Desperately Seeking Dilaudid

Dilaudid, aka hydromorphone, is an oral and IV pain medicine that is about 10 times stronger than morphine. It's a drug I'd never heard of before going into nursing, but one which is asked for by name in hospitals around the country...

Pain is obviously subjective, and everyone has different pain thresholds and manifestations of pain. But giving pain medicine scares me sometimes because it can cause respiratory depression (and nausea, which isn't scary, but still). This is especially true when my patient rates their pain as a 10/10 as their eyeballs are rolling back in their head, and insist I "push" the medication faster through their IV because it "works better". It's hard not to sound condescending when you explain that pushing the medication faster will get you HIGH, but no matter how fast or slow it's pushed it will "work" the same (ie. reduce pain). I feel like a bartender sometimes except I don't have the option of cutting off my customers. The whole interaction can become very manipulative on the part of the drug-seeking patient trying to pull one over on the stupid nurse.

I am by no means saying that my patients don't experience pain, and I have never withheld pain medicine because I personally felt someone didn't need it. The objective with pain management is to bring your pain to a manageable level, and that might mean not alleviating it 100%. We want you to be able to get some sleep while not slipping into a coma, for example. There is a fine line between Dilaudid and Narcan, and it's a road I would prefer not to travel.