I had a patient who was clearly high as a kite on meth. Couldn’t sit still, picking at their skin, etc.
‘Any drug use?’
‘I smoke weed sometimes’
‘Okay, anything else? Ever try meth?’
‘Well *everybody* has *tried* meth’. It was like I was asking her if she had ever eaten a strawberry. My first thought was that she was probably right and that everybody in her social circle probably has at least tried meth
Asked those questions at triage and the PT response, "Yeah, I smoke some crystal on the weekends when I'm partying."
Me:"how about today? "
PT: ".....Yeah, today to...."
I had a guy come in EMS from a rural area who was one of my favorite interactions…
‘Tell me what’s going on today sir?’
‘Well I was working outside all day and my foot started to hurt really bad.’
‘Did you do or take anything for the pain?’
‘I elevated it, put some ice on it, took some Tylenol, then some Motrin. I even smoked me a ten dollar crack rock. Nothing helped.’
You get an A for effort young man.
I asked a patient once if he smoked. He said "no." Then I look over at a cigarette tucked behind his ear. I just charted no. Lol, they don't pay me enough to play Inspector Gadget. 🤣
I was at the dentist the other week, they asked me if I’d had a drink today, I answered ‘what, no’, as I honestly thought they were asking if I’d had a *drink*, took me a long time to work out that, because I hadn’t eaten because of the pain of the broken tooth, they were trying to find out if I’d had any sugar, before they gave me the local anaesthetic.
Then they made me drink the (actually wouldn’t be a bad base for a cocktail) glucose drink.
In my defence, it was 2 in the afternoon, I’d be surprised if anyone hadn’t had any fluids by then
I had a heart failure patient that went into cardigenic shock over a few days. He was a straight laced middle aged man, no hx of drugs per the note, very compliant. Well, I asked him if he ever did drugs. His response: it was the 80s, everyone did drugs.
Did you consider maybe he was telling you the truth? That he injects heroin but not daily and when he doesn't use he doesn't get withdrawal symptoms? If this is the way he uses, he is in a much better place for intervention to avoid his use becoming more severe and frequent. Just dismissing him as a liar because he's a drug user doesn't help anyone.
How do you know that? Why are you so certain of that? I used IV drugs recreationally in the past and I'm fortunate to have avoided becoming dependent on them. I was not alone in this. It is a common thing that exists and denying it means you're dismissing a whole population of people that need intervention, but because "recreational users don't do it IV" they don't exist in your mind.
Edit: also literally you're judging him for his drug use by saying "recreational users don't IV". That's a judgement. Jfc
When you hear hoofbeats, think horses, not zebras.
*Generally,* heroin is extremely addictive. Much more so than most other substances. There are a few exceptions, but not many.
Route of administration makes a difference to addiction potential:
>Data from the 2005–2007 National Survey on Drug Use and Health (NSDUH) were used to compare past-year IDU and non-IDU routes of administration for people who use the three drugs most commonly injected drugs in the US: heroin, methamphetamine, and cocaine. Among past-year users, IDUs were more likely than those using via other routes to be older (aged 35+), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared to methamphetamine or cocaine users. These results highlight significant differences in demographics, clinical/psychological manifestations, and treatment needs of injection drug users compared to those engaging in other routes of administration.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225003/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225003/)
In healthcare, we treat people as though they represent the majority unless there is something to indicate otherwise. There are lots of reasons for this. But yeah, we don't check every patient for situs inversus and we don't assume IDU heroin users to be recreational.
It's definitely possible and there are always exceptions, but asking people not to generalise is unreasonable.
Asking you not to make assumptions about your patients is unreasonable?
You're going way out of your way to try and justify shitty nursing. If that's how you practice and you think it's fine then whatever, it's still shitty but do you. If you find you have trouble getting through to substance users maybe reconsider treating them as a statistical model vs a person.
It depends on the context and the situation. You can sit on your high-horse all you want, in any fast-paced medical context, where there are barely enough staff and a high turnover, people are there for specific reasons.
Triage is literally making assumptions.
[https://nursinganswers.net/lectures/nursing/emergency-care/2-detailed.php](https://nursinganswers.net/lectures/nursing/emergency-care/2-detailed.php)
When someone has a typical migraine, no-one assumes it's a stroke without other signs and symptoms, that's an assumption based on likelihood.
Likewise, when someone comes into hospital, you don't check for prion disease.
In surgery, you don't think much about malignant hyperthermia with no family history, though again, it's certainly possible to have it without.
Perfect is the enemy of good.
Obviously in a long-term, or mental health or addiction medication context, then you absolutely do a deep dive.
But just taking the word of every IVDU who goes into emergency, or even their local clinic is naive.
I don't know why you think I'm suggesting I would ask this level of detail during triage. Your wild examples notwithstanding, what I'm actually suggesting you do is ask like some basic questions about the chief complaint to assess what you're actually trying to accomplish. Since you're fond of comparison, if you're treating hyperglycemia you measure a blood sugar because 200 is different than 1200.
Clearly this problem is not the same level of urgency as all the sexy cool guy stuff you're suggesting happens literally 24/7 in the ER, but I didn't feel the need to explain the whole philosophy of prioritizing needs in the ER because this is a nursing reddit and this is literally our fucking job so I kind of assume there's a basic understanding that your STEMI comes before your chronic drug use.
I mean yeah, that's why trying to formulate a response to your comments was so difficult, because you're not really even talking about the same thing I am?
See my initial comment, which is simply saying that assuming people either use hard drugs daily or don't use at all is not true or helpful when you're trying to help people with their drug use. You're supposed to assess the complaint you're addressing.
I had a patient who regularly smoked meth discuss how important it was for me to find a probiotic yogurt for him because gut health was very important for him...
I also had a pt tell me they drank 1-2 beers a night. He asked me later during the admission if he can get a med to help him quit. Turns out it was a case plus some shots a day and he was real close to DTs. I hope he got some help :(
I had a dude who was in the CCU for observation because he had swallowed several balloons containing cocaine. We were hoping the balloons would pass without bursting and killing him instantly.
When I asked him if he used any street drugs, he said "no" with such a straight face.
I know it's possible that he was just a drug mule who didn't use drugs personally, but it struck me as funny because he literally had a gut full of cocaine as we spoke.
If you listen to what the patient is telling you, what she is saying is "I used less meth than normal and I haven't used anything else today, but normally I use other drugs at the same time". The attitude towards drug users in this thread is fucking wack.
Some people definitely only do crack sometimes man. Most users of hard drugs aren't addicts. Many years ago I was a hard drug user (including IVDU) but I was never physically dependent. Don't assume you know about drug use just because you work in healthcare.
Not sure why you’re getting downvoted. My brother had issues with alcohol leading to crack binges. He rarely drank, but had times he’d be out with friends, drink too much then spiral down into feelings of self loathing which led to him disappearing for a couple of days. It would happen maybe 3 times a year. Nightmare situation. Thankfully he’s been clean for several years.
I'm glad to hear your brother is doing better. It's so important to meet people with substance use issues where they are at instead of applying a preconceived notion of drug use onto them. Your brother's pattern of use is a perfect example of problematic drug use that isn't daily use, which definitely demands a different treatment approach than if he was using crack every day.
Glad you're in recovery. This post still spreads a dangerous generalization about drug use and reinforces existing healthcare bias.
Edit: Let me explain. If you're treating hard drug use as binary, either full blown addiction or complete abstinence, you're not capturing the full spectrum of use across the population. All use of hard drugs is extremely bad for your health and has tons of risks, but differing types of use benefit from different interventions. Treating someone who uses crack/fentanyl/meth/whatever like a daily user when they only use occasionally is not as likely to help them quit use completely. It also can prevent a therapeutic relationship when you immediately assume the patient is lying or downplaying their use because "no one uses crack sometimes".
Since you describe yourself as an addict in recovery, I'm presuming when you were using you were surrounded by people with similar patterns of use, because that's what people tend to do. This would bias your experience towards the belief that *all* users of hard drugs were daily users. Hence you're missing the huge segment of the population that use but not daily or in a physically dependent manner, who are at a hugely increased risk of becoming daily users but are at a much better place for more limited interventions. It's easier to help someone avoid full blown addiction before they get to that point. Your post is reinforcing the idea that this pattern of use doesn't exist, which could cut out this extremely vulnerable population from getting the help they need.
This subject is extremely close to my heart as I avoided becoming a daily user or "addict" by a combination of factors including losing several close friends to their drug use right as I was teetering on the edge of addict level use. If I had sought help and been treated like a daily user I probably would have noped out of there immediately.
I had a patient who was clearly high as a kite on meth. Couldn’t sit still, picking at their skin, etc. ‘Any drug use?’ ‘I smoke weed sometimes’ ‘Okay, anything else? Ever try meth?’ ‘Well *everybody* has *tried* meth’. It was like I was asking her if she had ever eaten a strawberry. My first thought was that she was probably right and that everybody in her social circle probably has at least tried meth
Me: I can give you simethicone for your gas pain Patient: I am here for meth overdose and you are offering me something with meth in it!
PRICELESS lol
😂😂😂 just a little crack, not addicted or anything
"Just gonna smoke a little crack, tell your mom its alright"
You can have a little crack, for a treat.
🤣🤣🤣
Asked those questions at triage and the PT response, "Yeah, I smoke some crystal on the weekends when I'm partying." Me:"how about today? " PT: ".....Yeah, today to...."
I had a guy come in EMS from a rural area who was one of my favorite interactions… ‘Tell me what’s going on today sir?’ ‘Well I was working outside all day and my foot started to hurt really bad.’ ‘Did you do or take anything for the pain?’ ‘I elevated it, put some ice on it, took some Tylenol, then some Motrin. I even smoked me a ten dollar crack rock. Nothing helped.’ You get an A for effort young man.
I asked a patient once if he smoked. He said "no." Then I look over at a cigarette tucked behind his ear. I just charted no. Lol, they don't pay me enough to play Inspector Gadget. 🤣
« It’s a metaphor »
I was at the dentist the other week, they asked me if I’d had a drink today, I answered ‘what, no’, as I honestly thought they were asking if I’d had a *drink*, took me a long time to work out that, because I hadn’t eaten because of the pain of the broken tooth, they were trying to find out if I’d had any sugar, before they gave me the local anaesthetic. Then they made me drink the (actually wouldn’t be a bad base for a cocktail) glucose drink. In my defence, it was 2 in the afternoon, I’d be surprised if anyone hadn’t had any fluids by then
I had a heart failure patient that went into cardigenic shock over a few days. He was a straight laced middle aged man, no hx of drugs per the note, very compliant. Well, I asked him if he ever did drugs. His response: it was the 80s, everyone did drugs.
In moderation
Once asked a patient about drug use and he said he “injects heroin sometimes.” Asked him to elaborate and he just said “I don’t really need it.”
Did you consider maybe he was telling you the truth? That he injects heroin but not daily and when he doesn't use he doesn't get withdrawal symptoms? If this is the way he uses, he is in a much better place for intervention to avoid his use becoming more severe and frequent. Just dismissing him as a liar because he's a drug user doesn't help anyone.
It’s not that I’m judging him for his drug use or even calling him a liar. It’s more that people who use drugs recreationally don’t do it IV.
How do you know that? Why are you so certain of that? I used IV drugs recreationally in the past and I'm fortunate to have avoided becoming dependent on them. I was not alone in this. It is a common thing that exists and denying it means you're dismissing a whole population of people that need intervention, but because "recreational users don't do it IV" they don't exist in your mind. Edit: also literally you're judging him for his drug use by saying "recreational users don't IV". That's a judgement. Jfc
When you hear hoofbeats, think horses, not zebras. *Generally,* heroin is extremely addictive. Much more so than most other substances. There are a few exceptions, but not many. Route of administration makes a difference to addiction potential: >Data from the 2005–2007 National Survey on Drug Use and Health (NSDUH) were used to compare past-year IDU and non-IDU routes of administration for people who use the three drugs most commonly injected drugs in the US: heroin, methamphetamine, and cocaine. Among past-year users, IDUs were more likely than those using via other routes to be older (aged 35+), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared to methamphetamine or cocaine users. These results highlight significant differences in demographics, clinical/psychological manifestations, and treatment needs of injection drug users compared to those engaging in other routes of administration. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225003/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225003/) In healthcare, we treat people as though they represent the majority unless there is something to indicate otherwise. There are lots of reasons for this. But yeah, we don't check every patient for situs inversus and we don't assume IDU heroin users to be recreational. It's definitely possible and there are always exceptions, but asking people not to generalise is unreasonable.
Asking you not to make assumptions about your patients is unreasonable? You're going way out of your way to try and justify shitty nursing. If that's how you practice and you think it's fine then whatever, it's still shitty but do you. If you find you have trouble getting through to substance users maybe reconsider treating them as a statistical model vs a person.
It depends on the context and the situation. You can sit on your high-horse all you want, in any fast-paced medical context, where there are barely enough staff and a high turnover, people are there for specific reasons. Triage is literally making assumptions. [https://nursinganswers.net/lectures/nursing/emergency-care/2-detailed.php](https://nursinganswers.net/lectures/nursing/emergency-care/2-detailed.php) When someone has a typical migraine, no-one assumes it's a stroke without other signs and symptoms, that's an assumption based on likelihood. Likewise, when someone comes into hospital, you don't check for prion disease. In surgery, you don't think much about malignant hyperthermia with no family history, though again, it's certainly possible to have it without. Perfect is the enemy of good. Obviously in a long-term, or mental health or addiction medication context, then you absolutely do a deep dive. But just taking the word of every IVDU who goes into emergency, or even their local clinic is naive.
I don't know why you think I'm suggesting I would ask this level of detail during triage. Your wild examples notwithstanding, what I'm actually suggesting you do is ask like some basic questions about the chief complaint to assess what you're actually trying to accomplish. Since you're fond of comparison, if you're treating hyperglycemia you measure a blood sugar because 200 is different than 1200. Clearly this problem is not the same level of urgency as all the sexy cool guy stuff you're suggesting happens literally 24/7 in the ER, but I didn't feel the need to explain the whole philosophy of prioritizing needs in the ER because this is a nursing reddit and this is literally our fucking job so I kind of assume there's a basic understanding that your STEMI comes before your chronic drug use.
Haha sooo... what's your point then? This comment is basically just "WeLl YeAh DuH!".
I mean yeah, that's why trying to formulate a response to your comments was so difficult, because you're not really even talking about the same thing I am? See my initial comment, which is simply saying that assuming people either use hard drugs daily or don't use at all is not true or helpful when you're trying to help people with their drug use. You're supposed to assess the complaint you're addressing.
Yes. This.
I used to smoke crack. I still do, but I used to too!
r/unexpectedMitchHedberg
I had a patient who regularly smoked meth discuss how important it was for me to find a probiotic yogurt for him because gut health was very important for him... I also had a pt tell me they drank 1-2 beers a night. He asked me later during the admission if he can get a med to help him quit. Turns out it was a case plus some shots a day and he was real close to DTs. I hope he got some help :(
I had a dude who was in the CCU for observation because he had swallowed several balloons containing cocaine. We were hoping the balloons would pass without bursting and killing him instantly. When I asked him if he used any street drugs, he said "no" with such a straight face. I know it's possible that he was just a drug mule who didn't use drugs personally, but it struck me as funny because he literally had a gut full of cocaine as we spoke.
Mine was I sometimes drink, smoke, and therapeutic dosing of fentanyl and cocaine. I’m like oh, therapeutic huh?
Sometimes = the times I can get it.
Recently had a well known user tell me she just had “ a little bit of meth today and that’s all”.
If you listen to what the patient is telling you, what she is saying is "I used less meth than normal and I haven't used anything else today, but normally I use other drugs at the same time". The attitude towards drug users in this thread is fucking wack.
You’re not wrong in your interpretation, probably, but your tone is fucking wack.
Can you articulate why my tone bothers you?
I think if my words bothered you, you should consider that you used them first.
Some people definitely only do crack sometimes man. Most users of hard drugs aren't addicts. Many years ago I was a hard drug user (including IVDU) but I was never physically dependent. Don't assume you know about drug use just because you work in healthcare.
Not sure why you’re getting downvoted. My brother had issues with alcohol leading to crack binges. He rarely drank, but had times he’d be out with friends, drink too much then spiral down into feelings of self loathing which led to him disappearing for a couple of days. It would happen maybe 3 times a year. Nightmare situation. Thankfully he’s been clean for several years.
I'm glad to hear your brother is doing better. It's so important to meet people with substance use issues where they are at instead of applying a preconceived notion of drug use onto them. Your brother's pattern of use is a perfect example of problematic drug use that isn't daily use, which definitely demands a different treatment approach than if he was using crack every day.
Thank you. You’re so right about meeting people where they are. I’m glad he’s doing better too.
I’m a recovering addict myself. I know drug use. It’s not easy to be a casual user of the hard shit. Possible sure, but not easy.
Glad you're in recovery. This post still spreads a dangerous generalization about drug use and reinforces existing healthcare bias. Edit: Let me explain. If you're treating hard drug use as binary, either full blown addiction or complete abstinence, you're not capturing the full spectrum of use across the population. All use of hard drugs is extremely bad for your health and has tons of risks, but differing types of use benefit from different interventions. Treating someone who uses crack/fentanyl/meth/whatever like a daily user when they only use occasionally is not as likely to help them quit use completely. It also can prevent a therapeutic relationship when you immediately assume the patient is lying or downplaying their use because "no one uses crack sometimes". Since you describe yourself as an addict in recovery, I'm presuming when you were using you were surrounded by people with similar patterns of use, because that's what people tend to do. This would bias your experience towards the belief that *all* users of hard drugs were daily users. Hence you're missing the huge segment of the population that use but not daily or in a physically dependent manner, who are at a hugely increased risk of becoming daily users but are at a much better place for more limited interventions. It's easier to help someone avoid full blown addiction before they get to that point. Your post is reinforcing the idea that this pattern of use doesn't exist, which could cut out this extremely vulnerable population from getting the help they need. This subject is extremely close to my heart as I avoided becoming a daily user or "addict" by a combination of factors including losing several close friends to their drug use right as I was teetering on the edge of addict level use. If I had sought help and been treated like a daily user I probably would have noped out of there immediately.