Thread: Advice from an ER doctor to drug seekers (As seen on

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    Advice from an ER doctor to drug seekers (As seen on 
    Bluelight Crew Damien's Avatar
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    Mar 2007
    714, CA, USA
    Date: 2007-03-27, 9:56AM PDT

    OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.

    The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

    The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.

    The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)

    The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage.

    The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)

    The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.

    So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.

    Your friendly neighborhood ER doctor
    Just thought I would share.
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    Bluelighter certified_bomb's Avatar
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    Feb 2006
    QLD, Australia
    What about the person stumbling into ER proclaiming he took x number of x drug and thinks he iz dieing?
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    Join Date
    Aug 2004
    Canada, in the GTA yo
    lol that was fucking gold.

    doctors aint dumb. they're real ppl like you n me.

    but the whole pissing in a cup thing...aahahahahaha, brilliant.

    and the percentage of dilaudid that gets squirted on the floor... he's damn fuckin right.
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    Bluelight Crew Swerlz's Avatar
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    Sep 2006
    Fent Liquordale
    would someone really go through all he describes to get vic's? lol
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    Aug 2004
    Canada, in the GTA yo
    ^I'm sure there must be, somewhere.

    I think it's safe to say that most junkies do desperate things.
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    Advice right back to the ER doc... 
    Join Date
    Dec 2006
    USA... *sigh*... sux.
    Thumbs down
    Most ER doctors I've run into (come across to me as) downright prejudiced, bigoted and morally judgmental toward recreational drug use.

    I recently suffered a case of extreme sleep deprivation + insomnia so bad that I couldn't stand up for more than a few minutes at a stretch, couldn't handle grocery shopping/washing clothes and came very close to committing suicide.

    I visited the ER three times in the two week period this went on, and not one ER doctor prescribed me any sleep aids. NOT A ONE. Of course, I was HONEST WITH THEM (just like this @sshole wants) about drug use, and just kept watching the circuits in their heads click off and being handed over to a nurse or social worker the instant they heard the term 'drug use'.

    I never received so much as an infant's aspirin tablet, despite the degree of suffering I was experiencing. The "diagnosis" was always 'polydrug use' (oh sure, you idiots got that from blood tests... never mind that the substances I use (some of the latest designer drugs or 'RC's') don't show up in blood or urine tests, because nobody has heard of them and wouldn't know what to test for. So how exactly was this "condition" "diagnosed?"

    Wish I had the patience to respond to the entire OP point-by-point, but my PC monitor is too expensive to be worth putting my fist through the screen over this . However, I will respond to a few of this guy's points. Please excuse the angry tone... I recently felt neglected and ignored by doctors much like this one during one of the neediest times in my life.

    The fifth rule is don't assume I am an idiot.
    No problem, but I absolutely guarantee you're a prejudiced, three-faced bigoted who agrees addiction is a 'disease' when talking to AA/NA member, agrees with scientists, researchers and such that it's a 'brain chemistry problem', and who actually believes (along with most of your colleagues) that drug users are morally reprehensible scumbags who should be locked away in prison ASAP.

    If I came to you for help, you'd be "enabling" me (to continue using) simply by saving my life, wouldn't you? That must be why you saw EVERY OTHER patient in the ER before me, once you knew I'd reported recent drug use. Or maybe you thought I was just a "worthless druggie" who should consider himself lucky to be allowed into the ER at all, let alone get shuffled to the bottom of the list.

    Oh yeah, and I never came to the ER requesting Vicodin, Xanax, etc. I came begging for help to get to sleep, so I could stop the hallucinations and delusions, stand up for more than a few minutes at a time, go grocery shopping, and get help with the constant physical malaise & exhaustion, mental confusion, extreme mood swings, trashed short-term memory and inability to concentrate.

    Not to mention, try and get help for the continuing insomnia that was part-and-parcel of this intractable case of sleep deprivation. Yet you never offered me any *non-addictive* sleeping pill such as Seroquel or Trazodone. Why, doc? Too good for someone who admitted recent drug use, aren't they? Just send me home with nothing but a piece of paper "diagnosing" me as a polydrug user and allow me to suffer, you bigoted piece of sh*t.

    The fourth rule is never ever ever lie to me about who you are or your history.
    This is the last point I'll respond to. Not only will I NOT "never ever ever" lie to you about my history, but you can expect to NEVER, EVER, EVER, EVER, EVER hear a single word of truth out of my mouth again.

    I tried the truth thing already, and found it to be hazardous to my physical and mental health & well-being. It was a hard, bitter lesson, but I learned it, Doc. I suffered much longer than necessary, simply because I told you or some other colleagues of yours the truth.

    Trust me, doc: I'm one of those rare people who've never even used caffeine, because I'm scared of getting too anxious from it. Once you hear me say that (not knowing my history, which is thankfully still protected by SOME privacy laws here in the U.S.), I know in advance you will treat me with the respect, dignity and compassion every suffering human being deserves, whether or not they happen to use drugs recreationally, because that's what always happened when I came in and DIDN'T mention drug use.

    And doc, one thing I actually appreciate about all this: As a (somewhat financially poor) white male in his early 40s, thank you very much for helping me understand what prejudice and bigotry feel like. I'd never really understood it fully until I recently visited some of your colleagues in the ER. I now know what many African-Americans and other ethnic and sexual minorities experience all the time here in America, and I'm amazed at how insulting, offensive and outrageous it is. Being a RICH white male yourself (who doesn't use drugs, except maybe for that syringe of Demerol hidden in the top drawer of your desk), you'll likely never have to find out.

    Fine, you aren't an idiot, doc. I'd actually rather be an idiot than a narrow minded, two-faced bigot who probably believes all recreational substance users are dumb enough to read your "few simple rules" letter and believe you have the authority to make rules like that (the hospital makes the rules, not you). Or so you've managed to convince yourself, anyway.

    But what I really don't get is this: Why did you think I wouldn't know about those injectable ampules of Demerol hiding in the top drawer of your desk? After all, I've been addicted to opiates a couple times in the past, and have known others who have as well -- don't you think I'd recognize a desperate attempt at self-justification, rationalization and egoistic "holier-than-thou" excuses for using drugs, like that stinking piece of used colostomy bag you refer to as a "list of rules?"

    Kindly get that biohazardous waste out of my face, Doc, and go put it where you know it belongs.
    Last edited by MDPVagrant; 02-06-2007 at 22:34.
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    Quote Originally Posted by MDPVagrant
    Most ER doctors are downright prejudiced, bigoted and morally judgmental toward recreational drug use.
    i agree.

    this article implies that so long as drug-seekers follow "the rules," ER docs will hook them up. this is complete BS. the author (who probably isn't even a doc) is just a dick on a power trip. given the way he paints such a rosy pictures of nurses, he's probably a nurse. and nurses are almost bigger junkies than pharmacists.
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    i like the image of a doctor calling me a "douchetard"
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    Bluelighter deaf eye's Avatar
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    Jan 2008
    Quote Originally Posted by newshounder View Post
    i agree.

    this article implies that so long as drug-seekers follow "the rules," ER docs will hook them up. this is complete BS. the author (who probably isn't even a doc) is just a dick on a power trip. given the way he paints such a rosy pictures of nurses, he's probably a nurse. and nurses are almost bigger junkies than pharmacists.

    when i was in the ER
    i overheard
    the chick in the bed next to me
    complaining of a stubbed toe
    ow it hurts
    do you want a tylenol ?
    no that didnt work
    do you want a percocet its a lil stonger
    oh yes please

    me and my brother were cracking up
    like she played that dr for a fool
    now i think about it
    she prolly got 1 or 2 '5 mg ' percocet
    and wonder how much she paid for the emergency room visit

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    Bluelighter mdmantpa's Avatar
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    Feb 2009
    Florida, USA
    This is bullshit...the er docs expect you to lie, so when you tell them 7 for pain, they automatically assume its a 4 and so on. Once you admit to being a drug user even if you are clean now, they automatically report polydrug use and they will not prescribe you anything, even if you come in with a real problem with serious pain.

    oh and you would be surprised what a real junkie would do for meds....When I got put on probation and had a bad heroin habit, I had my girlfriend run my leg over with her SUV so that I could be legally scripted opiates and could continue using heroin while having a reason to be failing all my drug tests. Fucked up,huh?

    Last point, the percentage of nurses who divert narcotics is astronomically high. Always check when they are giving you narcotics that it is the right pill, or when you get in IV that you are getting the appropriate dose. I know many nurses now in IPN (intervention program for nurses) who would take the patients dilaudid or morphine and then shoot them up while giving the pain patient saline or something. They have also been known to eat your vics/percs and give out tylenols....makes me sick
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    Bluelighter peacebone's Avatar
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    Apr 2008
    I'm fed up with being honest with doctors too, not because I don't think they deserve the respect, but because you end up getting treated worse than you would if you lied.

    Last time I was in the ER for a car accident, I had to wait THREE HOURS until someone gave me a tylenol. That was it. I was crying so hard I could barely tell my doctor that I had been laying in the room for a full hour since I'd seen anyone, and no one answered when I pushed my buzzer. I was in legit pain, and they sent me out with a bottle of Naproxen sodium and muscle relaxers.

    That's what happens when they know you're a druggie.

    Yet, my doctors I don't tell, even when I am in only the slightest pain, have no hestitation to write a pretty, young, innocent looking girl plenty of painkillers. What gives.
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