. She was a devout member, as a young girl. I'll have to keep my eye on her now I've read this story...
ReplyDeleteThis problem would be solved in the fantasy world of Happy Hosptialist where all drugs (including narcs)are available OTC.
ReplyDeleteYou know, I wrote up this whole whiny "Yeah I was once mistaken for a drug seeker, too" thing and I removed it. Not just 'cause it was whiny, but because something struck me.
ReplyDeleteIn the end both the honest patients and the medical people wind up the victims of the junkies. But then I thought of something else.
Think about the people who DEMAND to get tamiflu and such during flu season, whether they have the flu. Think about the people who DEMAND antibiotics when they likely have a viral infection, if they have an infection at all.
These are also people who are gaming & cheating the system. Generally they're not put in the same class because, seriously, narcotics are dangerous and people rarely die from a z-pack overdose.
But I am starting to think that they are a lot alike. Both abuse the system in a way that damages trust. Doctors want to trust their patients to be honest and accept proper treatment. Other patients don't want to have some other bonehead/criminal screw up the system so that they can't get properly treated.
I think that some medical folks get jaded after dealing with system-abusers, and that just hurts medical care all around.
I dunno, Dr. G. Maybe I'm stretching here. But I'm starting to really think that the best thing that could improve health care in this country is to give every self-important jerk, whether a junkie or someone who wants antibiotics for a cold, a swift kick in the ass.
I suffer from TN and you did the right thing. The pain is unbearable especially during the winter and the cold damp days.
ReplyDeleteThat is a classic story that just demostrates how far people will go to get narcotics. I had a call from a major medical practice in a city next to where I work. They told me there was a break in and robbery at their new medical offices. Not one of their new computers was touched, money was left behind, and other expensive equipment was left untouched including a nice flat screen television in the waiting area. What was stolen? All of their security paper prescription pads!
ReplyDeleteI know patients that would step over their dying mother to get one more Vicodin or Xanax. It is sad and pathetic. Grown men and women reduced to tears and throwing fits like a 3 year old brat over prescriptions that are too early to fill.
There is a certain percentage of the population that are made up of people who have let drugs competely consume their lives. And more often or not they go on year after year hopelessly hooked on drugs. It is a sad reality.
i assume that by 'looking' for junkies, you may have meant 'looking out' for junkies?
ReplyDeletenow u know why the tsa doesn't hold back in giving little old ladies the once over at the airport.
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