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Appropriate Prescribing of Controlled Substances. Sense and Sensibility with the Drug Seeker Suzanne J. Ferree, MD, owner/physician, Cambridge Medical Group. Objectives. Identify a potential personal weakness in your post-training practice of medicine Identify the drug seeker

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Appropriate Prescribing of Controlled Substances

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Appropriate prescribing of controlled substances l.jpg

Appropriate Prescribing of Controlled Substances

Sense and Sensibility with the Drug Seeker

Suzanne J. Ferree, MD, owner/physician, Cambridge Medical Group


Objectives l.jpg

Objectives

Identify a potential personal weakness in your post-training practice of medicine

Identify the drug seeker

Empower you to have a seeker-free practice

Become prepared to assist the drug seeker in getting help

Understand what our Georgia Medical Board considers unprofessional conduct

Gain basic understanding of controlled substances and the roles of the FDA and DEA


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The New Physician

  • Jack of all trades, cavalier

  • Altruistic

  • Relational

  • Growing business, big loans

  • Trusting

  • Inexperienced, unempowered

  • Unprepared


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The Drug Seeker

  • Knows all that about you!

  • Timing

  • Personality

  • History

  • Physical


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Unprofessional Conduct

  • Rule 360-3-.02 (handout)


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DEA controlled substance schedules

  • FDA/DEA

  • Potential for abuse and dependence

  • Accepted medical use

  • “Closed” system of distribution

  • Incomplete?

  • http://www.usdoj.gov/dea/pubs/scheduling.html


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What to look for (and document)

  • Stimulants

  • Benz and Barbs

  • Narcotics


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Alternative therapies

Sleep

Weight loss

ADD

Pain


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Food Makeover


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Exercise


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Avoiding and confronting pitfalls

  • Copay

  • New patients

  • Drugs

  • Physical

  • Document, document, document

  • Their inconvenience, your license


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The Prescribing Contract


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The Last 10%

  • Addiction therapist

  • Psychiatry specialist

  • AA/NA

  • Safety


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28 year old WF long history of well-documented ADD presents 5 days early for her refill and has lost 5 pounds. She’s stressed over her wedding in 2 months, and is going out of town for the long weekend and needs her prescription now

36 year old WM with 4th severe headache this semester, unresponsive to triptans. Has been unwilling to take a daily prophylactic medication and “doesn’t like neurologists” because of previous bad experience.

Discussion Cases


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38 y/o WM executive in a suit, always irritable about the wait, looking at his watch, being treated for resistant high blood pressure comes in smelling of alcohol and slurring his words

42 year old stay at home mom with shaking anxiety, her mom took something that begins with a Z her whole life, and Mom says that’s what she needs

Discussion Cases


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Conclusions

  • We are susceptible

  • They are out there

  • Boundaries are in everyone’s best interest

  • Know what’s legal and what’s not

  • Use a prescribing contract


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