How to Spot Drug Seekers in the Emergency Room Setting



Emergency rooms are a favorite place for drug addicts.



It doesn't take long as an emergency room nurse or physician to recognize the face of the drug seeker. All ERs are plagued with them. It's become a fact of life for all of us who try so hard every day to provide

compassionate care to those in need. We're faced with those repeat patients...the "frequent flyers"...who always know exactly what drug they need to ease their pain, thus jading us against the patients who truly deserve our compassion.

Don't let yourself be conned. The consequences for assisting a drug abuser/seeker are getting more and more stiff each passing day. Unfortunately, the days of giving the seeker what they want just to get them out of the department are all but gone. The DEA is cracking down on providers who knowingly prescribe and make available controlled substances to drug abusers. Your license is on the line...don't lose it because you think the easiest way to "get rid" of a drug seeker is to kick him or her out the door with their shot of preference and script in hand.


How To Spot A Drug Seeker
Often, drug seekers will exhibit unusual behavior in the waiting room or in triage. Be on the lookout for the patient moaning and wailing out loud in front of others. Look out for those patients who feel the need to lie down on the lobby floor while waiting to be shown to a room. These are also the patients that will declare very loudly that they are in the worst pain of their lives and need to be taken back immediately before anyone else.


Drug seekers often will refuse to provide identification to admission clerks, will declare no primary physician (to eliminate verification of medical history), will provide no insurance and, in some cases, present stating "I'm on vacation" or "I'm only visiting friends/relatives", etc.


Upon triage, symptoms are usually textbook specific or very vague. Typically, drug seekers present complaining of back pain, kidney stones or migraines. On weekends or off-hours, suspect patients will state that they need their prescriptions refilled or the prescription has been lost or stolen and needs to be replaced.


Drug seekers often demand a particular drug and, regardless of diagnosis, are hesitant or refuse a different drug. When offered a substitute medication, drug seekers often will claim to be allergic to that medication,

Percocet, Oxycotin and Vicodin are some are the popular drugs
requested by addicts in the ER.

stating that they "forgot" to list it on their allergies at triage. Be particularly suspicious of the patient who claims to be allergic to the generic form of a narcotic, but not the trade form. (Brand names have more street value.) At times, drug seekers will claim that there are only one or two different medications that control their pain and "nothing else ever works".

Drug seekers are typically resistant to other forms of pain control or therapies. For instance, TENS (Transcutaneous Electrical Nerve Stimulation) units or pain clinic referrals will almost always be refused by a drug seeker. They also tend to be "noncompliant" in following up with PCPs and have multiple visits over a short time frame for the same complaint.

And, yes, providers must also be suspicious of family members of the very young and of the elderly when prescribing or administering controlled substances to those patients. At times, drug seekers and addicts will use the very young and the elderly to obtain pain medication prescriptions for themselves. Drug seekers can also be "professional patients", or "middlemen", if you will, for drug pushers. For example, paraplegics and amputees are hired as professional patients by drug pushers and are paid per prescription. Amputees can abrade their stumps to give the appearance of cellulitis or other infection. Generally, they will receive an antibiotic and will ask for a pain medication. Upon arrival to the pharmacy, the amputee will then only fill the prescription for the pain med and then sell the pain med to the drug pusher for sale on the street.


What To Do When A Drug Seeker Presents To Your FacilityMake sure you perform a thorough history, physical and assessment and document all findings. Take the time to question your patient and elicit as much detail as possible. Many times, just by doing a thorough assessment, drug seekers will admit to being at other clinics, 24-hour urgent cares, etc. and expressing dissatisfaction regarding the service, medications, or treatment they received.


Make sure enough identifying information is collected, documented and included with the medical record to track patients, making retrieving information regarding previous visits as easy as possible for the next provider.
Make sure that prescriptions for controlled substances are written in small enough quantities that the patient must follow up with a primary care physician in order to get the prescriptions refilled. Ensure that prescriptions have the quantity written in both numeric and long hand form in order to keep the patient from changing #10 to #40.

Do not refill prescriptions for controlled substances through the emergency department, especially if you are unable to contact the patient's prescribing physician. Do not succumb to pressure from the patient to provide narcotics or opiates prior to exploring non-narcotic alternatives. If the patient claims that their prescription was lost or stolen, call the police. Refuse prescriptions until proper investigation and documentation has been completed.
Keep copies of original prescriptions in the patient's medical record. If a pharmacy calls questioning a quantity on a prescription, for example, the on-hand copy can be obtained for verification purposes. Always keep blank prescription pads out of easily accessible areas and do not carry them in your pockets and into patient rooms.


Learn about street drug combinations and what the most commonly mis-used prescriptions are. Remember that Soma and hydrocodone, when taken together, produce a heroine-type "high". Tagamet, when taken with crack, inhibits crack's metabolism in the liver, prolonging the addict's high.


Protect ALL patients' privacy rights as much as possible. Avoid posting "no narcs" or "drug seeker" lists at the nurses' station or staff lounges or any other easily visible place. Even keeping a compiled list of names in an out-of-the-way place can land a hospital in hot water with JCAHO and with the law as a blatant HIPAA violation.


Treat the patient with the respect and dignity with which you would treat any other patient. Drug seekers are addicts. They are slaves to the chemicals that they believe keep them functioning. Withdrawal is hell for them. Rather than looking down on them as "junkies" or "seekers", try to keep in mind the desperation that drove them to you in the first place. How low must they have sunk to resort to feigning illness or injury just to get a "fix"?