Q. What tips can you offer to help me determine if a patient is a drug-seeker rather than someone with a genuine or chronic condition needing medication?
A. What a timely question. The Medical Licensing Board of Indiana recently instituted new opioid prescribing rules effective Dec. 15, 2013. Find a summary of the rules prepared by the ISMA.
The typical drug-seeking patient is quite sophisticated and may have an unusually high level of medical knowledge. They’ll often describe symptoms that are hard to prove or disprove, e.g., low back pain. They may resist thorough workups or refuse non-narcotic medications, saying “they don’t work” or “I’m allergic.” Drug-seeking patients often request a specific drug by name, may “lose” prescriptions or “run out early.”
Because sufficient treatment of legitimate pain is an important goal and over-prescribing remains a concern, risk management experts suggest the following to lessen your risk:
- Consult and coordinate care with the patient’s other health care providers and verify medical history. It’s not a violation of patient/physician confidentiality or HIPAA privacy standards to securely disclose health care information with the patient’s other providers for treatment purposes.
- Consider using a screening tool, such as the Use and Abuse Rx Tool from the American College of Physicians (ACP), for drug-seeking patients. Find the tool on the ACP’s website.
- Check a patient’s report in INSPECT, which summarizes the controlled substances a patient has been prescribed, as well as other helpful details. Register for INSPECT.
- Schedule regular follow-up visits, and prescribe medication for the amount needed until the next visit – and avoid refilling prescriptions by phone.
- Keep narcotics and prescription pads secure in the office and maintain the security of each physician’s DEA number as vigilantly as prescription pads. Avoid using prescription pads pre-printed with a physician’s DEA number and maintain accurate inventory of medications and prescription pad supplies.
- Document! Document the patient’s diagnosis, indications for the medication – including your initial and subsequent exams – the patient’s pain levels and functional limitations, expectations for symptom resolution, time and course of treatment, and any recommendations and education provided the patient. If you suspect a patient is a drug-seeker, consider referral for substance abuse treatment.
Many physicians treat patients with chronic pain conditions and for those patients, a pain management contract may be a useful safeguard. In our next column, we’ll offer some risk management tips regarding such contracts.
Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via email.