Drug seekers :(

nitasarn · Sep 18, 2012

Week 3 of orientation and I have seen so many drug seekers its ridiculous. All they seem to be concerned with is Vicodin and xanax. Its getting pretty scary. One doc that is training me does not write for controlled substances at all and another doc writes for them all day long no questions asked. A third doc makes everyone give a urine drug screen and checks online to see where they are getting their narcotics from. If they are positive for any other substances or are going to more than one place, he will not prescribe the medication.
It makes it really hard to manage other aspects of care when the pt could care less about their abnormal labs and imaging reports. Today I would not give a lady her scripts until I got her mammogram results faxed over because the last note said she needed a MRI of the breast. Of course she had no clue of what I was talking about . I always wanted to do family practice/primary care while I was in school, but this is not what I expected. Maybe they will let me see the peds and GYN pts only. LOL, that would be very nice. At any rate, has anyone else experienced this in their practice? I am in Detroit so I know it occurs more here. But every pt?? Sheesh.

The office that I followed during clinicals, had a LOT of problem with drug seekers. #1 not that your in the position to do this but ALL of the practice needs to practice the same restraint as the 1st or third doc, the 2 d doc just keeps them coming back for more and then they start to bring there friends...and so on and so one. The practice I had did a 3 STRIKEs refer out. If in three visits you cant be controlled or not going down on medication you get sent to pain management... :up:

Tinabeanrn · Sep 18, 2012

Hum...thats a good idea. I dont want to see pts just bc they want pain meds...ya know? Its really annoying and ridiculous. I think they should have documented imaging reports to verify the need for a controlled substance in.the first place. And then go to the pain clinic.

CCRNDiva, BSN, RN · Sep 19, 2012

I feel for you. This is why I like my patients truly sick and dang near dead.

Tinabeanrn · Sep 19, 2012

@ CCRNDiva, LOL Intubated and sedated?? I like those pts too. I just got to tired of putting them in body bags.

reddgirl · Sep 26, 2012

Hmm, although I am not practicing yet, I know what you mean. They tend to be allergic to all the meds that they build up a toleranace to. I shouldn't have that problem because NP's can't prescribe controlled substances in Florida, but I know they will still try. Maybe someone should do a seminar on how to deal with drug seekers.

Tinabeanrn · Sep 26, 2012

You are so lucky to not have to deal with that problem! I am almost to the place that I dont want to get my DEA just for this issue. We are doing better with things know. We are having everyone requesting Narcotics to sign a pain contract stating they will be subject to random drug screens and will not sell or give away any of there medications, will not take any ones elses medications, wont change the dose or frequency...etc. The one doc is not on board with doing this though. But this is how I will practice. I really dont plan on prescibing narcs unless absolutely necessary. I have had ppl walk right out of the exam room bc I let them know they are not suppose to be on Vicodin for the rest of their lives...I mean seriously! I wont give it to pts that are positive for marijuanna any other illicit drug...and that is just that. :). If they leave they leave. But right is right

Aniva · Sep 27, 2012

Yes, but I side with the providers who do not often prescribe narcotics/controlled substances. Even if I do, it's extremely strict (contracts, screenings, etc.). If there's even one strike, they're out. It may also take a few visits for me to get to know the patient and exhausting other therapies before considering it as well...

Tinabeanrn · Sep 27, 2012

IKR Aniva..exactly! I had a brand new pt come in and tell me he take Vicodin ES and Xanax 1 mg. I checked MAPS and he had never received any scripts for any controlled substances. The girls at the office say that means he either sells the scripts to someone elses or has an underground pharmacy that will take the script, fill the medication but not report it to MAPS. Im sure he heard through word of mouth from other pts telling him to go up to the office and tell them you take xy and z and the doc there will write it for you.

I agree with your method. All other options should be exhausted, the pt should be reliable, screening should be done before prescribing narcotics. Its too much abuse and misuse of these drugs. And when they are started, shouldn't there be some tenative stop date too? What the heck is the plan? To leave pts on this stuff forever? It seems to be the case in these pts minds