The Journal of the Arkansas Medical Society Medical Journal November 2019 Vol. 116 No. 5 | Page 9

Case #2 – Patient Sold Out
by His “Customer”
A neighbor of the patient called the patient’s
pain clinic to report that the patient was selling his
oxys. The call came in the same day the patient
in question had been seen at the clinic. The clinic
called the neighbor to investigate such a serious
allegation. While ascertaining evidence, clinic
staff was told that the neighbor’s own relative
had purchased hydrocodone from the patient. The
neighbor also suggested that the patient was, at
the time of the call, currently gone to fill the new
prescription as evidenced by the line of people
waiting outside the patient’s home.
The prescribing physician called the phar-
macy, who had already dispensed the medication.
It came out later that the patient and his spouse
were working together as a team to acquire and
divert prescription medication.
A Drain on Your Time and Resources
Doctors tend to so much in a normal day –
seeing patients, updating medical records, mak-
ing follow-ups, tending to emergencies, hospital
rounds, etc. There’s enough to handle without
the added responsibility of determining patients’
honesty.
“Sadly, we know that some people will go
to great lengths to get narcotics for themselves
or to divert them for profit,” said AMS Executive
Vice President David Wroten. “The extra effort
that goes into keeping tabs on drug-seeking
patients affects everyone. It affects the honest
patients who are often required to justify them-
selves through drug screens and pill counts, or
worse, unable to find a physician to care for them.
It affects the medical practice through added time
and cost of safeguards. It affects physicians, who
have become more and more leery of prescrib-
ing any narcotics at all for fear of being judged
harshly by their medical boards and colleagues.”
Newsweek shared an editorial that touched
on the effect of drug seekers in the emergency
room and their ability to drain vast amounts of
time and resources. (“The Drug War Is Wrecking
Our ER Departments” 2016/Opinion). “It is not the
sheer number of drug seekers that exacerbates
what is already a problem of ER overcrowding,”
wrote Indiana Emergency Physician Geoffrey Hos-
ta, MD. “It is also the ailments that drug seekers
… create. They tend to invent symptoms indica-
tive of serious illnesses that offer a quick ticket
IS THE PATIENT DRUG-SEEKING?
BE AWARE OF RED FLAGS
Source: adapted from information provided by the Arkansas State Medical Board
Below is a list of “RED FLAGS” for patients who may be exhibiting “drug seeking” behaviors. While
compiled from several sources, this is not an all-inclusive list. The Board provides this list as an
educational tool for prescribers. Further, it should be used by the prescriber to carefully review
their practice for potential problems. Physicians and physician assistants should carefully review
the Medical Practices Act regarding the prescribing of controlled substances to make an informed
decision regarding prescribing.
RED FLAGS
• Patient reports stolen or lost drugs and has early refill requests.
• Patient has Allergies reported for:
» » Steroids
» » NSAIDS (anti-inflammatory drugs)
» » Acetaminophen
» » Codeine
» » Generics
» » Urine Drug Screens
» » Positive for Illicit Drugs
» » Negative for Prescribed Drugs
• Patient refuses or denies to try other drugs or therapy.
• Patient withholds information regarding other medical treatment.
• Patient’s admissions regarding alcohol use.
• Patient willing to pay cash only (especially large denomination bills).
• Patient has an extensive knowledge of various pain medicines.
• Patient request is specific with regard to brand, type, combination, and dose of medication.
• Patient does not live in the geographical area of clinic (30-mile radius).
• Patient already being prescribed a combination of benzodiazepine, Soma, and narcotic
pain medication.
• More than 20% early on controlled RX refill more than once in past six months.
• More than one prescriber of opioids in the past six months.
• Chronic pain patient less than 45 years of age.
• Physician aware of substance abuse or arrests involving controlled substances.
• Lost or stolen medications more than once a year.
• Patient is taking “uppers” and “downers” at the same time.
• Patient is unwilling to try physical therapy, diet, exercise.
• Timing of acute pain:
» » Fridays
» » Weekends
More on recognizing potential abuse:
https://www.deadiversion.usdoj.gov/pubs/brochures/drugabuser.htm
NUMBER 5
NOVEMBER 2019 • 105