[NP-Clinical] Chronic Pain/Med Contract/Drug screen + cocaine

[Priscilla Merrill]

Thanks, Kay.  This was a great answer and my gut didn’t want to treat him
from the get-go but what do you do when you have a new pt and you just know
something ain’t right?  In community health, we take them no matter what.  I
really DO want to fire him and your reasons were just the ammo I was looking
for. 

Thanks.  Priscilla

 

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Kay Schoeller
Sent: Sunday, January 14, 2007 7:14 PM
To: NP Clinical
Subject: Re: [NP-Clinical] Chronic Pain/Med Contract/Drug screen + cocaine

 

Hi Priscilla,

I work in pain management and our view is that we cannot control
interactions or side effects when we don't know what they are doing, so
illegal substance use buys an immediate discharge.  Of course, we do give
them contacts for  drug treatment.  The other perspective is, would you want
the DEA questioning why you gave opiates when you knew they were using
illicit substances?  I would have to look it up, but I believe the DEA's
latest 'guidelines' say its a no-no.
Kay Schoeller, APN

Priscilla Merrill <prispunnyfnp at metrocast.net> wrote:

How do you all handle + cocaine on your random drug screens for chronic pain
pts?  I have a fairly new pt. who is just a wreck to look at.  He was
apparently hit by a car as a pedestrian in years past.  This is at our
community health clinic and we don’t treat chronic pain as a rule but manage
till they get in.  Of course, he moved here recently and we can’t get his
records which make me suspicious.  He does have a bunch of scars so this I
believe.  It’s his wild-eyed manner that gave me pause so on the 3rd visit,
still having a story of why he couldn’t get into pain clinic, per our med
contract, I got a sample.  It showed + opiates, + oxycodone (He’s on
oxycodone and that’s his only med) and cocaine.

We had a long discussion about “firing him” or not.  No where on our
contract does it specify illicit drug use so we are in process of changing.

I just wanted to ask the group how they handle this.  Of course he has no
insurance so this is his only resort in this area.  The doc I work with
thought we should dismiss him and give him substance abuse contact info if
he chooses inpt. Admission.

As we’ve said, these folks are our biggest challenge because most DO have
chronic pain and I DO feel for this guy.  Very heavy smoker too.

Priscilla Merrill FNP

 

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