I have this young patient 56 yr been on methadone for years he states it's for pain got into accident years ago had chronic leg feet pain. According to his h&p from methadone clinic he's was iv Herion user and bipolar he denies this up and down!! He's very poor limited transportation to methadone clinic to pick up meds. He wants morphine for pain and states he quit methadone doctor however refuses this states he never be able to come off methadone. I suspect he is selling his methadone when I visit him he has all kinds traffic coming in and out. I used to be psych nurse and can pick out a meth head from mile away! His DX is COPD and he does have trouble breathing. He's using Ativan now for SOB but he's always calling for more when it's not time to reorder. I told him today the doctor won't rx morphine or methadone he asked for another hospice agency number. What more can I do ?

I believe that the hospice medical director should visit this patient so that a meaningful medication poc can be developed to meet his unique needs for symptom palliation.

If he believes he is not receiving appropriate palliation of symptoms he may choose another hospice.

Nothing. Let your supervisor know what is going on. If your agency is going to keep him, you might want to go through the same steps that are used at a pain clinic or palliative clinic -- have him sign an agreement that he will not request prescriptions early, etc.

if the man qualifies for hospice, genuinely, who cares what he is taking?

No one. The point is what he is not taking. The OP suspects that he is selling methadone which is being provided by the hospice. The hospice cannot knowingly standby and let this happen.

The agency I work for delivers medications for a 2 week supply so pt will get exactly enough for 2 weeks. If he is running out early than I would inquire why. If he is saying he needs to take more to relieve pain then the pain medication regimen needs to be changed immediately. Get with hospice doctor and come up with a medication that will work for him. Dont assume, dont get yourself mixed into the patients personal affairs. Just stick to the nursing.