There seem to be a group of people who have a serious deficiency of narcotics (what we in medicine call opioids), “nerve pills” (benzodiazepines), anxiety medicines, etc. They also, in my opinion, have a personality or morals deficiency to go along with this that causes them to act in all kinds of strange manners including boldly lying to get what they want. They don’t care who they hurt, so long as they get their drugs.
I am a gynecologist in private practice. I only work in the office, not the hospital. It amazes me what people will do to try and get controlled substances. We try to stop them at the initial contact – the phone appointment. We blatantly state that we are not taking patients for pain management. So, of course, these people call back asking for appointments for “a pap smear”, or “heavy bleeding” or even “a urinary tract infection”. All of these things are actually problems that would be legitimate things to be seen for in my office.
I will have patients go through a whole visit and at the end say, “oh, by the way, can you write me a prescription for xyz pain medication?” The woman ever mentioned that she was here because of pain. She didn’t point out any pain when she had her examination. Now, when we are wrapping things up, she brings up a need for a pain medication? Of course, I have to ask why? If this is a complex reason, the patient has to come back for another visit. They are usually not happy about this.
I know patients are going to be difficult if they have a list of “allergies” to multiple pain medications. Generally this means that they have a specific pain medication that they prefer. Often they will ask for it by name. Or they will ask for something close to the proper name. They say that this is the only medication that works for them. It generally is a very strong opioid (narcotic) that is only used for severe pain.
We have a special internet site in our state called the Board of Pharmacy. This is available in over 30 states. We can check any patient’s controlled substance history in the state with certain data that we can obtain over the phone. Many patients are aware of this, so they spell their name to the receptionist incorrectly (so we can’t check their drug use history). This is a common trick with people who want to be seen for pain medications. More and more physicians and Emergency Rooms are using this type of site to see when you got your last prescription (and where, and how much) before prescribing any medication. This site is online, so we can check after you get to the office. So this ruse doesn’t work.
It is illegal in my state to withhold information from a practitioner in order to obtain a prescription for a controlled substance. I have this law posted prominently several places in my office. I have been known to show it to patients who lie to me along with a copy of the results from their State Board of Pharmacy search. I had one patient who told me that it was “her sister” who got those medications. She threw a fit when I refused to fill her “Lortabs”, even though I had evidence that someone with the same name and birth date had gotten a prescription for a month’s worth filled seven days before.
For several years, I thought I could screen these patients by doing the board of pharmacy, getting old records, and checking their urine for drugs. I learned NOT to give them prescriptions on their first visit, because many of them were lying to me. The initial drug screens were positive for medications they weren’t supposed to be taking, negative for medications they were supposed to be taking, and often positive for medications that are not legal in my state or in the entire United States.
I have learned not to freak out anymore at a positive urine screen for Cocaine or Heroin. I was a little freaked out by the positive alcohol screen at 10:00 in the morning. Evidently this patient was still drunk from the night before. Then there is the drug that many patients do not think is illegal – Marijuana. Unfortunately, in my state it has not been legalized. I understand that it will stay in the tissue for a while. But it doesn’t stick around forever. And, NO, it isn’t OK if you smoke a little for any particular holiday. I don’t care, either if you “did a little Coke for the holiday”, or “thought the Heroin would help with the pain”.
As a physician, your health is my concern. If you lie about what you are taking, or start mixing drugs without really knowing what you are doing, you could suffer severe consequences. I don’t want your overdose or stroke or death on my conscience. So the answer is “No, ma’am. You cannot have that prescription here. I’m on to you. Don’t try it again here.”