Although physician practices seem to have made some progress in the fight against prescription painkiller abuse, drug-seeking and drug-addicted patients remain part of many medical offices’ daily reality, according to an article from Physicians Practice.
The best approach, according to Shawn Williams, acting medical director at Willingway, a Georgia-based addiction treatment center, is a direct one. He recommended beginning the conversation as follows: “I am concerned about writing for further narcotics or controlled substances for you. I’m more than willing to take care of your medical needs, including your pain. But, it will involve non-controlled substances at this point.”
The best of two possible outcomes, Williams continued, is for patients to recognize they’ve breached the physician’s trust and be willing to work on repairing that relationship and agreeing on a new treatment plan that eliminates or reduces significantly their use of controlled substances.
But patients who are willing to acknowledge and address an addiction represent a minority of about 20 percent, Damon Raskin, a board-certified internist and addiction medicine specialist in Pacific Palisades, California, told the publication. “And then, probably 70 percent to 80 percent are just going to continue their addiction until they’re ready,” he said. “A lot of the time, they’re just not ready.”
In the latter situations, physicians should refer patients to appropriate resources such as Narcotics Anonymous or mental health specialists.
If these good-faith efforts to help patients get on the right path don’t work, however, physicians may be left with little choice but to dismiss such patients from their practice, Raskin concluded. The dismissal process is not simple, the article noted, and practices should consult legal counsel for the specific procedure in their practicing state.