Q. How can I determine if a patient is a drug-seeker rather than someone with a genuine condition needing medication?
A. 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-addictive medications because “they don’t work.”
Also, drug-seeking patients often will request a specific drug they want by name, and are typically known to “lose prescriptions” or “run out early.” Another characteristic is a refusal of recommendations for non-pharmacologic treatments such as physical therapy, behavioral training, etc.
Because sufficient treatment for legitimate pain is an important goal – and over-prescribing a concern – risk management experts suggest the following tips to reduce your risk:
- Consult past caregivers and their records for a patient history; don’t simply take the patient’s word for it.
- Check the online Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) database for the patient’s controlled substance prescription history report here.
- Consider using a screening tool for drug-seeking patients such as “10 Questions to Identify Drug-Seeking Patients” from The American College of Physicians, available on this site. The American Academy of Family Physicians offers a systematic approach to identifying drug seeking patients here.
- Schedule regular follow-up visits and prescribe medication for the amount needed until the next visit. Avoid refilling prescriptions by phone.
- Make certain your prescription pads and your DEA number are secure.
- Document. That means documenting 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.
Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via email.