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There’s no universal mug shot or profile for someone out to con drugs from a physician, of course. They come in all shapes and sizes. But a few traits to watch out for:
- Prematurely using up a prescription– particularly if it happens more than once.
- Repeated visits or calls to complain of pain, especially if urgent or unscheduled.
- Reports that the prescription was “lost” and should be rewritten.
- Claims that the meds are ordinarily prescribed by another physician who is (conveniently?) unavailable.
Pain is subjective, but doctors are trained to assess it through signs as well as complaints. Is there a disparity between what you can observe and what the patient reports?
No one of the above is alone enough to draw an authoritative conclusion. They can signal the need for precautions, however.
There are classic remedies such as limited-quantity scrips with few or no refills. It helps to have office staff coordinate with other providers so everyone’s on the same page. It doesn’t hurt to periodically schedule a formal pain assessment, even if it means additional tests. And certainly, if you’re in a state with a prescription monitoring database, use it consistently and conscientiously, both you and your office staff.
If the patient is in line for long-term opioid treatment with the more potent variety, it’s best to start out by setting conditions on the arrangement:
- First, that a single pharmacy fills the prescription.
- Second, random urine screening to make sure the drug isn’t being misused.
- Third, that continued treatment with opioids depends on compliance with the contract.
No doubt that in the course of managing opioids properly, you’ll lose a few patients. That’s not necessarily a bad thing. You can always suggest a referral for addiction treatment– what they really needed in the first place, probably.
And you’ll be much better protected against unwanted liability for abuse of your prescription pad.