Narcotic medications are a big problem in every ER I’ve worked in. They are powerful medications, and can cause tolerance when used chronically. We get a lot of patients in the ER who want refills of their pills, and I have heard some far-fetched reasons why. Lost or stolen pills is pretty common, and one that I hear occasionally is, “I accidentally spilled my pills down the toilet.” Come on. Does that really sound believable to anybody?
One thing that continues to surprise me is patients who come in to the ER with a narcotic overdose, but are just awake enough to ask for for more pain medications, usually by name. One moment completely asleep, then, eyes barely open, asking for a dose of dilaudid. Umm, no.
Like most ER’s, we use a pain scale from 0-10, to gauge how much pain patients are having. Seems like 10/10 is the most common response, but sometimes it’s even higher. One of my former colleagues (not known for subtlety) would become irritated when he got a 10/10 pain level from a patient. He would roll his eyes and say “Oh really? So I could take a chain-saw and chop your legs off, and you wouldn’t even notice because you’re having so much pain?” Really sensitive. He had various other horribly painful examples to use depending on his mood. “So if I dropped you into a bathtub full of scorpions, you wouldn’t even notice because of your ankle sprain?”
This same doctor liked to sneak up on patients to see if they appeared to be in pain when they did not think they were being watched. He would literally creep around the corner, on his tip-toes and then pull back the curtain just a smidge. If he thought they were faking their pain just to get narcotics, he would be livid. Come on man, what are we? Twelve?