Quoted message said:Subject: Question for those with Prescriptive Rights
From: "Julianne" [email hidden]
Date: 10/13/2003 3:46 PM Pacific Daylight Time
Message-id: <rXFib.59462$k74.58384@lakeread05>
Quoted message said:I am appalled at the whole Rush thing. I was wondering if any of you have
ever prescribed legit meds to a patient who became dependent on them? Could
you not tell? Did you have any
Julianne..
I am an np with full prescriptive rights..
firstly...let's put this Rush thing to rest...surely he may have had pain...and
more than likely he had a doc that would have prescribed for him.....but surely
NOT in the amounts he obtained....
Patients with chronic pain WILL become dependent...addiction is defined as a
BEHAIVOR....even if someone is being prescribed adequate amounts (and become
dependent)...addiction is when they increase their dose way beyond what is
prescribed....and in the process of keeping a supply...they usually turn to an
illegal source,,,as Rush did
(or...obviously addiction is defined as taking a mood altering substance for no
medical reason)
Quoted message said:Could
you not tell?
patients getting opiates for chronic pain are very often being seen by a pain
management specialist....and it is not uncommon for these patients to sign a
"pain contract"...ie can't obtain meds from any other provider and must use one
pharmacy...legitimate pain patients have a difficult time obtaining adequate
meds...most will not violate these contracts..for fear of losing their provider
Quoted message said:How do you handle drug seeking patients in light of all the
JCAHO mandates that says if a patient says they are in pain, you treat it
regardless of whether or not you believe them? Without ever
You are most familiar with inpatient pain treatment...when you have the time to
evaluate on a continuing basis if the patient's demeanor matches their reported
level of pain..
in outpatient medicine we don't have that time with our patients...
personally I can be pretty gullible...if a patient tells me they have
pain,,,and around dancing around the exam room....I tend to believe them....I
get around to the initial abuse issue by prescribing in small
quantities..ie..30 of Vicodin....for larger amounts...I have an MD or the
patient's PCP see/talk to the patient...
I worked in an HMO where any patient with drug coverage (most)....HAD to use
the hmo's pharmacy...and all prescriptions were available on the computer!!!
Tho I did indeed get burned a few times...if I didn't take the time to check
the computer....it didn't happen that often....we were also encouraged to have
the pharmacy "flag" a patient's profile if they seemed to be visiting a
different clinic each visit..
hope that helps
hawki
