Thoughts from the trenches-
It only takes one, or a few "High (quantity) prescribers" to bring a culture of prescription drug abuse to an area or town. Once a prescriber (MD, DO, PA or NP. But more commonly MD or DO because of the ability to write for outpatient Schedule II drugs, like Oxycodone, Dilaudid and many others) starts prescribing liberally, the word gets out and their appointment book stays filled. Once the phenomena of widespread prescription drug abuse begins in an area, it's nearly impossible to stop it.
Many experienced (Smart) Primary Care providers will not accept new patients if they're "Pain Management" patients, unless the patient already has a contract with a Pain Management provider/ service, and do not hesitate to legally "Fire" a patient in their care that demonstrates diversion, abuse or illegal activity related to the prescribed meds.
OBNDD's Prescription Monitoring Program helps to identify persons that are overprescribed, drug seekers or obtaining meds by means of forgery or deception. It's not perfect, relies on correct identity and until recently, had a lag between dispensing and reporting that allowed some to slip through the cracks. Still, it's a handy tool to catch a seeker in a lie and confront them with the truth. Occasionally (Daily in the ED's across the country) it uncovers evidence of blatant abuse and helps prosecutors to stop it. I wish more providers would use it on 100% of new "pain complaint" patients and randomly on established chronic pain patients. But, again, some providers see it as a numbers game. Keeping the appointment book full and not asking too many questions= more money.
Ultimately, if our industry continues to fail in policing the ranks, at some point, either plantiff's Attorneys or our friendly Government will step in and do it for us.
Me? I'm just tired of the layers of lies and exaggerated complaints told to me daily.
"It was stolen" (Call the Cops and make a report).
"I took it back to the Pharmacy"...
"No, your paperwork is wrong, I never picked up that prescription"..(PMP entries are based upon the properly identified patient physically taking posession of the meds. Would you like me co have the Cops come over and take your report of theft of CDS?)
"I must have accidentally took my Grandma's, boyfriend's, friend's, whomever's.. Oxycodone/ Lortab/ Xanax/ Dilaudid/ whatever" in response to a urine drug screen report that tells a different story than the patient did.
"It's a 10" (When asked to rate their pain from 0-10. 10, being the most severe pain they could imagine), despite a relaxed/ calm patient with a normal resting pulse rate. Try smashing your thumb with a hammer, fracturing your femur, frying your face, chest, arms and hands with fryer grease or breaking off a mouthful of teeth on a handlebar and see how your pulse and affect change.
I just say "No"!
It goes on and on. The classic cat and mouse game. No one doubts that there are many people out there with genuine pain, but there's a looming problem in our society that's going to get way worse before it gets better.
Genuine pain is fairly easy to distinguish from BS, but that doesn't stop them from coming in, over and over.
It only takes one, or a few "High (quantity) prescribers" to bring a culture of prescription drug abuse to an area or town. Once a prescriber (MD, DO, PA or NP. But more commonly MD or DO because of the ability to write for outpatient Schedule II drugs, like Oxycodone, Dilaudid and many others) starts prescribing liberally, the word gets out and their appointment book stays filled. Once the phenomena of widespread prescription drug abuse begins in an area, it's nearly impossible to stop it.
Many experienced (Smart) Primary Care providers will not accept new patients if they're "Pain Management" patients, unless the patient already has a contract with a Pain Management provider/ service, and do not hesitate to legally "Fire" a patient in their care that demonstrates diversion, abuse or illegal activity related to the prescribed meds.
OBNDD's Prescription Monitoring Program helps to identify persons that are overprescribed, drug seekers or obtaining meds by means of forgery or deception. It's not perfect, relies on correct identity and until recently, had a lag between dispensing and reporting that allowed some to slip through the cracks. Still, it's a handy tool to catch a seeker in a lie and confront them with the truth. Occasionally (Daily in the ED's across the country) it uncovers evidence of blatant abuse and helps prosecutors to stop it. I wish more providers would use it on 100% of new "pain complaint" patients and randomly on established chronic pain patients. But, again, some providers see it as a numbers game. Keeping the appointment book full and not asking too many questions= more money.
Ultimately, if our industry continues to fail in policing the ranks, at some point, either plantiff's Attorneys or our friendly Government will step in and do it for us.
Me? I'm just tired of the layers of lies and exaggerated complaints told to me daily.
"It was stolen" (Call the Cops and make a report).
"I took it back to the Pharmacy"...
"No, your paperwork is wrong, I never picked up that prescription"..(PMP entries are based upon the properly identified patient physically taking posession of the meds. Would you like me co have the Cops come over and take your report of theft of CDS?)
"I must have accidentally took my Grandma's, boyfriend's, friend's, whomever's.. Oxycodone/ Lortab/ Xanax/ Dilaudid/ whatever" in response to a urine drug screen report that tells a different story than the patient did.
"It's a 10" (When asked to rate their pain from 0-10. 10, being the most severe pain they could imagine), despite a relaxed/ calm patient with a normal resting pulse rate. Try smashing your thumb with a hammer, fracturing your femur, frying your face, chest, arms and hands with fryer grease or breaking off a mouthful of teeth on a handlebar and see how your pulse and affect change.
I just say "No"!
It goes on and on. The classic cat and mouse game. No one doubts that there are many people out there with genuine pain, but there's a looming problem in our society that's going to get way worse before it gets better.
Genuine pain is fairly easy to distinguish from BS, but that doesn't stop them from coming in, over and over.
