CASE 1: DRUG
SEEKING PATIENTS
Sometimes termination involves a
twist. The cases that follow are examples. They are actual practice
situations that were called in to ProMutual Group’s risk
management telephone consultation service.
A patient who suffered severe
injuries in a motor vehicle accident was treated by his internist over a
period of months with a number of different opioids. None brought
the relief the patient was seeking. He sought increasingly higher
doses of increasingly stronger medications, until, at length, he was
requesting prescriptions for 100 tablets of OxyContin every four
days. The physician, suspecting drug seeking, called ProMutual
Group to ask how to terminate the patient from his practice.
The patient may have been a drug
seeker. It is equally likely that he was selling the
OxyContin. However, termination should not be initiated because of
a suspicion, no matter how strong. At best, the patient was
in pain and needed active pain management. Alternatively, he may
have become addicted to OxyContin, and needed referral to a
detoxification program.
After ensuring that the patient no
longer had a medically-related need for opioids, the physician might
have confronted the patient about his requests for excessive amounts of
OxyContin, shared his concern about drug dependency, and told the
patient that he could not continue to prescribe the OxyContin in the
quantity apparently needed to control the pain. He could then have
suggested either (a) switching to a non-opioid drug therapy, (b) helping
the patient enroll in a licensed detoxification program, or (c)
referring the patient to a physician specifically registered to help
with the detoxification process. He should not have tried
prescribing decreasing amounts of OxyContin in an attempt to wean the
patient from the drug.
Federal statute prohibits
physicians from dispensing drugs for the purpose of detoxification
unless they have a separate registration or a waiver from such
registration to do so.8 (See 21 U.S.C
§823.) That means that they should not prescribe a different,
perhaps less potent, drug nor should they offer lessening amounts of the
same drug in an attempt to wean a patient from a drug dependency or
addiction.
Unless the patient had been proven
to be selling the prescribed OxyContin, termination in this case should
have been offered only after all other options had been offered and
refused. The termination process itself should have included
assurances that the patient was obtaining the required ongoing
care. If, on the other hand, the patient was found to be engaging
in criminal activities, termination could have been immediate.
Next Page: Case
2: Non-Compliance
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