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.