Managing Opioid Diversion and Abuse

Author: Stephen J. Ziegler

Stephen Ziegler:  Many prescribers are faced with ethical and legal dilemmas stemming from patients who they suspect might be diverting their prescription drugs.  And it’s going to be difficult for prescribers to detect this deception because even police officers have difficulty doing so. And if a physician or prescriber suspects that their patient is diverting or suspects that they have a substance abuse problem and they subsequently deny them medication, there is the possibility that this person actually needs that medication and essentially they are denying them pain relief.

Kevin Barnard:  On the other hand, there is the dilemma of continuing to prescribe to somebody that you are correctly suspicious about and that you could be furthering an addiction. So it’s important to have an honest conversation with these patients, and not to be afraid to confront what you feel might be going on.  There’s no shame in that.  This should be viewed as a potential disease beyond pain management or chronic pain.

Jennifer Bolen: When faced with a problem patient, it’s important to remember the physician–patient relationship, and to keep that front and center.  Prescribers should avoid labeling and not avoid the issue. State-licensing boards are going to encourage the provider to talk to the patient about a potential problem, and in some cases mandate that there be a referral.  The responsibility from a regulatory or licensing board sense and certainly ethically would be to take that patient and get them some help and not just wash your hands of it because it’s beyond your scope. Prescribers need to walk carefully to make sure that they don’t violate HIPAA, they don’t breach the physician–patient relationship, and that they don’t ignore that there’s a real human being before them even if that person has done something wrong to break the law.  And they need to document their decision-making and rationale clearly.

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