Here are the responses to the following question: 'How are ...



Here are the responses to the following question: "How are other centers handling patients who have a narcotic/controlled substance agreement and a random drug screen shows positive for the opiates and marijuana. The patient is following our care plan otherwise. She also is not asking for early refills. The main question is what would other providers do with a patient like this."

 

1. We are giving the patient 1warning by letter and if they have a repeat,then formally discharge the patient from the clinic giving adequate list of alternate providers in the area and informing the HMO if they have one.

 

2. This is a very provider dependent question/answer.  At my clinic we would either - suspend the person from her opiates for 4-6 months pending clean urine (especially if the patient was not honest and upfront about the marijuana use) or talk to the patient about the importance of not using illegal substances and give her another chance with the warning that if another urine came back positive for anything other than the prescribed med she would be suspended from the pain management program.  We are very strict at our clinic because if you start making exceptions to the rules for one patient than others will find out and you can wind up deep into making excuses for everyone.

 

3.  We check also to see if they are using what we are prescribing them…   many times we are finding that the vicodin or whatever we are prescribing is not in their urine drug screen…   Finding that some are selling it instead….  

 

4.  If she has a positive urine screen.  We do not refill the narcotics again until they provide documentation of completion or participation in a drug treatment program.  It is their responsibility to call and arrange with the treatment program.  They are given a list of numbers to call which are categorized according to health plans accepted and/or places that will accept "no insurance".  Once they provide documentation i.e. a letter on letterhead of treatment, then the provider will consider rewriting script. Attendance at AA meetings or NA meetings, though good is not considered treatment.   Our agreement state we will do random drug screens and will discharge if positive.  The option to enter treatment program is to avoid discharge for our patients who have limited options.  If this happens a second time and pain is a predominant issue.  We discharge from the practice.We usually do the first random drug screen, on the day the agreement is signed.  Of note at least 25% of clients tested return positive with substances and then require treatment.  It works well.  Almost, all will find a treatment program and complete.  About 25% of those will test positive at a later date.  It really helps to sort out drug seekers and people who are using the narcotics perhaps for other purposes to get illegal substances.  Unfortunately, I do not have it in policy format as of yet for this process.   I do have narcotics agreement and a pain policy on file, however.  

5. You need to follow your contract or get rid of it...

 

 

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