Managing the Drug-Seeking Patient

With the opioid prescription abuse problem at epidemic proportions, many providers face the challenge of recognizing and managing patients who fabricate symptoms to obtain certain prescribed substances, mainly controlled substances.

Drug-seeking patients typically display several common behaviors. Being aware of these “red flags” can help providers identify these patients. Here are a few behaviors that fall into the “red flag” category. The patient:

• Frequently changes providers in an attempt to find one who will prescribe the desired medication (“doctor shopping”)
• Exhibits a history of last-minute calls for refills to “carry him or her through the weekend”
• Believes only one medication—the requested drug—can relieve symptoms
• Makes complaints that cannot be confirmed with objective clinical findings or appear exaggerated based on objective clinical findings
• Repeatedly reports loss of written prescriptions
• Uses different pharmacies over an extended geographical area

Providers can implement the following strategies to mitigate risk exposures related to prescribing practices, particularly as it relates to drug-seeking patients:

1. Utilize the state Prescription Drug Monitoring Program (PDMP) to identify patients who are at high risk for drug diversion and/or doctor-shopping. State PDMP websites can be accessed at http://www.pdmpassist.org/content/state-pdmp-websites
2. Implement a systematic procedure for refilling prescriptions, educating appropriate staff, and enforcing strict compliance with the policy
3. Inform patients verbally and in writing about their practice’s medication refill procedure
4. Establish a treatment agreement with the patient that outlines the provider’s expectations; this agreement should address the number and frequency of prescription refills, early refills, replacement of lost or stolen medications, and specific reasons for discontinuing or changing the drug therapy (e.g., violating the treatment agreement)
5. Consider referral to or consultation with a pain management specialist for patients not responding to the treatment plan
6. Exercise the right to terminate patients who fail to follow the treatment plan or adhere with the treatment agreement
7. Maintain accurate and complete medical records

In 2016, the CDC released a Checklist for Prescribing Opioids for Chronic Pain. The checklist includes information on considerations for prescribing an opioid, renewing a prescription, and reassessing the need to continue opioid therapy. This checklist can be accessed at http://www.cdc.gov/drugoverdose/pdf/PDO_Checklist-a.pdf.

Dealing with a drug-seeking patient is inevitable at some point for most providers. However, being aware of the “red flags” and risk strategies addressed here can help them recognize and manage these patients.