Cross Posted from Home Health Nursing: Narcotic Diversion

[Katillac, RN]

Sorry about the typo in the subject line, I can't figure out how to edit that!

Hi, All.

I'm wondering if anyone has any resources they can point me to regarding suspected narcotic diversion in a home care patient. This is a case where we strongly feel that narcotics are being hoarded, used by someone other than the patient, and potentially sold. My questions include to what extent is the nurse liable, as well as the prescribing doctor? What is the ethical and legal response when someone is in legitimate pain but also has documented history of past narc abuse and every appearance of doing so presently? While I would appreciate opinions, credible references would be the most helpful. I realize I may need to look for a lawyer, but how to find one that has expertise in this particular area?

Thanks in advance,

Katillac

[river1951]

We have very occasionally run into this problem in hospice and we have had a meeting up front with the suspect and patient and told them we will refer to law enforcement/adult protective services. Depending on the situation, we have also taken out long acting narcotics on a tightly controlled schedule or bought a lock box for the home, key going to patient alone. If the patient is the narcotic abuser; it is a harder call.

I would rather give someone too much than undertreat someone's pain- the abuser will always find a way to get drugs-but undertreating pain is a huge harm. This really requires the doctor and nurse as well as other team members to work together and document well.