Types of Patients III: Drug Seekers

If drug seekers would spend as much time, energy, and creativity trying to get their drugs illegally on the street as they do with their Oscar-level dramatics, theatrics and hysterics in the ER, the world might be a better place.

But no!

The problem with street drugs (among many) is they cost money, and the people who sell them are not the sort to send out billing statements that the user can promptly ignore.

So the drug seekers come to us because (1) they know we are required by law to provide them with a medical screening regardless of their ability (or lack thereof) to pay (see "EMTALA"), and (2) they know that they can throw away those billing statements; our not-for-profit hospital is not likely to get blood from stoners.

Who is the typical drug seeker?

Typical drug seekers are people who know the system and are smart enough to make the system work for them. They complain of pain but cannot specify an injury; they complain of 9/10 pain while hobbling in, but are able to overcome their misery as they leave with a narcotics pain prescription.

Drug seekers are recidivists. They return frequently, usually with different areas of complaint but always with the complaint of pain. Dental pain, back pain, migraines are the most common. They make the rounds, going from hospital to hospital, visiting ERs, and sometimes private physicians and clinics, anywhere they can find a narc script.

Fundamentally, drug seekers are liars. But they must also be fearless, because obtaining narcotics under false pretenses (i.e., lying, fake identification, fake name, etc.) is a felony.

Although EMTALA requires that we provide a medical screening for each patient, it does not require that we treat patients who do not have emergent medical conditions. Most drug seekers do not complain of emergent problems; they are never in medical crisis (unless withdrawal is considered a medical emergency).

Unfortunately, as an ER nurse, I am often put in the position of having to search out the information on drug seekers. Checking past records, calling other local hospitals, calling pharmacies. This takes a lot of time that I could otherwise use to care for truly ill patients. I am not a law enforcement officer, but I do this because its hard to care for someone who I know is lying to me.

Some drug seekers leave a sloppy trail, others are more sophisticated. Still, others are too smart for there own good.

One example: A well-dressed 36 year old male patient complained of chronic back pain. He said he had flown into town for a well-known and popular annual event but had forgotten his Fentanyl duragesic patches. He had one on that was due to be changed. Noting this, the doctor ordered a new patch, and we placed it on him. The next morning, EMTs responded to the local homeless shelter where the man had been staying and found him dead with a hypodermic in his arm and the dry duragesic patch with a small needle hole lying beside him. This is your brain obliterated by Fentanyl.

This crime didn't pay.