Challenges of addiction exposed in court-ordered drug treatment programs| Mark Ryan
Medical providers working in the substance abuse field would refer to him as a “frequent flyer.”
The patient in line at the medication window was well known to staff because he had been treated so many times at the hospital for alcohol and drug abuse. He was one of several court-mandated patients on the inpatient detoxification unit.
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According to the National Center for Drug Abuse Statistics, nearly 19 million people aged 12 and older needed substance abuse treatment in 2018. (Alcohol and drug rehabilitation can occur in a variety of settings that include partial hospitalization and outpatient programs. Rehabs utilize different forms of treatment and therapies, and last for varying lengths of time.)
The patient’s orders included routine medications and lots of “as needed,” or PRN (an acronym for the Latin term “pro re nata”) meds prescribed to help with withdrawal symptoms. The nurse administered the routine night-time meds, and then he asked for several PRNs, including PRN trazodone for insomnia.
“I need the hydroxyzine, too,” he said.
The nurse explained that the hydroxyzine – ordered by his assigned psychiatrist for either anxiety or insomnia – had parameters such that he could only get three doses of hydroxyzine in a day, and he had already taken three doses.
The routine and PRN meds placed in front of the patient on the counter had filled more than three medicine cups – but he was still looking for more.
“Can I get the PRN valium?”
“It was discontinued,” the nurse said. “The only other PRN you have is milk of magnesia for constipation.”
“I’ll take it.”
“You’re not constipated, are you?” the nurse asked.
“No, not really.”
Before the med-seeking man exited the medication window, he indicated that he’d be back at midnight to get his first dose of hydroxyzine for the next day.
The nurse, overtired and annoyed but always professional, refrained from saying what she was thinking – “I’m sorry the doctor hasn’t ordered any PRN methamphetamines or PRN cocaine.”
Addicts can be challenging, even when they’re off the cocaine and meth. They tend to push limits. Contrary to success-rate statistics promoted by the rehab companies, it was the nurse’s opinion that patients admitted on a voluntary basis were generally more compliant and motivated than those mandated for treatment.
The court-ordered patient was motivated – motivated to resolve his legal situation. His long rap sheet included current felony charges for drug possession and grand theft. The charges would be dropped if he completed a plea-bargain arrangement for detox and rehab.
The nurse wondered about judges and District Attorney Office prosecutors who failed to hold criminal addicts accountable while overlooking justice for the victims. For repeat offenders, the old-school sentencing trend of jail instead of court-ordered rehabilitation seemed to make more sense.
Jail can be the best rehab for some addicts.
For this frequent-flyer patient, a very structured environment (no midnight hydroxyzine) would probably be in everyone’s best interest.
For more information: Visit National Center for Drug Abuse Statistics (scroll down near bottom and see 2018 stats under “Drug Abuse Treatment & Prevention:)” at drugabusestatistics.org/.
Mark Ryan, a registered nurse, and his wife, Anabel Perez, are members of Premier Health and Fitness Center in Tallahassee.
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This article originally appeared on Tallahassee Democrat: Challenges of addiction exposed in court-ordered drug treatment
