“Oh, but I just ran out of my oxycontin medications the day before coming into hospital. Could you write me a script for when I go? I won’t see my GP until 4 days time”.
Sigh. This man was on 90mg of oxycontin a day for back injury sustained years ago. The pharmacist thought his story was dodgy, as did the nursing staff. Bells and whistles were going off, and I couldn’t help but think that this is one of drug seekers that I’ll be facing for the rest of my career.
The nurses had found syringes in his belongings. Not only that, but his story was extremely sketchy. There was an unaccounted period of 3 months of which he hadn’t obtained any oxycontin from his last GP. He must have been doctor shopping in that period of 3 months. In addition to all this, the man was demanding. He told the nursing staff that he wouldn’t leave hospital until he got some scripts.
I didn’t know what to do. I had a feeling that I could perhaps tell him that it is not one of my policies to discharge people home on strong pain relief when I am not familiar with their medical history especially in regards to his pain and his scripts. Being like any junior doctor who is stuck about what to do, I phoned my registrar. She told me to just give the scripts. So, I wrote the scripts (only for 8 tablets however – to last him till his supposed appointment with his GP in 4 days time) The man took off shortly after being given the scripts. I felt defeated.
Reflecting in hindsight, I don’t really see why I didn’t just decide to not write the scripts in the first place. There were 3 months of unaccounted scripts of oxycontin that he wasn’t getting from his regular GP, his story of running out of medications was extremely suspicious, and the nurses found syringes in his belongings. My biggest fear at the time however, was always the thought that what if I don’t write the scripts and he definitely had no medications? I thought about not writing the scripts and telling him to see ED if there were any issues with pain, but it felt irresponsible. Also, I was afraid of what would happen with his threats of not leaving until he got a script. These patients sure are scary (he looked scary too – missing a few teeth, menacing eyes that glared at you).
I recently read an article (http://www.racgp.org.au/afp/2010/august/prescription-drug-misuse/) that deals with the very issue of drug seekers. They’re a challenging group of patients to cater for. They may use tactics of intimidation, and guilt tripping to get what they want; more pain medications. In Australia, oxycontin and alprazolam are the most abused drugs. What’s more, there are an estimated 20,000 prescription drug shoppers in any 3 month period.
The article goes on highlighting some strategies to deal with the drug seeker, something like saying “it’s my choice” or saying “it’s our policy that we don’t prescribe strong opiods/benzodiazepines for new patients” effectively giving no room for negotiation from the patient. The second strategy is really good, but I feel the first one could still give room for a drug seeker to negotiate and manipulate. One thing the article really highlights however, is the fact that role plays with such scenarios have shown that doctors are initially embarrassed or too shy to say no to drug seekers.
Would I write another script for a suspected drug seeker? Probably. But I’ve learnt something from this encounter. I learned that it’s quite hard saying no to a drug seeker. But with this experience in mind, I’m in a better standing for that next encounter with the drug seeker.