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In the recent blog about drug-seeking behavior, I referred to the emergency or urgent care physician who faces drug seekers every day and struggles with the decision to prescribe or not prescribe. That is often a very difficult decision to make!

A very good friend of mine practiced emergency medicine for over forty years. After reading the article, he shared with me some of his experiences. He graciously agreed to let me share them with you. His ER experience varied considerably having worked in inner city, suburban, and rural emergency rooms. He immediately relates that drug-seeking behavior is not a strictly inner city phenomenon. The mere existence of a medical facility of any type is a potential source of opioids, or other illicit substances, for desperate seekers, and it’s location is insignificant.

His comments began, “The last few years when I went to work in ye olde ER, my biggest dread  was knowing I would confront some drug seekers. No one is happy in these situations! Oh, the stories [I heard]!! Everything known to man and then some….The “biggies”: headache, toothache (many had chronically bad teeth so who could tell), back pain, kidney stone, sickle cell crisis [painful destruction of red blood cells], old injuries, chronic pancreatitis [severe abdominal pain], Crohn’s disease, and the list goes on….” 

He continued, “It was difficult: the crying, the pleading, the seemingly honest request saying ‘I have nowhere else to go’ or ‘You’re my last chance’ or ‘What else can I do.’” “Trying to decide who is real and who is not….One of the biggest helps in later years was Indiana’s INSPECT system. [INSPECT is a statewide database that keeps a record of all controlled substances prescribed in Indiana. The drug, it’s strength, the amount prescribed, the dispensing facility, and the person for whom it was prescribed, or dispensed, are all recorded]. I could look up what someone got, when, how many, and from where….many would lie…and say ‘No, I haven’t had any _____ lately……INSPECT might show they got 60 oxycodone 2 days ago and more before that. I’d go back to the room printout in hand and ask again, ‘Have you had any ______ lately?’ If they said ‘No,’…..I showed them the paper…. and read it out loud. I followed with I can’t give you any—the nurse will be back to sign you out—as I left the room…..It’s a wonder I didn’t get attacked, but I always kept my distance and a very close watch. In one ER, “the nurses told me if the ‘drug seekers’ saw my car in the parking lot, they wouldn’t sign in to be seen.” 

Opioid addiction and the drug-seeking individuals who are it’s victims are a huge problem in the U.S. I certainly don’t have an answer for the situation, but physicians who are major contributors need to be vigilant, skeptical, and prudent in deciding who should and who should not receive narcotics. From this narrative, one can see how difficult it can be for physicians to decide. Having a tool like the INSPECT system, however, is invaluable for controlling the abuse and mis-use of opioids. Using it for any patient in question is a must.

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