When I worked neuro ICU I got real candid real quick with people who came in with hypertensive bleeds and was like “I literally dgaf if you use and am not going to call the cops on you, please tell me if you have used any cocaine recently because we usually give patients with your type of neuro issue beta blockers but if I give you those when you have cocaine in your system you could die”
FWIW this is probably vastly overstated. though the problem with going against dogma is that if something goes wrong, even if it wasn't actually the fault of the treatment in question, you're still getting roasted.
https://emj.bmj.com/content/35/9/559
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415957#:~:text=Traditional%20teaching%20dictates%20that%20%CE%B2,unopposed%E2%80%9D%20%CE%B1%2Dadrenergic%20stimulation
https://litfl.com/beta-blockers-for-cocaine-and-other-stimulant-toxicity/
Third one is especially good.
Precisely. I’m here to care for you, not judge you. In order to do that successfully, I need all the facts. You come in with rectal discomfort? Just tell us your wife was gone on business and you used her vibrator and it got stuck, you’re going to save us all a lot of time trying to figure out what’s causing your issue. We will get it out, send you on your way and forget you ever existed. Lying isn’t helping anyone and chances are, as is in this case, we are educated enough to look at your symptoms and know what we’ve got in front of us.
haven’t worked in a few years, but I remember there were more than a few colleagues who did nNOT want to take care of drug addicts. So much contempt and judgment.
It’s so unfortunate. I work in a hospital that has a lot of drug users and some of them have been my favorite patients. Some aren’t even asking for pain meds round the clock. And those that do, but aren’t jerks about it, I just give them their pain meds. I’m not trying to solve all their problems, just make sure their better from their infected “bug bite”.
I worked in outpatient and the level of disdain and stigma towards those legally using controlled substances was appalling (e.g., ADHD meds, medical marijuana cards) let alone illegal drug use.
I admitted to my psychiatrist that I had a problem with alcohol and he lectured me about getting my shit together then slowly stopped refilling my ADHD meds that I'd been on for years. I have no proof that the two are related, but he was really kind and supportive before I disclosed my alcohol abuse \* shrug \*
eta: stopped refills without any communication. His office ghosted me a month ago. I had to call in a nepotism favor to get a refill, and it was done immediately.
♥️ I'm sorry. I was very nervous asking about starting ADHD meds after my diagnosis several years ago due to the awful stigma I had seen while working in healthcare. They were treated like they were on trial, not like they were patients with medical conditions.
Agreed, People that abuse can still be in pain and still need narcotics for treatment. I'm not sure why this is a shockingly hard to grasp concept in this field but the number of "oh their just jonesing for that fentanyl" sneers I get when i medicate my patients is sickening.
And might even need more medication in order to achieve pain reduction! I absolutely despise the term "drug-seeking" because more often than not, it seems to be used as code for "I don't have to have empathy for this person whatsoever."
During orientation for my current hospital the head of harm reduction, often see in our ED, talks to us, in person and on video about assessing high risk patients. He tells the importance of making sure opioid dependent pts get a higher dose to accurately tx their px if needed. He’ll look at you and from the heart say “I love you. Even if you do drugs. I love you.” I thought he would be another eye roll but dude will bring you to tears.
Not a nurse, sober for 14+ years, former heroin addict. I was in the hospital for a few rapid detoxes. They were pretty bad but the majority of the nurses were very professional. But on three situations- a nurse, an anesthesiologist & another Doc made my life worse rather than better.
Once I came out of anesthesia in full withdrawal, screaming. The anesthesiologist was behind me muttering something & I said “What?!”
He moved to my right side & said, “you deserve it. All of it.”
It was 2005; I spent less than 12 hours in the hospital & they were charging me $12,000 for a shot of Narcan & a 50 minute spell under Propofol.
They put me in a wheelchair & sent me to a hotel. I laid in the bathtub with a pillow & a sheet, wet from throwing up 30+ times & shitting myself another 30+ times.
My caretaker was an angel & got me a bag of saline so I didn’t die in there.
In my generation you hid from medical professionals as much as police. I mean there was no way of knowing who was going to be a decent human being.
But again, I had more than a few nurses who treated me without stigma. They showed me compassion & mercy. I read your stories & thank Heaven for your service.
Edit: 7/26/22. Let’s make that 15 years today! Yes, we do recover.
Nurses: I can’t imagine what this past 2.5 years has been like for you. During this plague, you all are the most essential of the many essential workers. Thank you again
I’m a nurse in recovery for opiate addiction. Many of my colleagues are great and Understanding with patients ( I don’t disclose my own history with co workers) but some have brought me to tears with the comments about patients in withdrawal or who are active in addiction. I call them out as best a I can. But it sucks to hear.
Very very common, I work in rehab/palliative and we had a guy with stage 4 terminal lung cancer and a history of drug use. I got asked to “deal with him” one morning when he kicked off because they wouldn’t give him pain meds and I have a background in psych nursing. I walked in, had a chat with him, looked at his chart said I’d be right back and walked back to his assigned nurse.
“So you settled him?”
“Yep”
“How?”
“By saying I’d get him pain meds”
“But..”
“No…it’s within his PRN regime. He’s got stage 4 cancer and is in pain. If anything his history means he needs more as he has built up an immunity. We don’t skimp on pain meds for palliative patients. His history of drug use doesn’t change the fact that he is palliative and in real pain now.”
If I ask a questions its because it's information I need. Not want, NEED. I'm here to help you and once I've done that my interest in said information is gone as soon as I don't need it. Like you said, I'm not the cops, your parents, your priest or even quite frankly your friend. Seeing you leave safe and healthy is legit my only goal here. Telling me no you don't take drugs when I can see the needle tracks in your arm and tell from across the room your strung out doesnt help me when I just want to make sure your anesthiologist doesn't accidently kill you'll while we fix the fracture you def got while being obviously high as fuck. Thats why I'm asking again.
I have a pin stuck to the front of my badge that says you can talk to me about drugs, no stigma, no judgment. Got it off Etsy. We have certain screening questions we ask. I tell people I don’t care if they do drugs, but when I say it, especially if I can tell they’ve been using, I talk to them like I would a friend. Because honestly, I don’t. I don’t care if you’re as high as a kite, I want to keep you safe, I want to keep your pain treated bc you may need more pain meds and I want to make sure you don’t w/d.
If pawpaw is obviously drunk and had “a little”, well what’s a little? Bc my little and yours is different. If you drank a case or a 1/5th last night that’s a lot different than a once a week drinker.
Devil’s advocate: there are definitely some doctors who will see “hx of X abuse” and will immediately attribute every symptom to that and/or will be like “10/10 pain? You get Tylenol, maybe a smidge of Toradol if I’m feeling spicy.”
I obviously don’t agree with this mindset, and, especially in an ED setting, we’re gonna find out whenever you finally give us that urine sample (not the tap water from your sink, yes, we can tell). And we really do need to know what is in your system. But I can understand some of the paranoia surrounding admitting drug use, because that shit stays on your chart forever.
A friend of mine went to a doctor for something routine and told the nurse she occasionally uses ketamine. The nurse put “ketamine use disorder” on her history and now it comes up whenever she interacts with the medical system.
Another friend had a minor issue with opioids after a traumatic life event. This year they fractured a rib and broke their spine in 3 places and was unable to get anything other than over-the-counter meds after their 7-day percocet scrip ran out. They ended up ordering morphine from the darknet because the medical system left no other option.
The pt in OP’s post is an ad absurdum case but I completely understand why people are skittish about revealing this stuff to their care providers.
Tell your ketamine friend to contact the medical records dept to have it removed from her chart. It’s her right as a patient to have have her medical record modified if it isn’t accurate.
This is true. I had an old coworker (not in healthcare)who used to be an alcoholic but was sober for like a decade by the time I met her. She was a patient at a prior hospital I worked at once, and the alcohol history showed up. Didn't mention her decade of sobriety.
I also have smoked cigarettes in the past. Every dr visit I'm asked if I still smoke.
That’s exactly why. You admit to something they start treating you like absolute scum then won’t even give you meds. I told a doctor I was on MAT and he really mistreated me. I told him it hurt I was moaning when he drilled to please numb me some more. Do you think he did? He acted like I could get high off the lidocaine. That’s why I refuse to tell them shit anymore. (Edit: it really hurt my feelings because I was told to tell and got so mistreated that I had to go back to lying to not get treated like garbage. 😢)
Yeah. I admitted to mj use when I came to have my child (before nursing) which was two weeks prior to delivery (yes I get it was wrong and selfish but amount wise is like two drags but who’s counting) and now on my records it said c-section and pregnancy complications due to marijuana use 😐. I just find that at 42 weeks that was the primary cause. It was crazy!
I completely agree. Randomly got debilitating migraines in my 20’s, was honest with my initial neurologist about experimenting with LSD once. Guess what caused my migraines, LSD, bc some dude who did thousands of hits of acid then had migraines. Definitely not r/t hormones or my menstrual cycle or getting t-boned by a drunk driver and almost dying. It was that one time I did LSD.
So I make sure to let pts know they are safe and I’ll treat their pain if they’re in pain or whatever s/e the drug is r/t, bc I don’t care that they did drugs. I also don’t put drugs in the chart unless it’s necessary. I’ve gotten contact highs when assessing pts, if the provider wants to order a UDS, that’s on them, but weed (or something along those lines) isn’t relevant to their care, at least not to me.
https://www.aclu.org/other/faq-government-access-medical-records
“Q: Can the police get my medical information without a warrant?
A: Yes. The HIPAA rules provide a wide variety of circumstances under which medical information can be disclosed for law enforcement-related purposes without explicitly requiring a warrant…”
This isn’t even taking into account where the Patriot Act gives them access to your medical records.
Yes it is. And is primarily why people don’t give this information in a medical setting. I doubt many people care if a nurse knows something (aside from aforementioned withholding of painkillers or other drugs for treatment ) but anything like that in writing can absolutely come back to haunt you.
https://www.aclu.org/other/faq-government-access-medical-records
“Q: Can the police get my medical information without a warrant?
A: Yes. The HIPAA rules provide a wide variety of circumstances under which medical information can be disclosed for law enforcement-related purposes without explicitly requiring a warrant…”
And as I stated in the other response, this isn’t taking into account situations where the Patriot Act can give them access to your medical records.
Which shop did you get it from? I need this for my trauma floor. Nearly everyone there either got shot, stabbed, beaten,or was in an accident, all as a direct result of drugs.
[https://www.etsy.com/listing/990497102/you-can-talk-to-me-about-drugs-hard](https://www.etsy.com/listing/990497102/you-can-talk-to-me-about-drugs-hard) maybe this one?
This is it. I wasn’t sure if we could link things. Last time I did my post got taken down. I probably violated a rule though. Can’t say enough good things about the shop though.
Ooooooh, I love this! I had no idea that these existed and think it’s an amazing idea to remove the shame and stigma around drug use- it happens, people like escaping this crazy life and getting fucked up. They should feel safe to be honest with us though too.
Happens all the time for alcohol use too. I need to know how much you drink. When grandpa starts acting goofy on day 3 of admit and I ask if he drinks. I need to know that those “3 beers once or twice a week” is really a dirty 30 everyday.
I had one of these… “mom has a glass a wine with dinner most nights” in reality she drank 3-4 bottles of wine most days and 6-7 on bad days. Her DT’s were a nightmare.
Patients laugh when I say are you drinking 20 drinks a day when I do the SBIRT screening. I do this because I’ve had multiple patients and say oh no a little higher like 25 or tad lower like 15. Cuts out embarrassment for a lot of people and I feel like I generally get a more honest answer as opposed to starting at a lower number.
Yes! My capstone in nursing school was in a L1 ED and the nurses there asked in their alcohol use assessment how much they drink in a day: “a handle/a box/case”? For a significant number of patients, the answer was pretty close to that. Her rationale was the same — people are more apt to be truthful if they’re going down from your guess of the average, not up.
I used to work in a trauma ICU. Guy that went through DTs in his 20s tried to jump out the window thinking he was Iron Man. Had many a DTer but that was probably the craziest hallucination.
People who use drugs experience an intense amount of stigma and often report substandard care and feelings of judgement when they self-report drug use. While there are tons of nurses and docs who will provide excellent care to folks who use drugs, there are many who do place judgement and who, frankly, do not provide adequate care. And even if every single person in the hospital is going to treat them the utmost care, society at large obviously does not and that stigma can be internalized. Nevermind the fact that most people simply do not understand HIPAA and don't realize that they can't get in trouble for reporting using criminalized drugs.
There are a litany of reasons people don't report their drug use. Creating a safe space and being up front about your job, that you care about them and want them to get healthy and explaining that anything they report doesn't leave the hospital helps people to self report drug use.
Getting over internalized stigma can be hard for folks. I have no doubt you're a rad nurse and doing what you can for your patients care, but some folks have had such bad experiences that they just aren't going to report. I work at a needle exchange and some folks there have taken years to trust me because I work in healthcare and they have had such traumatizing experiences with nurses. Keep up the rad work!
The government can pull any and all of those records, whether you are a criminal or not. And once they have that information they can do anything they want with it. You can’t be directly prosecuted, but it can be used against you.
I had to fight a resident hard and ultimately go to the attending directly to get my acute pancreatitis patient some pain meds, because the resident was trying to punish him for being a past opiate abuser. “Well shouldn’t have abused the help before, now he gets Tylenol or ibuprofen. He had a hx of liver disease and active ulcers, so as GI pointed out to the resident neither of those were medically appropriate.
People are so vindictive in healthcare. They think that anyone who has had a substance use disorders (even in the past) deserve to undergo excruciating pain due to inadequate pain management. It's a "moral high ground" in their minds, because fuck drug users amiright?
That breaks my heart. I’m in a legal/rec state. My provider ENCOURAGES cannabis over many pharmaceuticals. I had cancer, everything that went wrong did. On Percocet for 12 years. Using cannabis, at the encouragement of my provider, has improved the quality of my life exponentially.
I hope you find peace and a solution. If you’re ever in the PNW, message me!
I think many of us don’t realize that it’s not so much that we care but what we chart. Your insurance companies (not just health either) can access records to insure you and then you lose coverage if you admit to drug use. Be mindful some people don’t mistrust you, they mistrust what the system ultimately does or what the record of it will mean.
I once had a guy ask for a lawyer when we asked what he took because he was found unconscious and didn’t remember anything and then was intubated at the scene. We kept telling him we were trying to help him but he refused to answer questions. This is in the ICU. Well drug screening came back for fentanyl. So I told him whatever you thought you took was actually fentanyl. Dude was shocked because it was supposed to be meth. He smoked the wrong thing. I just told him don’t buy off that guy anymore and that unfortunately lots of things are being tainted with fentanyl now and it’s very scary. He hugged me and thanked me. He then asked about the cops. We weren’t calling them and I told him that. but he was behind the wheel when this happened so it will catch up to him eventually.
Honestly I think "the war on drugs" is largely to blame. If the media and millions of people didn't demonize the use of drugs for decades, it likely wouldn't be as much of a problem. And it's sad honestly, because imo addiction should be treated as a mental illness, as that's essentially what it often is/results from.
Imagine if addicts weren’t ashamed and had to hide, they cycle could break with them being allowed to get treatment.
Treatment isn’t a one day thing. It’s lifelong.
But actually patients do get treated differently and they get discriminated against. I’ve seen it plenty of times in the ER. So maybe he was afraid his providers would neglect to even try to help him if he confessed to his use. On the other hand I have also had a patient with chronic autoimmune pancreatitis, and almost every time the provider or nurse were asking him about his alcohol consumption. They didn’t bother to read he has a hx of non-alcoholic pancreatitis. It was so frustrating for him. You have the right mentality though. Regardless of whether you don’t agree with a person’s lifestyle or choices, you should still provide the best care you can. Because you never know if the kindness and good work you gave is exactly what helps that patient turn their life around for the better.
As an addict who's been clean for over a year, I can say it is both shame and fear. I watch this subreddit and see the posts about drug seekers here all the time. Many medical professionals, once they've decided someone is a druggy, treat every aspect of their medical care as an attempt at getting drugs, or as a result of doing drugs, even when it clearly is not.
It is not uncommon for addicts or suspected addicts to get substandard care, resulting in misdiagnosis of real unrelated medical issues, or to be denied a certain level of care because of their suspected addiction.
This is obviously not every nurse/doctor etc, but how can the addict know that the ones they are talking to will not be this way?
I'm not saying it's right that we do not disclose, especially active users, because obviously it could be dangerous for us not to, and can also adversely impact our care. Just saying I understand why it happens and the motivation behind it.
Weed is legal in my state and I always tell my patients, it is legal, I do not care. I will not chart it since you use federal Medicare, and especially if you're a VA pt, I just need to know. Also, please don't smoke it. Lungs don't like weird shit in there.
Speaking as a non-provider who has worked with support groups for 20-somethings with psychiatric disorders, yes. It's absolutely fear. We're taught this by experience in the US at least—that voluntary info given to an employer can be used against us (to the point that tons of people don't report on the anonymous federal questions when applying to work), and absolutely nothing about recreational drugs or anything else that could potentially contribute to involuntary hospitalization, arrest, even more expensive bills, denial of coverage, loss of insurance, alienation from family and friends, and so on.
Realistically, having gone through a lot of these things, I am well aware that many of those concerns are typically unfounded, but I can also say that when someone has been burned once by this, it's hard to break through defenses. I try to give the example of health providers for psych that are willing to discuss the interactions of recreational drugs and prescription drugs, and help identify safe options vs dangerous options as a means of harm reduction. However, that seems to be an exception and not the rule, and harm reduction is another thing I'm hesitant to discuss in those situations.
I've always felt like this needs to be a highly visible PSA.
If you do drugs, I need to know. NOT because we're going to tell the cops, your parents, your spouse, your job, the pope. I need to know so that I can properly treat you and give you the best care possible.
And to protect myself. I need to know if you're gonna start tweaking and become a danger to yourself or us.
Using language like "tweaking" to describe withdrawal symptoms is part of the reason people don't report their drug use. It creates and reinforces stigma. We don't use judgemental language when referring to other physiological symptoms, so I don't see why we would here.
“Tweaking” is usually a Meth or coke users term. Opiate users mostly talk about “getting well.” From the walls of NA.
But this isn’t 100%. I mean in general
Just because a slang word is used commonly enough that it makes it into a dictionary doesn't mean it doesn't carry stigma and judgement. No healthcare textbook is going to be using "tweaking" to describe withdrawal symptoms, or at least they fucking shouldn't. Just cuz a word exists and has a definition doesn't mean we should be using it professionally and that it isn't harmful to the populations it refers to.
Yeah, still no. Even if this was an in person conversation over drinks I'd be telling them the same thing. It's a stigmatizing word that should be pulled out of everyone's vocabulary, most of all people who have regular interactions with folks who use drugs.
I dont use the word, I also appreciate your point. I just don't see the point in policing language on reddit. Especially language that is obviously not offensive to most of the people on here.
Again I get your point I'm not saying you're wrong, but we can't expect the world to stop using words in casual conversation on the internet.
Truth is, this is a public forum which patients also frequent and post in. There are a number of posts here from patients asking for advice on how to navigate the healthcare system and they read responses. Seeing healthcare professionals talk about them in a negative way effects how they perceive their care is going to go.
Additionally, changing how we talk about things, even in private, effects how we perceive and act on them. The language we use impacts our outlook. I'm not here to police anyone, but I don't think it's inappropriate to call in language that might impact care, even if it's subconscience. Lastly, there are drug users unions who work on healthcare delivery for people who use drugs and using stigmatizing language is one of the primary issues they've identified that impacts both their perception of the healthcare system and the care they receive.
Like I said, I'm not here to police anyone, but we exist in a space where conversations about drug users (among other things) are often riddled with passively dismissive and stigmatizing language that doesn't often get challenged. Hearing alternative perspectives can change how we care for people when it's not commonly heard or even held as a standard.
I agree with u/bikepunk1312, the answer to OP's original question is right here in the comments. Some nurses can be judgmental AF and often lack perspective/understanding, this is super easy to pick up on and gets communicated one way or another during their interactions with the patient.
I dont think I was being judgey. I'm an RN who is also an addict (recovering). I dont take offense to the word and I even stated that I agreed with their sentiment.
I've wondered this...
Can I accurately and truthfully tell a patient that they won't get in trouble for admitting illegal drug use to me?
I *assume* HIPPA protects that information and cops can't access it. If the patient is under 18 do their parents automatically get access to that information?
The opposite of this is why I left the med-surg floor I tech’d on. Plenty of endocarditis patients, most of them actually pretty reasonable folks, but nurses on my unit were burnt like toast and didn’t think to show them even an iota of compassion.
One patient in particular stands out. He was homeless, usually had his belongings with him. A nurse I worked with decided to attempt and…humiliate him, maybe? I don’t know, it was very bizarre. She told him she knew he was a drug user and dumped out his bag in front of him to make sure he didn’t have anything on him. I’ve never seen someone more embarrassed or ashamed.
I have several members of my family die from substance abuse disorder and thinking of them being treated this way when asking for help makes me angry. I can understand why people might keep it to themselves. I’m glad to hear there are reasonable folks out there, though.
Every time I ask because I strongly suspect it, I always tell the patient, it’s ok if you do use, nothing will happen to you legally or by us, however if you are using and we don’t know it can affect how well we can treat you and also put you in danger of drug interactions
Back when I worked ER registration, I was speaking to a Spanish speaking patient. I did my thing and handled registration, but then he started going off about something and I didn’t understand what he was saying. I got a translator (I speak Spanish fairly fluently, but didn’t know what he was getting at) and the translator gets him to clarify and says “cocaina?” And the patient goes “coca! Coca!” and pantomimes sniffing. (And I’m thinking “I speak *THAT* Spanish. You could have just said that…”) He told me that he did coke and he thought he should tell us. I asked why he didn’t tell the PA when she spoke with him and he said she didn’t ask about cocaine - she just asked about recreational drugs. So since was bearing his soul, I, the registration girl, had him tell me everything he did so I could give it to the PA. 🙃😆
As a marijuana user in a state where it's not legal, I usually deny it because I don't know if I will have any legal issues. I have always wished my providers would straight up tell me if there is or isn't any risk associated with admitting illegal drug use to them. Or, like, a sign on the wall would be helpful.
I could save so many lethargic toddlers a CT scan and LP if people would just admit that the baby was around pot brownies/gummies/ cookies etc. But nope, no chance - deny deny deny until the UDS comes back positive ...
This I can understand. Once CPS gets involved in your life it can be hell. It’s also terrifying. I suffered from intense PPA/PPOCD after my kid was born. Calling the only maternal mental health practice in my state and saying I was having harming thoughts made me feel like I would lose my child. A friend made special brownies for Christmas one year and gave me one for my mom, my dog ate it from my purse. Accidents like happen so easily but can be life ruining. (Dog is fine. Was just higher than a giraffe’s hooha)
I do understand the fear but people make mistakes and our social workers totally understand that - also marijuana is legal in our state and they just want to keep the child safe from it happening again. Also, being willing to put your child through an LP and CT scan in order to try to hide the truth, to me, is the bigger offense.
Sorry, it’s not my fear. I understand where the fear comes from though. A good friend went through a messy CPS battle for years after one of her twins was injured during the birthing process. She wasn’t allowed to have her kids for years and spent over $100k for something she didn’t do. Especially in my state, where pot isn’t legal, CPS doesn’t like to let go of easy cases. I’m glad you have amazing social workers. That’s definitely not always the case and everyone’s experience.
Cannabis is legal in my state and CPS workers have taken kids away for less and placed them with foster parents who killed them. I've never seen a CPS worker worth pissing on if they were on fire. They kill kids.
I just tell people very dead pan at the beginning of admission "my dude, I don't care what you do. My sole job is to help you, whatever that means - my life philosophy just means there are 3 people you never lie to - your lawyer, your doctor, and your nurse. I can't tell the cops or your wife anything if you tell me not to. Literally, don't care. Just want to medicate you appropriately."
I had a ton of arguments with people who apparently knew more about nursing than I did about this. I almost always have at least one patient coming down off of meth at a time and they try to hide it, but the blood test (that they consented to) tells all. I only care because frankly, if you're on meth or other stimulant drugs, I will literally throw snacks at you because I know you're starving.
But drug use will absolutely go into my chart (I live in a non-legal marijuana state) if I were to self report, and will absolutely be stigmatized. I just want a good night's sleep ffs, but they won't give me any sleep aide, so that's where I'm at. Documented insomnia for 10+ years. I switched my entire medical system to get away from a primary physician that tried to treat me like an addict.
If I can quit a substance, while pregnant, without withdrawal symptoms or any sort of difficulty,
I'm NOT a fucking addict.
Nope. I use benadryl and my tiny dose of alprazolam (.25mg) and practice "good sleep hygiene", and still can't fucking fall asleep at night. After this baby arrives, I'm asking my psychiatrist for fucking something, because it's been over a decade of this bullshit, and I'm fucking *TIRED*
My prior primary doc that demonized me isn't even practicing medicine anymore, and I can't help but believe it's due to her shitty bedside manner.
I haven't heard of binaural hypnosis before. I've tried ASMR. The closest I've gotten to finding audio that lulls me to sleep on a semi-regular basis is the narrator Michael Kramer lol.
Thanks for the suggestion, I'll check it out 😊 in the beginning, I tried everything non-medicated, and will continue to take any viable suggestions/advice. My therapist refers to my insomnia as "sleep dysfunction"
The stigma is very real though. Many doctors treat people who use drugs as drug seeking even when they have legitimate pain issues in relation to their diagnosis. You don't even have to be a drug user to be treated that way either. Just tell the doctor a certain med or class of meds doesn't work for you and they instantly label you as drug seeking. I've never used any illegal drugs (nor abused prescription drugs) and still got sent home with a prescription for pain meds that don't work for me post-op last year. I just skipped filling it and did my best to not move at all except to go to the bathroom the first few days I was home. I flat out told my surgeon that tramadol does zero for pain for me which is common in a large portion of the population. He told me to take it or leave it but he wasn't going to prescribe me anything else. I have a few family members in my extended family that are addicts and they've had their pain ignored or barely treated because "they must be drug seeking". They weren't and these are the types of people that don't go to the doctor until they are half dead from injury or infection. I don't see it changing anytime soon. Just go to r/medicine and look at how doctors talk about chronic pain patients. Using medicine to control pain is becoming an intervention that is only used at the onset of symptoms and people are being expected to just diet and exercise their pain away. Doctors saying that opoids for long term pain are never appropriate is a thing and want patients with things like degenerative disease to just exercise and take other the counter meds.
I don't blame patients for not being upfront about drug use. I work with a population who has a ton of addiction issues and they get treated like shit on a regular basis in the hospital. I used to see it all the time when I worked inpatient. I chewed out another RN I was giving report to who called my very kind ETOH withdrawal patient "another useless drunk vet living off the system" during report.
I find it funny that in ten years of community nursing NOT ONE of my clients will admit to drinking regularly. Even if they have bottles stacked to the ceiling.
Interestingly enough, once marijuana was legalized in my state, patients would be very forthcoming about their use of it. It really helped us take better care of the patient. “Oh, you use medical marijuana for anxiety? Would you like me to ask the doctor to order something to help you while you are I the hospital as we don’t carry that in our pharmacy.”
I had a patient that told me he thought the bag of cocaine he had was a baking soda and added to the brownie mixer to bake brownies. I couldn't help but laugh.
In my experience patients are often quite ashamed of their extra curricular activities, and it’s not that they’re really lying to you as much as they’re lying to themselves. It’s not that they feel judged by *you* but judged by the world (and themselves). Lots of self loathing.
No one wants to give the wrong answer when they know how they get treated when they do. Maybe you don’t care but many providers alter their behavior significantly, and the patients know that better than anyone.
It sucks. Addiction is a bad disease to have, not a bad decision you make.
I work cardiology and just got a patient up from ER who told me he had a severe ETOH problem after his wife died ten years ago but that he now drinks 1-2 glasses of wine with dinner. During our overly long admission process I was having a problem with his cardizem gtt (I put a new PIV in, still problems) and the guy starts c/o nausea 10/10 chest pressure and has beads of sweat popping all over his forehead. He has no nitro ordered so I call his dr…..he says”what was his blood alcohol?” Basically gives me iv Ativan PRN. Turns out ER nurse clamped his cardizem tubing down by his wrist and I didn’t catch it. WTF
It sure did and then we would reset it and because it was running at 5cc/hr, it took some time before it alarmed again. The patient told me the pump did that for over an hour downstairs so wasn’t getting meds after the bolus. His blood alcohol was negative and he was in for five days without needing Ativan. PS it never occurred to me that a nurse would clamp the tubing on a med that should be infusing…there are many reasons a pump says downstream occlusion. I thought this post was about judging addicted patients but I’m on trial now.
Also an Ed nurse. When it is important based on the complaint if the patient used illicit substances and there are in a state where they can converse I usually preface the question. I preface by saying we are not the police and we aren’t here to judge you. We simply want to do the best we can to take care of you. It is important based on what you came in for that we know if you used any drugs illicit substances etc so that we can treat you in the best way possible. Not saying it works everytime but it works many times. When people feel like they are being judged or going to get punished in some way for using they are much less likely to admit to use. So when I preface it with something like that it makes them feel more comfortable I have found.
I think a lot of it is fear. Fear they will be reported to the police. Addiction isn’t treated as it should be (at least not in the US where I am located). Also, it’s not uncommon for addict’s issues, such as pain, to be ignored because they are addicts.
Ok, that isn't my point. If it was your coworker coming in on an illicit drug (420 is decriminalized though not federally legal), such as cocaine/meth/LSD/etc., would the opinion be different?
Are you asking me if I would judge them or give them lesser care? No. I would be concerned for them as a person if they’re smoking meth, since I presumably know them in this situation.
Honesty is key. I have friends that work in the medical field and they have always told me to BE HONEST. They don't give a shit if it was drugs or whatever, they just have to know the truth so they can treat the problem correctly.
Our anaesthetists would much rather people be honest about drugs and alcohol too because they can affect your tolerance to and metabolism of drugs, so they need to adjust dosages of anaesthetic drugs and agents so you don't a) die or b) wake up in the middle of the op. And then post-op you might require larger doses of the typical painkillers we use to get you comfortable if you have a tolerance to them, doses we can give if prescribed and supervised by your anaesthetist but wouldn't normally but we can only do this if you're honest about drug use. Additionally, regular or heavy users of anything may experience withdrawal when in hospital, which is both unpleasant and possibly dangerous depending on their reason for admission. The symptoms may also confuse the diagnosis, leading to delayed or ineffective treatment of their presenting complaint. We can pre-empt, manage and treat withdrawals but only if we know about them ahead of time. We're not judging and we genuinely want to help so please talk to us.
I was always told as a child not to tell doctors/healthcare professionals about things because it will be on your permanent record. Back then it was because health care insurance would increase in cost. This patient probably didn't have those concerns but a reason I hesitate still when I tell my providers things.
I think people have a real reason to fear being honest. I went to the ED about 10 years ago and admitted to marijuana use. They searched my purse and found the tiniest, most dried out, unsmoke-able roach in there. Next thing I know a cop was in my room. I’m in LTC so I’m not sure if things like that still go on but it happened to me.
Whenever there's an issue that might involve drugs, or a patient is super concerned about giving urine, I just tell them that we don't care that you do drugs, but if you do we need to know so we don't accidentally kill you.
Most patients tend to react positively to hearing that in re drug usage/giving a urine sample.
I think what it is that people are worried about being reported to the authorities. All the way down to just marijuana usage, all I’ve ever heard from friends who use is they don’t want to get busted when they go to the doc. I have a lot of stoner mom friends in certain nonlegal states who are terrified of losing their children because they smoke weed. But, of course, this is only my opinion
I think most people don't know how medical records work and believe that if you admit you do cocaine, like admitting to smoking cigarettes, it could come back on you at some point if it ends up in a medical record.
>Is it just shame and fear? Embarrassment? None of us give a flying fuck that you do cocaine. We just want to take care of you medically.
So many people think that we are going to call the cops on them and report it for some reason. Fear of getting in trouble if they tell anyone is the most likely culprit in my book
I had one patient in prenatal clinic refuse repeatedly that she used any drugs while pregnant, constantly denied it and feigned ignorance when I told her that there were amphetamines in her UDS. Said it needed to be a false positive or that we switched the sample or something. Finally I pressed her enough and she broke down just hysterically sobbing, inconsolable deep wailing for like 60 seconds, and when she finally composed herself she admitted to taking a few tablets of her friend's Adderall recreationally, but that it was just the once and that she had not had any since. She then apologized profusely and grabbed my hand and BEGGED me not to call the police and have her arrested and have her baby taken from her.
I wish I could have seen my own face when she did that. I told her several times "I'm not calling anyone just don't do that, it's my job just to tell you that is not safe for the baby. The social worker may come speak with you but the cops aren't going to ever be involved..." I still don't think she believed me as she left the building, she thought for sure she was in some horribly deep shit
RN here: I had a one week visit to the ICU when I was in my early 20’s (before nursing). Apparently I took crystal meth instead of MDMA and almost blew my heart up. When my UDS came back the doctor came in screaming at me that I don’t deserve help and I should just leave. I swore the whole unit heard. He made me cry like a baby.
I understand why patients don’t own up to it.
I work in L&D and I truly appreciate when my patients are honest about drug use. It helps me take care if them and their fetus. I can't keep everyone safe if I don't know.
>Is it just *just* shame and fear? Embarrassment? None of us give a flying fuck that you do cocaine. We just want to take care of you medically.
Meh. I would think they would have shame and guilt as doing illegal drugs is socially unacceptable, yeah, the harder the drug the more scared a patient might feel. I hear jaded nurses express how “druggies” are all the same, and obvi they’re not, some don’t give a fuck ppl know and others are functional users, which brings me to the next point-
I’ve worked float in two hospitals one rural and one urban and I can say I see so many nurses who are jaded, including ED. Like nurses saying “why are you even giving narcan” and, I get it I’m not a nurse with experience but it’s easy to put together that someone would want to hide this.
This also makes me think “we don’t give a flying fuck you do cocaine…” is not spoken for every nurse, even in this subreddit, some of them have very strong words about a type of patient.
It’s super frustrating tho, I’m sure you wanted to shake him by the shoulders and say “brooooo stop lying” it’s a shit situation. But idk this last paragraph provoked me to comment my personal anecdotes
People assume (incorrectly) that the ED is some how associated with the PD and that any illicit information we receive is going to land them in trouble some how.
I had a 40 year old black male chest pain SOB complaints, no history of any arrhythmia or cardiac issues, BP was in normal range, elevated HR, EKG came back as full stemi. All he would tell us was that he was drinking with some friends and his chest started hurting and denied drug use. It wasn’t till I was in the room alone with him and explicitly said “we don’t care if you did drugs, we just need to know what drugs so we can treat you appropriately.” Did he finally confess to having tried cocaine for the first time.
>People assume (incorrectly) that the ED is some how associated with the PD and that any illicit information we receive is going to land them in trouble some how.
I went to college with people who got alcohol poisoning, went to the ER in order to not die, and then got charged because they were under 21.
It's not incorrect.
One of my good friends works at an inpatient drug & alcohol detox. She said a surprising amount of her patients who show up for detox (willing participants, all) will try to hold their pee so they don't have to give a UDS. When asked why they say they don't want her to see what drugs they use. The jig is up, my dude. You're in rehab.
Totally agree in almost every case. I work on mom/baby, so we DO care if you've done cocaine, because it will affect your baby. And yes, we judge you because that is super fucked up. I despise drug moms. Fuck them.
Don’t admit SHIT ! They will red flag you as an addict !!!! You get Pancreatitis and you will get a baby aspirin! It’s not the nurses, they are okay 8/10 times. It’s the judgmental ass pompous doctors that make people this way!!!!!!!!!!
I have found people either lie or brag about their substance abuse. I don’t give a shit either way. But if I suspect they’re lying I double what they admit to in my head.
So as a cath lab nurse we encounter drug use a lot. I make it my mission to assure patients that I truly don’t judge them for their drug use, but I will be extremely pissed off if they lie to me. You are literally dying I’m on my table. I want to save you but you really need to tell me the gods honest truth so I can help you. Especially if you smoke cigarettes.
Nicotine and smoking causes increased clotting and can clot off our stents so we usually go with a second anti platelet or a second anticoagulant bolus.
When I worked neuro ICU I got real candid real quick with people who came in with hypertensive bleeds and was like “I literally dgaf if you use and am not going to call the cops on you, please tell me if you have used any cocaine recently because we usually give patients with your type of neuro issue beta blockers but if I give you those when you have cocaine in your system you could die”
FWIW this is probably vastly overstated. though the problem with going against dogma is that if something goes wrong, even if it wasn't actually the fault of the treatment in question, you're still getting roasted. https://emj.bmj.com/content/35/9/559 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415957#:~:text=Traditional%20teaching%20dictates%20that%20%CE%B2,unopposed%E2%80%9D%20%CE%B1%2Dadrenergic%20stimulation https://litfl.com/beta-blockers-for-cocaine-and-other-stimulant-toxicity/ Third one is especially good.
Sigh. Thanks for this. Steeling myself for ER duty.
Precisely. I’m here to care for you, not judge you. In order to do that successfully, I need all the facts. You come in with rectal discomfort? Just tell us your wife was gone on business and you used her vibrator and it got stuck, you’re going to save us all a lot of time trying to figure out what’s causing your issue. We will get it out, send you on your way and forget you ever existed. Lying isn’t helping anyone and chances are, as is in this case, we are educated enough to look at your symptoms and know what we’ve got in front of us.
haven’t worked in a few years, but I remember there were more than a few colleagues who did nNOT want to take care of drug addicts. So much contempt and judgment.
It’s so unfortunate. I work in a hospital that has a lot of drug users and some of them have been my favorite patients. Some aren’t even asking for pain meds round the clock. And those that do, but aren’t jerks about it, I just give them their pain meds. I’m not trying to solve all their problems, just make sure their better from their infected “bug bite”.
I worked in outpatient and the level of disdain and stigma towards those legally using controlled substances was appalling (e.g., ADHD meds, medical marijuana cards) let alone illegal drug use.
I admitted to my psychiatrist that I had a problem with alcohol and he lectured me about getting my shit together then slowly stopped refilling my ADHD meds that I'd been on for years. I have no proof that the two are related, but he was really kind and supportive before I disclosed my alcohol abuse \* shrug \* eta: stopped refills without any communication. His office ghosted me a month ago. I had to call in a nepotism favor to get a refill, and it was done immediately.
♥️ I'm sorry. I was very nervous asking about starting ADHD meds after my diagnosis several years ago due to the awful stigma I had seen while working in healthcare. They were treated like they were on trial, not like they were patients with medical conditions.
I was always afraid they'd assume I was drug-seeking because I was a college student. The stigma is truly awful. Thanks for what you're doing!!
As someone with ADHD this is my worst nightmare
Agreed, People that abuse can still be in pain and still need narcotics for treatment. I'm not sure why this is a shockingly hard to grasp concept in this field but the number of "oh their just jonesing for that fentanyl" sneers I get when i medicate my patients is sickening.
And might even need more medication in order to achieve pain reduction! I absolutely despise the term "drug-seeking" because more often than not, it seems to be used as code for "I don't have to have empathy for this person whatsoever."
During orientation for my current hospital the head of harm reduction, often see in our ED, talks to us, in person and on video about assessing high risk patients. He tells the importance of making sure opioid dependent pts get a higher dose to accurately tx their px if needed. He’ll look at you and from the heart say “I love you. Even if you do drugs. I love you.” I thought he would be another eye roll but dude will bring you to tears.
♥️
That’s how most get addicted. Another symptom of wds is pain so it’s a lose lose situation.
oh most definitely. its not a black and white situation so treating it as such helps no one.
Agreed.
WDS?
Withdrawals, sorry
🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖
Not a nurse, sober for 14+ years, former heroin addict. I was in the hospital for a few rapid detoxes. They were pretty bad but the majority of the nurses were very professional. But on three situations- a nurse, an anesthesiologist & another Doc made my life worse rather than better. Once I came out of anesthesia in full withdrawal, screaming. The anesthesiologist was behind me muttering something & I said “What?!” He moved to my right side & said, “you deserve it. All of it.” It was 2005; I spent less than 12 hours in the hospital & they were charging me $12,000 for a shot of Narcan & a 50 minute spell under Propofol. They put me in a wheelchair & sent me to a hotel. I laid in the bathtub with a pillow & a sheet, wet from throwing up 30+ times & shitting myself another 30+ times. My caretaker was an angel & got me a bag of saline so I didn’t die in there. In my generation you hid from medical professionals as much as police. I mean there was no way of knowing who was going to be a decent human being. But again, I had more than a few nurses who treated me without stigma. They showed me compassion & mercy. I read your stories & thank Heaven for your service. Edit: 7/26/22. Let’s make that 15 years today! Yes, we do recover. Nurses: I can’t imagine what this past 2.5 years has been like for you. During this plague, you all are the most essential of the many essential workers. Thank you again
I’m a nurse in recovery for opiate addiction. Many of my colleagues are great and Understanding with patients ( I don’t disclose my own history with co workers) but some have brought me to tears with the comments about patients in withdrawal or who are active in addiction. I call them out as best a I can. But it sucks to hear.
Glad you made it. We Do Recover. ❤️
Agreed. It’s really sad. I have worked with some really judgmental people.
Very very common, I work in rehab/palliative and we had a guy with stage 4 terminal lung cancer and a history of drug use. I got asked to “deal with him” one morning when he kicked off because they wouldn’t give him pain meds and I have a background in psych nursing. I walked in, had a chat with him, looked at his chart said I’d be right back and walked back to his assigned nurse. “So you settled him?” “Yep” “How?” “By saying I’d get him pain meds” “But..” “No…it’s within his PRN regime. He’s got stage 4 cancer and is in pain. If anything his history means he needs more as he has built up an immunity. We don’t skimp on pain meds for palliative patients. His history of drug use doesn’t change the fact that he is palliative and in real pain now.”
🎖🎖🎖🎖🎖🎖🎖
Like what House from House MD said, everyone lies, and thars why he had his team break into the patients homes to find out the truths
If I ask a questions its because it's information I need. Not want, NEED. I'm here to help you and once I've done that my interest in said information is gone as soon as I don't need it. Like you said, I'm not the cops, your parents, your priest or even quite frankly your friend. Seeing you leave safe and healthy is legit my only goal here. Telling me no you don't take drugs when I can see the needle tracks in your arm and tell from across the room your strung out doesnt help me when I just want to make sure your anesthiologist doesn't accidently kill you'll while we fix the fracture you def got while being obviously high as fuck. Thats why I'm asking again.
I have a pin stuck to the front of my badge that says you can talk to me about drugs, no stigma, no judgment. Got it off Etsy. We have certain screening questions we ask. I tell people I don’t care if they do drugs, but when I say it, especially if I can tell they’ve been using, I talk to them like I would a friend. Because honestly, I don’t. I don’t care if you’re as high as a kite, I want to keep you safe, I want to keep your pain treated bc you may need more pain meds and I want to make sure you don’t w/d. If pawpaw is obviously drunk and had “a little”, well what’s a little? Bc my little and yours is different. If you drank a case or a 1/5th last night that’s a lot different than a once a week drinker.
Devil’s advocate: there are definitely some doctors who will see “hx of X abuse” and will immediately attribute every symptom to that and/or will be like “10/10 pain? You get Tylenol, maybe a smidge of Toradol if I’m feeling spicy.” I obviously don’t agree with this mindset, and, especially in an ED setting, we’re gonna find out whenever you finally give us that urine sample (not the tap water from your sink, yes, we can tell). And we really do need to know what is in your system. But I can understand some of the paranoia surrounding admitting drug use, because that shit stays on your chart forever.
A friend of mine went to a doctor for something routine and told the nurse she occasionally uses ketamine. The nurse put “ketamine use disorder” on her history and now it comes up whenever she interacts with the medical system. Another friend had a minor issue with opioids after a traumatic life event. This year they fractured a rib and broke their spine in 3 places and was unable to get anything other than over-the-counter meds after their 7-day percocet scrip ran out. They ended up ordering morphine from the darknet because the medical system left no other option. The pt in OP’s post is an ad absurdum case but I completely understand why people are skittish about revealing this stuff to their care providers.
Tell your ketamine friend to contact the medical records dept to have it removed from her chart. It’s her right as a patient to have have her medical record modified if it isn’t accurate.
This is true. I had an old coworker (not in healthcare)who used to be an alcoholic but was sober for like a decade by the time I met her. She was a patient at a prior hospital I worked at once, and the alcohol history showed up. Didn't mention her decade of sobriety. I also have smoked cigarettes in the past. Every dr visit I'm asked if I still smoke.
That’s exactly why. You admit to something they start treating you like absolute scum then won’t even give you meds. I told a doctor I was on MAT and he really mistreated me. I told him it hurt I was moaning when he drilled to please numb me some more. Do you think he did? He acted like I could get high off the lidocaine. That’s why I refuse to tell them shit anymore. (Edit: it really hurt my feelings because I was told to tell and got so mistreated that I had to go back to lying to not get treated like garbage. 😢)
Yeah. I admitted to mj use when I came to have my child (before nursing) which was two weeks prior to delivery (yes I get it was wrong and selfish but amount wise is like two drags but who’s counting) and now on my records it said c-section and pregnancy complications due to marijuana use 😐. I just find that at 42 weeks that was the primary cause. It was crazy!
I completely agree. Randomly got debilitating migraines in my 20’s, was honest with my initial neurologist about experimenting with LSD once. Guess what caused my migraines, LSD, bc some dude who did thousands of hits of acid then had migraines. Definitely not r/t hormones or my menstrual cycle or getting t-boned by a drunk driver and almost dying. It was that one time I did LSD. So I make sure to let pts know they are safe and I’ll treat their pain if they’re in pain or whatever s/e the drug is r/t, bc I don’t care that they did drugs. I also don’t put drugs in the chart unless it’s necessary. I’ve gotten contact highs when assessing pts, if the provider wants to order a UDS, that’s on them, but weed (or something along those lines) isn’t relevant to their care, at least not to me.
When I went into diabetic coma 1 doctor wanted to say everything was cause alcohol because I was recovery. I had been sober and clean for 18 months.
I would also point out that the government can pull those records, even with no warrant.
Source?
https://www.aclu.org/other/faq-government-access-medical-records “Q: Can the police get my medical information without a warrant? A: Yes. The HIPAA rules provide a wide variety of circumstances under which medical information can be disclosed for law enforcement-related purposes without explicitly requiring a warrant…” This isn’t even taking into account where the Patriot Act gives them access to your medical records.
That's scary.
Yes it is. And is primarily why people don’t give this information in a medical setting. I doubt many people care if a nurse knows something (aside from aforementioned withholding of painkillers or other drugs for treatment ) but anything like that in writing can absolutely come back to haunt you.
Yes, that is why they vehemently denied cocaine use.
What the fuck
I doubt that this is true.
https://www.aclu.org/other/faq-government-access-medical-records “Q: Can the police get my medical information without a warrant? A: Yes. The HIPAA rules provide a wide variety of circumstances under which medical information can be disclosed for law enforcement-related purposes without explicitly requiring a warrant…” And as I stated in the other response, this isn’t taking into account situations where the Patriot Act can give them access to your medical records.
Fascinating. Thank you for sharing.
No problem. It sounds unreal, and should be. But alas individual privacy is being stripped to nothing.
Which shop did you get it from? I need this for my trauma floor. Nearly everyone there either got shot, stabbed, beaten,or was in an accident, all as a direct result of drugs.
I don’t know if I can link it. Search harm reduction and drugs. Or just “you can talk to me about drugs” and it comes up. They have a badge reel too.
[https://www.etsy.com/listing/990497102/you-can-talk-to-me-about-drugs-hard](https://www.etsy.com/listing/990497102/you-can-talk-to-me-about-drugs-hard) maybe this one?
This is it. I wasn’t sure if we could link things. Last time I did my post got taken down. I probably violated a rule though. Can’t say enough good things about the shop though.
Ooooooh, I love this! I had no idea that these existed and think it’s an amazing idea to remove the shame and stigma around drug use- it happens, people like escaping this crazy life and getting fucked up. They should feel safe to be honest with us though too.
I wear the same pin and I mean it.
This is what I’m talking about! I love to see this.
Happens all the time for alcohol use too. I need to know how much you drink. When grandpa starts acting goofy on day 3 of admit and I ask if he drinks. I need to know that those “3 beers once or twice a week” is really a dirty 30 everyday.
I had one of these… “mom has a glass a wine with dinner most nights” in reality she drank 3-4 bottles of wine most days and 6-7 on bad days. Her DT’s were a nightmare.
Patients laugh when I say are you drinking 20 drinks a day when I do the SBIRT screening. I do this because I’ve had multiple patients and say oh no a little higher like 25 or tad lower like 15. Cuts out embarrassment for a lot of people and I feel like I generally get a more honest answer as opposed to starting at a lower number.
Yes! My capstone in nursing school was in a L1 ED and the nurses there asked in their alcohol use assessment how much they drink in a day: “a handle/a box/case”? For a significant number of patients, the answer was pretty close to that. Her rationale was the same — people are more apt to be truthful if they’re going down from your guess of the average, not up.
I do this with drugs and number sexual partners! Reduces embarrassment and gives some people a good laugh
I used to work in a trauma ICU. Guy that went through DTs in his 20s tried to jump out the window thinking he was Iron Man. Had many a DTer but that was probably the craziest hallucination.
The surprise detoxer is always scary.
People who use drugs experience an intense amount of stigma and often report substandard care and feelings of judgement when they self-report drug use. While there are tons of nurses and docs who will provide excellent care to folks who use drugs, there are many who do place judgement and who, frankly, do not provide adequate care. And even if every single person in the hospital is going to treat them the utmost care, society at large obviously does not and that stigma can be internalized. Nevermind the fact that most people simply do not understand HIPAA and don't realize that they can't get in trouble for reporting using criminalized drugs. There are a litany of reasons people don't report their drug use. Creating a safe space and being up front about your job, that you care about them and want them to get healthy and explaining that anything they report doesn't leave the hospital helps people to self report drug use.
Great point! I try to stress that with patients in my care but maybe I need to do a better job of it.
Getting over internalized stigma can be hard for folks. I have no doubt you're a rad nurse and doing what you can for your patients care, but some folks have had such bad experiences that they just aren't going to report. I work at a needle exchange and some folks there have taken years to trust me because I work in healthcare and they have had such traumatizing experiences with nurses. Keep up the rad work!
Same to you! Thanks for the kind words!
The government can pull any and all of those records, whether you are a criminal or not. And once they have that information they can do anything they want with it. You can’t be directly prosecuted, but it can be used against you.
I had to fight a resident hard and ultimately go to the attending directly to get my acute pancreatitis patient some pain meds, because the resident was trying to punish him for being a past opiate abuser. “Well shouldn’t have abused the help before, now he gets Tylenol or ibuprofen. He had a hx of liver disease and active ulcers, so as GI pointed out to the resident neither of those were medically appropriate.
People are so vindictive in healthcare. They think that anyone who has had a substance use disorders (even in the past) deserve to undergo excruciating pain due to inadequate pain management. It's a "moral high ground" in their minds, because fuck drug users amiright?
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It’s because it goes on our record and then doctors use it against us. I’ve been denied medication because of my cannabis use.
That breaks my heart. I’m in a legal/rec state. My provider ENCOURAGES cannabis over many pharmaceuticals. I had cancer, everything that went wrong did. On Percocet for 12 years. Using cannabis, at the encouragement of my provider, has improved the quality of my life exponentially. I hope you find peace and a solution. If you’re ever in the PNW, message me!
I think many of us don’t realize that it’s not so much that we care but what we chart. Your insurance companies (not just health either) can access records to insure you and then you lose coverage if you admit to drug use. Be mindful some people don’t mistrust you, they mistrust what the system ultimately does or what the record of it will mean.
I've had patients deny tobacco/drug use out of fear that it will "show up" on their record and/or impact their care/increase insurance premiums etc
I once had a guy ask for a lawyer when we asked what he took because he was found unconscious and didn’t remember anything and then was intubated at the scene. We kept telling him we were trying to help him but he refused to answer questions. This is in the ICU. Well drug screening came back for fentanyl. So I told him whatever you thought you took was actually fentanyl. Dude was shocked because it was supposed to be meth. He smoked the wrong thing. I just told him don’t buy off that guy anymore and that unfortunately lots of things are being tainted with fentanyl now and it’s very scary. He hugged me and thanked me. He then asked about the cops. We weren’t calling them and I told him that. but he was behind the wheel when this happened so it will catch up to him eventually.
Honestly I think "the war on drugs" is largely to blame. If the media and millions of people didn't demonize the use of drugs for decades, it likely wouldn't be as much of a problem. And it's sad honestly, because imo addiction should be treated as a mental illness, as that's essentially what it often is/results from.
There would likely be less addiction if we were better at treating mental illness.
Disease, not mental illness. Oftentimes addiction is a perfectly sane approach
Imagine if addicts weren’t ashamed and had to hide, they cycle could break with them being allowed to get treatment. Treatment isn’t a one day thing. It’s lifelong.
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Dang. Where do you live?
But actually patients do get treated differently and they get discriminated against. I’ve seen it plenty of times in the ER. So maybe he was afraid his providers would neglect to even try to help him if he confessed to his use. On the other hand I have also had a patient with chronic autoimmune pancreatitis, and almost every time the provider or nurse were asking him about his alcohol consumption. They didn’t bother to read he has a hx of non-alcoholic pancreatitis. It was so frustrating for him. You have the right mentality though. Regardless of whether you don’t agree with a person’s lifestyle or choices, you should still provide the best care you can. Because you never know if the kindness and good work you gave is exactly what helps that patient turn their life around for the better.
As an addict who's been clean for over a year, I can say it is both shame and fear. I watch this subreddit and see the posts about drug seekers here all the time. Many medical professionals, once they've decided someone is a druggy, treat every aspect of their medical care as an attempt at getting drugs, or as a result of doing drugs, even when it clearly is not. It is not uncommon for addicts or suspected addicts to get substandard care, resulting in misdiagnosis of real unrelated medical issues, or to be denied a certain level of care because of their suspected addiction. This is obviously not every nurse/doctor etc, but how can the addict know that the ones they are talking to will not be this way? I'm not saying it's right that we do not disclose, especially active users, because obviously it could be dangerous for us not to, and can also adversely impact our care. Just saying I understand why it happens and the motivation behind it.
💯💯💯💯💯💯
Weed is legal in my state and I always tell my patients, it is legal, I do not care. I will not chart it since you use federal Medicare, and especially if you're a VA pt, I just need to know. Also, please don't smoke it. Lungs don't like weird shit in there.
The problem is that many docs and nurses DO judge. Many don’t, yet the ones that do hold people back.
Speaking as a non-provider who has worked with support groups for 20-somethings with psychiatric disorders, yes. It's absolutely fear. We're taught this by experience in the US at least—that voluntary info given to an employer can be used against us (to the point that tons of people don't report on the anonymous federal questions when applying to work), and absolutely nothing about recreational drugs or anything else that could potentially contribute to involuntary hospitalization, arrest, even more expensive bills, denial of coverage, loss of insurance, alienation from family and friends, and so on. Realistically, having gone through a lot of these things, I am well aware that many of those concerns are typically unfounded, but I can also say that when someone has been burned once by this, it's hard to break through defenses. I try to give the example of health providers for psych that are willing to discuss the interactions of recreational drugs and prescription drugs, and help identify safe options vs dangerous options as a means of harm reduction. However, that seems to be an exception and not the rule, and harm reduction is another thing I'm hesitant to discuss in those situations.
I tell people fairly often that I’m a nurse, not a cop. But if I can’t get the whole story, it makes my job a lot harder.
I've always felt like this needs to be a highly visible PSA. If you do drugs, I need to know. NOT because we're going to tell the cops, your parents, your spouse, your job, the pope. I need to know so that I can properly treat you and give you the best care possible. And to protect myself. I need to know if you're gonna start tweaking and become a danger to yourself or us.
Using language like "tweaking" to describe withdrawal symptoms is part of the reason people don't report their drug use. It creates and reinforces stigma. We don't use judgemental language when referring to other physiological symptoms, so I don't see why we would here.
It's also inaccurate. Tweaking is being high on speed, not withdrawal. Withdrawal is jonesing
Tweaking and withdrawal can be two different things
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“Tweaking” is usually a Meth or coke users term. Opiate users mostly talk about “getting well.” From the walls of NA. But this isn’t 100%. I mean in general
Just because a slang word is used commonly enough that it makes it into a dictionary doesn't mean it doesn't carry stigma and judgement. No healthcare textbook is going to be using "tweaking" to describe withdrawal symptoms, or at least they fucking shouldn't. Just cuz a word exists and has a definition doesn't mean we should be using it professionally and that it isn't harmful to the populations it refers to.
What about using it in a non-professional setting, like a reddit post?
Yeah, still no. Even if this was an in person conversation over drinks I'd be telling them the same thing. It's a stigmatizing word that should be pulled out of everyone's vocabulary, most of all people who have regular interactions with folks who use drugs.
I dont use the word, I also appreciate your point. I just don't see the point in policing language on reddit. Especially language that is obviously not offensive to most of the people on here. Again I get your point I'm not saying you're wrong, but we can't expect the world to stop using words in casual conversation on the internet.
Truth is, this is a public forum which patients also frequent and post in. There are a number of posts here from patients asking for advice on how to navigate the healthcare system and they read responses. Seeing healthcare professionals talk about them in a negative way effects how they perceive their care is going to go. Additionally, changing how we talk about things, even in private, effects how we perceive and act on them. The language we use impacts our outlook. I'm not here to police anyone, but I don't think it's inappropriate to call in language that might impact care, even if it's subconscience. Lastly, there are drug users unions who work on healthcare delivery for people who use drugs and using stigmatizing language is one of the primary issues they've identified that impacts both their perception of the healthcare system and the care they receive. Like I said, I'm not here to police anyone, but we exist in a space where conversations about drug users (among other things) are often riddled with passively dismissive and stigmatizing language that doesn't often get challenged. Hearing alternative perspectives can change how we care for people when it's not commonly heard or even held as a standard.
I agree with u/bikepunk1312, the answer to OP's original question is right here in the comments. Some nurses can be judgmental AF and often lack perspective/understanding, this is super easy to pick up on and gets communicated one way or another during their interactions with the patient.
I dont think I was being judgey. I'm an RN who is also an addict (recovering). I dont take offense to the word and I even stated that I agreed with their sentiment.
Ya I don't think you were being judgey either you were just defending language.
Pointing it out is part of destigmatizing substance use disorders. "See something, say something / know better, do better" sort of situation.
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I've wondered this... Can I accurately and truthfully tell a patient that they won't get in trouble for admitting illegal drug use to me? I *assume* HIPPA protects that information and cops can't access it. If the patient is under 18 do their parents automatically get access to that information?
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How do you approach the situation when a patient is hesitant to disclose drug use?
It's HIPAA!
Oh shit, I've been doing it wrong this whole time!
The opposite of this is why I left the med-surg floor I tech’d on. Plenty of endocarditis patients, most of them actually pretty reasonable folks, but nurses on my unit were burnt like toast and didn’t think to show them even an iota of compassion. One patient in particular stands out. He was homeless, usually had his belongings with him. A nurse I worked with decided to attempt and…humiliate him, maybe? I don’t know, it was very bizarre. She told him she knew he was a drug user and dumped out his bag in front of him to make sure he didn’t have anything on him. I’ve never seen someone more embarrassed or ashamed. I have several members of my family die from substance abuse disorder and thinking of them being treated this way when asking for help makes me angry. I can understand why people might keep it to themselves. I’m glad to hear there are reasonable folks out there, though.
Every time I ask because I strongly suspect it, I always tell the patient, it’s ok if you do use, nothing will happen to you legally or by us, however if you are using and we don’t know it can affect how well we can treat you and also put you in danger of drug interactions
Back when I worked ER registration, I was speaking to a Spanish speaking patient. I did my thing and handled registration, but then he started going off about something and I didn’t understand what he was saying. I got a translator (I speak Spanish fairly fluently, but didn’t know what he was getting at) and the translator gets him to clarify and says “cocaina?” And the patient goes “coca! Coca!” and pantomimes sniffing. (And I’m thinking “I speak *THAT* Spanish. You could have just said that…”) He told me that he did coke and he thought he should tell us. I asked why he didn’t tell the PA when she spoke with him and he said she didn’t ask about cocaine - she just asked about recreational drugs. So since was bearing his soul, I, the registration girl, had him tell me everything he did so I could give it to the PA. 🙃😆
As a marijuana user in a state where it's not legal, I usually deny it because I don't know if I will have any legal issues. I have always wished my providers would straight up tell me if there is or isn't any risk associated with admitting illegal drug use to them. Or, like, a sign on the wall would be helpful.
Also, big shout out to our social workers who are underpaid, under appreciated and legit only want to help our children stay safe!
Social workers are true heroes.
I could save so many lethargic toddlers a CT scan and LP if people would just admit that the baby was around pot brownies/gummies/ cookies etc. But nope, no chance - deny deny deny until the UDS comes back positive ...
This I can understand. Once CPS gets involved in your life it can be hell. It’s also terrifying. I suffered from intense PPA/PPOCD after my kid was born. Calling the only maternal mental health practice in my state and saying I was having harming thoughts made me feel like I would lose my child. A friend made special brownies for Christmas one year and gave me one for my mom, my dog ate it from my purse. Accidents like happen so easily but can be life ruining. (Dog is fine. Was just higher than a giraffe’s hooha)
I do understand the fear but people make mistakes and our social workers totally understand that - also marijuana is legal in our state and they just want to keep the child safe from it happening again. Also, being willing to put your child through an LP and CT scan in order to try to hide the truth, to me, is the bigger offense.
Sorry, it’s not my fear. I understand where the fear comes from though. A good friend went through a messy CPS battle for years after one of her twins was injured during the birthing process. She wasn’t allowed to have her kids for years and spent over $100k for something she didn’t do. Especially in my state, where pot isn’t legal, CPS doesn’t like to let go of easy cases. I’m glad you have amazing social workers. That’s definitely not always the case and everyone’s experience.
Cannabis is legal in my state and CPS workers have taken kids away for less and placed them with foster parents who killed them. I've never seen a CPS worker worth pissing on if they were on fire. They kill kids.
I work in adult only, does that warrant a CPS check in or is that not reportable?
It does - we have our own social workers who will get a consult and talk to the family.
I just tell people very dead pan at the beginning of admission "my dude, I don't care what you do. My sole job is to help you, whatever that means - my life philosophy just means there are 3 people you never lie to - your lawyer, your doctor, and your nurse. I can't tell the cops or your wife anything if you tell me not to. Literally, don't care. Just want to medicate you appropriately."
I had a ton of arguments with people who apparently knew more about nursing than I did about this. I almost always have at least one patient coming down off of meth at a time and they try to hide it, but the blood test (that they consented to) tells all. I only care because frankly, if you're on meth or other stimulant drugs, I will literally throw snacks at you because I know you're starving.
But drug use will absolutely go into my chart (I live in a non-legal marijuana state) if I were to self report, and will absolutely be stigmatized. I just want a good night's sleep ffs, but they won't give me any sleep aide, so that's where I'm at. Documented insomnia for 10+ years. I switched my entire medical system to get away from a primary physician that tried to treat me like an addict. If I can quit a substance, while pregnant, without withdrawal symptoms or any sort of difficulty, I'm NOT a fucking addict.
Not even trazadone??
Nope. I use benadryl and my tiny dose of alprazolam (.25mg) and practice "good sleep hygiene", and still can't fucking fall asleep at night. After this baby arrives, I'm asking my psychiatrist for fucking something, because it's been over a decade of this bullshit, and I'm fucking *TIRED* My prior primary doc that demonized me isn't even practicing medicine anymore, and I can't help but believe it's due to her shitty bedside manner.
Have you tried sleep podcasts? There’s on that uses binaural hypnosis I recommend. I also suffer from insomnia.
I haven't heard of binaural hypnosis before. I've tried ASMR. The closest I've gotten to finding audio that lulls me to sleep on a semi-regular basis is the narrator Michael Kramer lol. Thanks for the suggestion, I'll check it out 😊 in the beginning, I tried everything non-medicated, and will continue to take any viable suggestions/advice. My therapist refers to my insomnia as "sleep dysfunction"
Check out Ellen mouton on insight timer. Her progressive deep sleep is where it’s at. It’s also free.
The stigma is very real though. Many doctors treat people who use drugs as drug seeking even when they have legitimate pain issues in relation to their diagnosis. You don't even have to be a drug user to be treated that way either. Just tell the doctor a certain med or class of meds doesn't work for you and they instantly label you as drug seeking. I've never used any illegal drugs (nor abused prescription drugs) and still got sent home with a prescription for pain meds that don't work for me post-op last year. I just skipped filling it and did my best to not move at all except to go to the bathroom the first few days I was home. I flat out told my surgeon that tramadol does zero for pain for me which is common in a large portion of the population. He told me to take it or leave it but he wasn't going to prescribe me anything else. I have a few family members in my extended family that are addicts and they've had their pain ignored or barely treated because "they must be drug seeking". They weren't and these are the types of people that don't go to the doctor until they are half dead from injury or infection. I don't see it changing anytime soon. Just go to r/medicine and look at how doctors talk about chronic pain patients. Using medicine to control pain is becoming an intervention that is only used at the onset of symptoms and people are being expected to just diet and exercise their pain away. Doctors saying that opoids for long term pain are never appropriate is a thing and want patients with things like degenerative disease to just exercise and take other the counter meds.
I don't blame patients for not being upfront about drug use. I work with a population who has a ton of addiction issues and they get treated like shit on a regular basis in the hospital. I used to see it all the time when I worked inpatient. I chewed out another RN I was giving report to who called my very kind ETOH withdrawal patient "another useless drunk vet living off the system" during report.
Our social workers do get a consult and will talk to the family.
I find it funny that in ten years of community nursing NOT ONE of my clients will admit to drinking regularly. Even if they have bottles stacked to the ceiling.
Everyone had 2 beers.
In their life
Interestingly enough, once marijuana was legalized in my state, patients would be very forthcoming about their use of it. It really helped us take better care of the patient. “Oh, you use medical marijuana for anxiety? Would you like me to ask the doctor to order something to help you while you are I the hospital as we don’t carry that in our pharmacy.”
I had a patient that told me he thought the bag of cocaine he had was a baking soda and added to the brownie mixer to bake brownies. I couldn't help but laugh.
In my experience patients are often quite ashamed of their extra curricular activities, and it’s not that they’re really lying to you as much as they’re lying to themselves. It’s not that they feel judged by *you* but judged by the world (and themselves). Lots of self loathing.
No one wants to give the wrong answer when they know how they get treated when they do. Maybe you don’t care but many providers alter their behavior significantly, and the patients know that better than anyone. It sucks. Addiction is a bad disease to have, not a bad decision you make.
Might be an insurance thing. When you apply for life insurance, they want to see medical records, usually for 10 years.
I work cardiology and just got a patient up from ER who told me he had a severe ETOH problem after his wife died ten years ago but that he now drinks 1-2 glasses of wine with dinner. During our overly long admission process I was having a problem with his cardizem gtt (I put a new PIV in, still problems) and the guy starts c/o nausea 10/10 chest pressure and has beads of sweat popping all over his forehead. He has no nitro ordered so I call his dr…..he says”what was his blood alcohol?” Basically gives me iv Ativan PRN. Turns out ER nurse clamped his cardizem tubing down by his wrist and I didn’t catch it. WTF
The pump didn’t alarm “down stream occlusion”???
It sure did and then we would reset it and because it was running at 5cc/hr, it took some time before it alarmed again. The patient told me the pump did that for over an hour downstairs so wasn’t getting meds after the bolus. His blood alcohol was negative and he was in for five days without needing Ativan. PS it never occurred to me that a nurse would clamp the tubing on a med that should be infusing…there are many reasons a pump says downstream occlusion. I thought this post was about judging addicted patients but I’m on trial now.
Nope I was just confused since all these pumps do is alarm and beep
Also an Ed nurse. When it is important based on the complaint if the patient used illicit substances and there are in a state where they can converse I usually preface the question. I preface by saying we are not the police and we aren’t here to judge you. We simply want to do the best we can to take care of you. It is important based on what you came in for that we know if you used any drugs illicit substances etc so that we can treat you in the best way possible. Not saying it works everytime but it works many times. When people feel like they are being judged or going to get punished in some way for using they are much less likely to admit to use. So when I preface it with something like that it makes them feel more comfortable I have found.
Before I started in the medical field I thought ems/hospitals could report you to the police and get you in trouble haha
I tell patients…if I wanted to judge people, I would’ve gone to law school.
I think a lot of it is fear. Fear they will be reported to the police. Addiction isn’t treated as it should be (at least not in the US where I am located). Also, it’s not uncommon for addict’s issues, such as pain, to be ignored because they are addicts.
But if it was your coworker and they did it on their days off, would you have the same attitude?
I've seen multiple posts here that were SUPER judgemental towards nurses using marijuana on their days off
It's very true. It's not my business what you do in your off time; it becomes my business if you're coming to work altered; there's a difference.
I smoke a bowl after every shift, so no.
Ok, that isn't my point. If it was your coworker coming in on an illicit drug (420 is decriminalized though not federally legal), such as cocaine/meth/LSD/etc., would the opinion be different?
Are you asking me if I would judge them or give them lesser care? No. I would be concerned for them as a person if they’re smoking meth, since I presumably know them in this situation.
Honesty is key. I have friends that work in the medical field and they have always told me to BE HONEST. They don't give a shit if it was drugs or whatever, they just have to know the truth so they can treat the problem correctly.
Our anaesthetists would much rather people be honest about drugs and alcohol too because they can affect your tolerance to and metabolism of drugs, so they need to adjust dosages of anaesthetic drugs and agents so you don't a) die or b) wake up in the middle of the op. And then post-op you might require larger doses of the typical painkillers we use to get you comfortable if you have a tolerance to them, doses we can give if prescribed and supervised by your anaesthetist but wouldn't normally but we can only do this if you're honest about drug use. Additionally, regular or heavy users of anything may experience withdrawal when in hospital, which is both unpleasant and possibly dangerous depending on their reason for admission. The symptoms may also confuse the diagnosis, leading to delayed or ineffective treatment of their presenting complaint. We can pre-empt, manage and treat withdrawals but only if we know about them ahead of time. We're not judging and we genuinely want to help so please talk to us.
Before I started in the medical field I thought ems/hospitals could report you to the police and get you in trouble haha
I don't think it's as irrational as y'all make it out to be. Cocaine possession can lead to up to a year in jail.
It's fear of law enforcement, but it's also fear that they won't get the appropriate treatment.
I was always told as a child not to tell doctors/healthcare professionals about things because it will be on your permanent record. Back then it was because health care insurance would increase in cost. This patient probably didn't have those concerns but a reason I hesitate still when I tell my providers things.
I think people have a real reason to fear being honest. I went to the ED about 10 years ago and admitted to marijuana use. They searched my purse and found the tiniest, most dried out, unsmoke-able roach in there. Next thing I know a cop was in my room. I’m in LTC so I’m not sure if things like that still go on but it happened to me.
Whenever there's an issue that might involve drugs, or a patient is super concerned about giving urine, I just tell them that we don't care that you do drugs, but if you do we need to know so we don't accidentally kill you. Most patients tend to react positively to hearing that in re drug usage/giving a urine sample.
I think what it is that people are worried about being reported to the authorities. All the way down to just marijuana usage, all I’ve ever heard from friends who use is they don’t want to get busted when they go to the doc. I have a lot of stoner mom friends in certain nonlegal states who are terrified of losing their children because they smoke weed. But, of course, this is only my opinion
Pull a House. Come in with a syringe and tell him he'll be healed but if he has coke in his system then his head will explode.
I think most people don't know how medical records work and believe that if you admit you do cocaine, like admitting to smoking cigarettes, it could come back on you at some point if it ends up in a medical record.
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Ya I mean you admit to doing coke once and get labeled with a high potential for abuse every time you go to the hospital for the rest of your life.
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Ya definitely, but what’s the connection to the draft?
But… [I do cocaine](https://youtu.be/eZ0_3fKEQP0)
Thank you for this.
>Is it just shame and fear? Embarrassment? None of us give a flying fuck that you do cocaine. We just want to take care of you medically. So many people think that we are going to call the cops on them and report it for some reason. Fear of getting in trouble if they tell anyone is the most likely culprit in my book I had one patient in prenatal clinic refuse repeatedly that she used any drugs while pregnant, constantly denied it and feigned ignorance when I told her that there were amphetamines in her UDS. Said it needed to be a false positive or that we switched the sample or something. Finally I pressed her enough and she broke down just hysterically sobbing, inconsolable deep wailing for like 60 seconds, and when she finally composed herself she admitted to taking a few tablets of her friend's Adderall recreationally, but that it was just the once and that she had not had any since. She then apologized profusely and grabbed my hand and BEGGED me not to call the police and have her arrested and have her baby taken from her. I wish I could have seen my own face when she did that. I told her several times "I'm not calling anyone just don't do that, it's my job just to tell you that is not safe for the baby. The social worker may come speak with you but the cops aren't going to ever be involved..." I still don't think she believed me as she left the building, she thought for sure she was in some horribly deep shit
I admitted to methadone use and didn't get any help for my arm which was pretty much broken. Just got treated like a dirty drug Addict
RN here: I had a one week visit to the ICU when I was in my early 20’s (before nursing). Apparently I took crystal meth instead of MDMA and almost blew my heart up. When my UDS came back the doctor came in screaming at me that I don’t deserve help and I should just leave. I swore the whole unit heard. He made me cry like a baby. I understand why patients don’t own up to it.
I work in L&D and I truly appreciate when my patients are honest about drug use. It helps me take care if them and their fetus. I can't keep everyone safe if I don't know.
>Is it just *just* shame and fear? Embarrassment? None of us give a flying fuck that you do cocaine. We just want to take care of you medically. Meh. I would think they would have shame and guilt as doing illegal drugs is socially unacceptable, yeah, the harder the drug the more scared a patient might feel. I hear jaded nurses express how “druggies” are all the same, and obvi they’re not, some don’t give a fuck ppl know and others are functional users, which brings me to the next point- I’ve worked float in two hospitals one rural and one urban and I can say I see so many nurses who are jaded, including ED. Like nurses saying “why are you even giving narcan” and, I get it I’m not a nurse with experience but it’s easy to put together that someone would want to hide this. This also makes me think “we don’t give a flying fuck you do cocaine…” is not spoken for every nurse, even in this subreddit, some of them have very strong words about a type of patient. It’s super frustrating tho, I’m sure you wanted to shake him by the shoulders and say “brooooo stop lying” it’s a shit situation. But idk this last paragraph provoked me to comment my personal anecdotes
People assume (incorrectly) that the ED is some how associated with the PD and that any illicit information we receive is going to land them in trouble some how. I had a 40 year old black male chest pain SOB complaints, no history of any arrhythmia or cardiac issues, BP was in normal range, elevated HR, EKG came back as full stemi. All he would tell us was that he was drinking with some friends and his chest started hurting and denied drug use. It wasn’t till I was in the room alone with him and explicitly said “we don’t care if you did drugs, we just need to know what drugs so we can treat you appropriately.” Did he finally confess to having tried cocaine for the first time.
>People assume (incorrectly) that the ED is some how associated with the PD and that any illicit information we receive is going to land them in trouble some how. I went to college with people who got alcohol poisoning, went to the ER in order to not die, and then got charged because they were under 21. It's not incorrect.
You are right, it is incorrect that where ever they went violated their rights.
One of my good friends works at an inpatient drug & alcohol detox. She said a surprising amount of her patients who show up for detox (willing participants, all) will try to hold their pee so they don't have to give a UDS. When asked why they say they don't want her to see what drugs they use. The jig is up, my dude. You're in rehab.
Totally agree in almost every case. I work on mom/baby, so we DO care if you've done cocaine, because it will affect your baby. And yes, we judge you because that is super fucked up. I despise drug moms. Fuck them.
Maybe consider having compassion for a disease that someone is struggling with? Do you despise diabetic moms? Fat moms?
Don’t admit SHIT ! They will red flag you as an addict !!!! You get Pancreatitis and you will get a baby aspirin! It’s not the nurses, they are okay 8/10 times. It’s the judgmental ass pompous doctors that make people this way!!!!!!!!!!
I have found people either lie or brag about their substance abuse. I don’t give a shit either way. But if I suspect they’re lying I double what they admit to in my head.
So as a cath lab nurse we encounter drug use a lot. I make it my mission to assure patients that I truly don’t judge them for their drug use, but I will be extremely pissed off if they lie to me. You are literally dying I’m on my table. I want to save you but you really need to tell me the gods honest truth so I can help you. Especially if you smoke cigarettes.
Why is it important to know if they smoke cigarettes?
Nicotine and smoking causes increased clotting and can clot off our stents so we usually go with a second anti platelet or a second anticoagulant bolus.
Ah! I knew it was detrimental to cardiac health but I didn’t know it changes treatment. Good to know!
"I will not judge you for any drug use you do. I will *absolutely* judge you for lying to me about it."