The Journal of the Arkansas Medical Society Medical Journal November 2019 Vol. 116 No. 5 | Page 8

by CASEY L. PENN
Dealing With Drug-
Seeking Patients
I
“
t’s crazy what some patients will do,
don’t you think?” said Julio Olaya, MD,
AMS member and anesthesiologist
specializing in pain management. “Dealing
with pain patients, my goal is to diminish the use
of opioids wherever possible while alleviating
legitimate pain in patients when I can. Sometimes
that’s easier said than done. You don’t know at
times who to believe and who not to believe as
some patients will lie or fake pain. Some of the
performances I’ve seen are worthy of an Oscar.
Others are blatantly ridiculous.”
Dr. Olaya spoke at length about his experi-
ences and went on to relay stories about patients
trying to work the system. In one instance at one
of the pain management clinics where he works,
the plumbing system revealed – eventually – that
patients were cheating on drug tests. “The drug
screen is helpful as a specific way for us to tell if
patients are taking the drugs. If they’re taking them
regularly, they should be metabolizing in their urine.
If their drug screen is clear, we know they are not
taking them. If they’re taking illicit drugs, we can
see that also from the drug screen,” he said.
Unfortunately, some patients were learn-
ing a way around the drug test. “Suddenly, the
clinic’s plumbing was backing up. We had to call
in a plumber. He found tremendous amounts of
condoms in the plumbing system. Investigation
revealed that dishonest patients were bringing
‘clean’ urine, whether their own or not, in con-
doms. They would keep this in their underwear
or somewhere on the body to mimic the body’s
natural warmth. They would pour the
urine into the container for the drug
screen and then drop the empty con-
dom into the toilet. To remedy this,
we began sending a female or male
escort in with the patients to be sure
this was not happening.” tion room, the attending physician reviewed the
patient chart and ascertained that the patient was
not advanced in age and was already taking three
Oxycodones per day (90 mg daily). Upon opening
the exam room door, the physician noticed the pa-
tient clearly grimacing and audibly complaining of
pain “all over.”
Case #1 – Jekyll & Hyde The attending physician cancelled the
prescription before it could be filled and discharged
the patient from his clinic. He said, “If I had not
gone to the parking lot, the patient would have
gotten away with it.”
When touched in the self-des-
ignated pain area, the patient quickly
fell nearly to the floor screaming and
exclaiming of great pain. This patient’s
chart documented that other therapies
had been tried such as steroids and
injections. For this reason, the attend-
ing physician believed the patient,
Other stories from our mem-
who requested a fourth pill daily, and
bers* involve patients showing a dif-
Julio Olaya, MD
prescribed it (now up to 120 mg daily).
ferent side of themselves beyond the
clinic walls, offering to pay cash for pain medica- Shortly after the visit, the attending physician had
tions, or far “overselling” their pain levels. Consid- reason to leave the building and walk toward his car.
He saw in the distance the patient he had just seen,
er the following experiences shared by member
“jumping and laughing and crossing from one stop-
physicians.
light to another.”
A middle-aged patient, appearing to be phys-
ically fit, visited a pain clinic. The patient was not
new to the clinic but was seeing a doctor new to
the clinic. As the patient waited in the examina-
104 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 116