Policy Paper Drug seeking in the ER

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Sacred Heart University
NU 501 - Health Care Policy and Ethics

Policy Paper
Reducing and Preventing Drug Seeking Behavior in the Emergency Department

November 28, 2012

Problem identification
“Drug seeking” in the emergency department is a serious social and health problem in the United States today. Abuse and exploitation of controlled prescription medication is a significant and growing problem on a daily basis, especially for the emergency room staff. This is a difficult healthcare issue and the goal is to try to reduce potential damages while still addressing legitimate medical needs of these challenging patients. I would at first like to define several terms for the purposes of this paper. “Drug seeker” or “drug seeking (behavior)” are phrases commonly used in common medical lingo and have several definitions. According to a medical dictionary, “ A drug seeker - a person who seeks narcotic agents from a physician or other licensed prescriber, either for personal use or to sell.” (Drug seeker, 2012) Drug seeking patients often present with conditions that are difficult to evaluate and easily feigned, such as headache, back pain, and dental pain. In addition, I would like to define a phrase “controlled medication seeking” as: intentionally faking or amplifying a medical condition, using deception (example prescription tempering) to obtain a controlled medication. Controlled medications are classified as schedule (classification) I-IV by The Controlled Substances Act (CSA). “The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain substances is regulated.” (Controlled Substances Act, 2012) The foundation for the regulation is to attempt to prevent the danger of addiction, abuse, physical and mental harm, the illegal distribution of them, and the risks from actions of those who have used these substances. As healthcare providers we are being strongly encouraged to treat pain more aggressively, due to recent research that patients were not having their pain adequately managed. The Joint Commission, U.S. Department of Health & Human Services, and World Health Organization have all begun to include pain control criteria besides other criteria for accreditation or reimbursement. These societal changes require that the healthcare staff becomes familiar with current means of pain assessment and treatment and utilizes them. However, this situation can be looked at as a Catch 22; research also shows that at the same time there is an increase in percentages of individuals falsifying or exaggerating medical conditions to get controlled prescription, especially narcotics.

Background
“Prescription drug abuse increased 75 percent from 2002 to 2010, according to a new study from the Centers for Disease Control and Prevention.” (Stuart, 2012) The CDC report indicated that, in the past five years the number of ER visits driven by abuse of prescription drugs almost doubled and the highest number of visits were recorded for oxycodone, hydrocodone, and methadone. “The Drug Abuse Warning Network (DAWN) estimated that number of ED visits for nonmedical use of opioid analgesics increased from 144,600 to 305,900 visits from 2004 to 2008.” (Notifiable Disease Data Team, 2010) The types of patients who seek controlled medication from the emergency department are those who intend to obtain it from our emergency facility exclusively for recreational effects or for financial profit. Recreational effects are feelings of euphoria, exhilaration, increased confidence and an indifference to pain/fatigue, calmness, intoxication, warmness, and general sense of well-being. “The emergency department is the largest ambulatory source for opioid analgesics with 39% of all opioids prescribed, administered, or continued coming from emergency departments.” (National Center for Health Statistics, 2006) There are some common...
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