Question for those with Prescriptive Rights

Discussion in 'Health and medical' started by Julianne, Oct 13, 2003.

  1. Julianne

    Julianne Guest

    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 clue or red flags? If you did, did you
    ignore them? 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 denying a
    patient pain relief, do you subscribe to the belief that a patient should
    always have their pain treated even when you doubt the veracity of the
    information? (Isn't addiction painful and isn't enabling it actually cruel
    when you can offer other forms of help?)

    I have given lots of drugs. I have never prescribed them, though and wonder
    how those with the responsibility feel about the liberal use of Darvocet,
    Lortab, etc.

    j
     
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  2. Hawki63

    Hawki63 Guest

    >Subject: Question for those with Prescriptive Rights
    >From: "Julianne" [email protected]
    >Date: 10/13/2003 3:46 PM Pacific Daylight Time
    >Message-id: <[email protected]>


    >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)



    > 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

    > 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
     
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