LAS VEGAS—Addicts who seek prescription opioid drugs spend most of their waking hours planning how to get their drugs and have numerous ploys to scam physicians into prescribing the medications, said John Burke, President of the National Association of Drug Diversion Investigators.
“If you’re in a pain management practice, and even if you’re not, you’re going to get duped from time to time,” Burke told listeners.
It is not illegal to be duped, he added, but it is illegal for a prescriber to continue prescribing to the scammer.
Some typical behaviors of drug seekers trying to scam a practitioner, include compliments, deliberately mispronouncing a drug name, becoming agitated when cut off from their drugs of choice, threatening to sue, and leaving abruptly when the scam does not work.
By getting a potential drug seeker out of the office without a prescription, practitioners send a message to other drug seekers that they are not an easy mark, Burke said.
Best practices that can reduce drug seeking behavior in your practice include:
- New patient forms that asks when a physician or other practitioner was last seen and when they were last prescribed a prescription drug. The form also should ask patients to list the names of practitioners they have seen and the prescription drugs prescribed. Office staff should be sure questions are answered, he said.
- Ask patients to provide photo identification, which should be copied and placed in patients’ medical records
- Obtain complete medical histories from former physicians—do not rely on photocopies supplied by the patient
- Check for and utilize electronic prescription monitoring program databases for their state and any bordering states, if available
- Connect with emergency department physicians. “You might learn a lot about your patient that you didn’t know. What goes on at 3 o’clock in the morning in emergency room may be a lot different in your office at 3 o’clock in the afternoon,” Burke said.
- Make copies of all controlled substance prescriptions and place them in the patient’s file
- Look for physical signs of addiction, such as inflamed nasal passages, track marks on the arms, neck, and between the toes and fingers
Burke advised attendees to document thoroughly patient history, physical examination findings, and treatment plans and to document all diversion issues, such as pill counts, urine screens, early refills, and so on.
He cautioned practitioners to be suspicious of patients who express an unusual interest in controlled substances or request specific controlled substances as well as patients who are always in a hurry or who refuse or constantly delay urine testing or are unwilling to see a pain specialist. Patients who are disinterested in non-drug treatments, insist on brand-name controlled substances, or claim allergy to non-narcotic medications should also be considered as suspicious. Other red flags include consistent early refill requests, excuses for why drugs are missing, inability to recall past offices or clinics where treatment was provided,and unwillingness or inability to identify past physicians and give permission to obtain past medical records.
Patients suspected of diversion should be subjected to periodic urine screens and pill counts. Physicians should consult with pharmacies to find out about the filling of prescriptions for non-controlled substances. Burke also cautioned about diversion of family members or caregivers of the patient and stressed that physicians should never postdate prescriptions or sign them in advance. “Treat prescription pads like your personal checkbook,” Burke said. Prescriptions should be written out in alpha numerics and the refill spot should not be left blank.
Burke concluded the session by emphasizing that physicians listen to their office staff because they often are the first to identify drug seekers. They may see a completely different side of the patient that the physician does not see.