Patient’s medication taken away

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I have a patient who is on a Methadone treatment with the clinic for his drug addiction. He was referred to us from a hospital. His doctor in the hospital prescribed him a methadone to treat his drug addiction and Xanax PRN to treat his anxiety. Xanax is a benzodiazepine and has to be taken cautiously because mixing these two medications can be fatal. Our NP took his Xanax away from him and asked me to put it in a safe. As per NP, he can get it back on his day of discharge or maybe never. When he asked to get it back, I  called NP and she said I couldn’t give it back to him. The reason is it’s dangerous and he might die from it, he might sell it to other drug addicts etc. I never encountered a situation like and I am in doubt it’s the right thing to do. I understand where NP is coming from, but  is it legal to withhold someone’s medication?

Thank you very much!

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Specializes in Psych (25 years), Medical (15 years).

Typically, the pharmacy is responsible for storing meds, not the unit.

Yes, Xanax and methadone used concurrently does increase the likelihood of a reaction if not closely monitored and supervised.

However, prescribing it in the hospital where administration is supervised, and depending on the dosages, the situation is not outside of the realms of being appropriate, Marlene.

Plus, if the Xanax was prescribed only as an inpatient, not prescribing it as a discharge med is perfectly logical.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I agree that because it was prescribed as an inpatient, he is not automatically entitled to have it back. I don't think you're in any legal trouble area. 

On an unrelated note, we have had a few patients found with drugs in their belongings upon admission to critical care. Usually these people are on ventilators and we send the drugs to security, per our hospital policy. We have had a few get very upset when they realize we have taken their drugs. One patient even called the police and wants to file a report that we had stolen their drugs! Ha!

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1 hour ago, Davey Do said:

Typically, the pharmacy is responsible for storing meds, not the unit.

Yes, Xanax and methadone used concurrently does increase the likelihood of a reaction if not closely monitored and supervised.

However, prescribing it in the hospital where administration is supervised, and depending on the dosages, the situation is not outside of the realms of being appropriate, Marlene.

Plus, if the Xanax was prescribed only as an inpatient, not prescribing it as a discharge med is perfectly logical.

Thank you!

1 hour ago, JBMmom said:

I agree that because it was prescribed as an inpatient, he is not automatically entitled to have it back. I don't think you're in any legal trouble area. 

On an unrelated note, we have had a few patients found with drugs in their belongings upon admission to critical care. Usually these people are on ventilators and we send the drugs to security, per our hospital policy. We have had a few get very upset when they realize we have taken their drugs. One patient even called the police and wants to file a report that we had stolen their drugs! Ha!

Thank you!

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Not sure I agree with the above or maybe I'm not understanding the situation. I assumed we were talking about medications the patient was prescribed at (hospital) discharge and that he has now presented to a different kind of treatment facility with said medications on his person.

I understand that the facility may have a policy that such medications need to be kept in the safe, and I can understand a situation where he is asked or even required to surrender certain medications as a condition of participation at the methadone clinic. But some of this doesn't sound like solid footing, such taking them away--and taking them away for the given reason specifically:

5 hours ago, Marlen0802 said:

The reason is it’s dangerous and he might die from it, he might sell it to other drug addicts etc.

If he has filled legal Rxs appropriately, are those medications not his personal possessions?

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Specializes in Med-Surg, Geriatrics, Wound Care.

I also don't think it sounds correct. If the patient had instead given the filled prescriptions to a friend or family member before being admitted to your facility, they would still have access to it. I agree that while inpatient, storing medications is common. Most hospitals attempt to store them away from patients or request patients send the medications home after reconciling the med list.

The only reasons I could think of for him not to have them returned on discharge is if the literally threatened suicide by using the medications.  Just because a medication is "dangerous" is not justification, millions (?) of people are prescribed that medication. I'm not even sure if they could be withheld if he threatened to sell them. But, perhaps when he checked in there was a consent for not returning medications?

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Specializes in Community and Public Health, Addictions Nursing.

I'm confused- are you working in an outpatient facility like a methadone clinic, or has the patient been admitted to another inpatient setting like residential treatment?

If it's an outpatient clinic, and he brought his Xanax with him as part of intake, then that means he was discharged from the hospital with the Xanax, and that medication is his whether another prescriber agrees or not. It's his property, and nobody else should be taking it and locking it up. Just like I wouldn't take shoes from a patient, lock them up, and refuse to give them back.

If it's residential treatment, then yes, you need to follow the orders of the NP and any other provider caring for the pt. And that might include making adjustments to the pt's med plan. 

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Thank you very much to all of you for your input. I work in an outpatient methadone clinic and this patient brought his Xanax and all other meds on his first day after being discharged from the hospital. So those medications were prescribed by a hospital doctor, scripts were filled out in a hospital pharmacy and we would never have an access to it if he wouldn’t bring it. By knowing that in our clinic patients are not allowed to be on a methadone and benzodiazepines simultaneously,  it’s still in his possession and no consent was signed that he is allowed us to store his medication. 
Thanks again!

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1 hour ago, Marlen0802 said:

I work in an outpatient methadone clinic and this patient brought his Xanax and all other meds on his first day after being discharged from the hospital.

 Yes, so to the best of my knowledge he can be required to voluntarily surrender these as a condition of participation (I.e. he can choose to surrender them or choose not to participate in the program), but as far as I know his belongings can't just be stolen from him. There has to be some legal basis for declining to return his possessions to him even if he does choose to have you hold them for safe-keeping during his participation in the program.

-Not a lawyer, not an expert; this is just my personal best understanding in contexts that I have been exposed to as a nurse.

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On 2/7/2021 at 6:18 PM, JBMmom said:

I agree that because it was prescribed as an inpatient, he is not automatically entitled to have it back. I don't think you're in any legal trouble area. 

On an unrelated note, we have had a few patients found with drugs in their belongings upon admission to critical care. Usually these people are on ventilators and we send the drugs to security, per our hospital policy. We have had a few get very upset when they realize we have taken their drugs. One patient even called the police and wants to file a report that we had stolen their drugs! Ha!

I recently had a patient leave AMA when we wouldn't give her IV Dilaudid. When she requested her possessions from security, her purse, prescription meds, and lighter were returned.  I had to explain to her that we would not be giving her back the pot we found in her pocket.  "Why not?" Um, because it's illegal.

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