Tonight I experienced a patient who reminded me there are limits to drug seeking behavior in the Emergency Department. Having been on the receiving end of this, I’d like to pass on some words of wisdom.

Basic rules: don’t put

• “allergic to hydrocodone 5′s, but not the 7.5′s”
• I’m just here for a pain shot
  • and I need “Demerol”
• “yes, I have some hydrocodone, but need more”

on your triage list.

Advanced rules: don’t

• start screaming for another doctor 30 seconds after being told ‘no pain shot’
• ask the nurse “is taking 7 darvocet like one hydrocodone 7.5?”
• ask for refills of Soma, Duragesic and Oxycodone at 2 AM, on a weekend, without being able to supply name doctors at hospitals that have previously treated you.
• think “the only drug that works for me starts with a D…” isn’t going to make us less wary…
• ask “is doctor ‘X’ on duty?” (knowing the names of the EM docs is never a good sign)
• And, True, the clothes make the man, but they often give away the drug seeker

And the most basic rule: and ED nurse can smell BS at 20 paces, and can point out ‘not right’ in about 3 seconds. Never, ever, screw with an ED nurse.

Oh, and ticking off the ED doc isn’t good, either.