“Prescription for Addiction,” which ran in the Wall Street Journal this past weekend, is one of the most thorough, best researched and best written articles to date on the national issue of prescription painkiller abuse. I urge you to read the article carefully. Among its many astute observations, the article encapsulated what I call “The Healthcare Provider’s Dilemma,” when it wrote (in summary) that providers don’t always know when a patient is doctor-shopping for more pills, and pharmacies can’t “second guess” questionable prescriptions. Let’s break this down in terms of what it means for a doctor, osteopath, physician’s assistant and pharmacist trying to practice ethically and comply with federal and state laws governing furnishing of Schedule II painkillers.
1. MD’s, DO’s and PA’s: The Journal got it right: Doctor-shopping doesn’t always jump out at even the most discerning practitioner. A provider-client of mine was recently threatened by a patient who said she’d report him to the Medical Board if he refused to refill her scrip. (Naturally, he refused.) Short of such explicit behavior, though, are you supposed to know every time? The law enforcement agencies whose marching orders are to “crack down” on so-called overprescribers think so. This, even though everyone knows that state-run PDMP‘s (Prescription Drug Monitoring Programs) vary widely in their effectiveness, real-time availability of data, and pharmacy participation, so a database’s usefulness to a provider can be very limited. Faced with a clever doctor-shopper who wants to play you, on the one hand, and a hungry federal agent who almost hopes you get duped into writing the scrip, on the other, how are you to handle this swirling turbine of danger?
2. Pharmacists: You as a pharmacist probably have more room than you know, when it comes to ensuring that you’re filling valid prescriptions from righteous providers for legitimate medical purposes. Many states expressly tell pharmacists that “no” is an acceptable answer to a patient seeking what the pharmacist may think is an excessive dose, or overly frequent refills, or anything else the pharmacist thinks would compromise patient safety or professional ethics. But there is a fine line between calling out a drug-seeking patient or a dirty doctor, and going hogwild turning away business in the name of a one-person crusade against prescription painkiller abuse.
How to handle The Provider’s Dilemma without losing your patience or your patients? The Answer: Be in compliance with the state and federal laws governing prescribing Schedule II painkillers. There are some clear statements of law, and more often there are the more murky (and therefore more dangerous, in this environment) “guidelines” for writing scrips. You need to know that law, or have it explained to you. Then you need to incorporate a compliance program within your practice: From patient intake and screening, to informed consent and periodic review, to regular exams, to diligent record keeping, to making use of whatever PDMP database is available – these and related steps, in much more detail, ensure your good and ethical practice of medicine, provision of legitimate healthcare, and they show objectively to an investigating agency that you are practicing appropriately and your patients are in safe hands. Comply now, and be thankful later, for anyone can come under DEA or FDA or Medical Board scrutiny at any time. You can’t help it if you’re placed under investigation, but there is a lot you can do to help guide the outcome, keep yourself out of trouble, and stay in business.
Call PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS today, at 213.293.3737, for a free consultation. Or, write to us at firstname.lastname@example.org. Remember: An Apple A Day Keeps the Doctor Away, and Compliance Can Protect You From the D.E..A!