Monday, June 6, 2011

Drug seeking - a lesson in creativity

After 14 years of private practice, I think I've seen my fair share of the unbelievable.  This week, I saw something new.  A patient misspelled their name when they registered with our office.  On purpose.  You'll understand the importance of this is in a minute.

In April, Karla, my physician assistant, saw a new patient who came in for a visit.  He had moved to Illinois from out of state, and based on his medication list, we knew this patient was going to need careful monitoring.  He was on a significant amount of narcotics and anxiety drugs.   Karla came to me for guidance, and we decided that based on the sheer amount of narcotic he was taking (80+ milligrams a day), he would need to get his prescriptions through a pain management physician.  So, we gave him some names, asked him to let us know when he secured an appointment with the pain specialist, and sent him on his way.

He called 2 weeks later, saying he was going out of state and was afraid of running out of medicines.  He said he had an appointment with the pain management doctor for when he returned.  So, I refilled his medicines, but just one time, and made it clear to the patient I wouldn't refill them again.

This past week, we received a fax from a local big-box pharmacy, with a list of prescriptions filled by the above patient, from 5 different physicians in the last 12 weeks.  Narcotics, anxiety drugs, sleep medicines.  And there was my name, scattered amongst the other physicians who were prescribing for him.  The pharmacy was notifying us they wouldn't fill any further prescriptions for the patient, because he was getting the same medicine from multiple prescribers.

The list which was faxed to us is from the Illinois Prescription Monitoring Program.  Controlled medicines, like narcotics, are reported by pharmacies to the state, which then posts the information on a website for prescribers and pharmacists.  It's a fantastic resource.  34 states have a monitoring program like this, but Florida does not.

We checked this database the moment the patient left our office.  The database didn't show any controlled substance prescriptions for him, because he misspelled his last name on his registration forms.  ON PURPOSE.  He knew we were going to check the database.  The fax from the pharmacy listed the patients birth date and name, but his last name was spelled differently.  We actually addressed the spelling issue when he checked in, because his wife's insurance card had a different spelling on it.  In addition, the patient conveniently had forgotten his driver's license, so we couldn't double-check his information against a legitimate form of ID.

We got a call from the pain management physician on Friday that the patient failed to show up for his appointment.  I will be discharging the patient from our practice next week.

Chronic pain is a problem for millions of people.  Narcotics are a mainstay of managing their pain.  The difference between compliant patients and the addict I describe above is that compliant patients are exactly that.  They keep appointments.  They allow the doctors to count their medicines.  They sign narcotic contracts.  They don't take advantage of the physician.

Two or three times a year we get new patients like this.  A few years ago, we had no way to check if we were being played by patients seeking inappropriate prescriptions.  The IPMP has changed the game.  Physicians can remain compassionate, without thinking every patient requesting a strong pain medicine is a drug seeker.  If we are suspicious, we can easily check to see if they are listed, and if their name doesn't come up, we can take care of them without concern.

Prescription monitoring programs should be in place in all 50 states.  There is no reason why physicians and pharmacies shouldn't have the ability to check for patients who abuse medicines.  The problem is, we aren't utilizing these resources like we should.  If we checked these databases on each and every patient, it would be a significant deterrent to stop this type of behavior.  If we could make it harder for them to get their fix, then maybe, with the grace of God, we could help them climb out of the hole of addiction.

2 comments:

  1. In a household with two FL voters, this will significantly change my attitude towards Rick Scott. It makes no sense that he would be against this program in FL. Honestly, it troubles me since we live so close to AL and now I know this issues brings problem people to the state for one reason. See the following story: http://www.postonpolitics.com/2011/04/scott-bondi-tout-florida-progress-on-pill-mills-on-foxnews/

    Good info Dr. Jim!

    Notably, he blames Republicans for this problem.. we can't keep politics out of any issue, can we?

    ReplyDelete
  2. this is a real problem we as a society face today, as I shared with you last week during my visit, this affected my family this past year when we discovered one of my siblings who lives out of state was obtaining prescriptions for pain medication and sleeping medications from several physicians. It seems so simple to put some safeguards in place to not only help identify the addicts who need help but also those who work the system to obtain medications that they in turn resell for a handsome profit. Now I am not naive enough to think that simply putting a monitoring system in place will eliminate the problem. Those who want to beat the system bad enough will find new and creative ways to beat the system.

    Why do you think more states don't implement the monitoring programs? Is it privacy concerns? Budgetary constraints? A desire for smaller government?

    ReplyDelete