Treatment and Disposition

Ihe treatment of drug-seeking behavior is to refuse the controlled substance, consider the need for alternative medication or treatment, and consider referral for drug counseling. Unfortunately, successful management has been documented only by anecdote and case report.24

Ihe patient who complains of multiple drug allergies can be difficult. Occasionally the medical record will show previous administration of the drug in question (usually a narcotic substitute) with no adverse reaction other than no pain relief. When confronted with a physician's discovery of their fraudulent behavior, many drug-seeking patients become verbally abusive, and hospital security may be required to escort the patient out of the department. Alternatives to narcotics can be offered, and patients should understand that refusal to prescribe narcotics is not a refusal of care.

When drug-seeking behavior is confirmed or suspected in ED, it should be documented in the chart with careful attention to the facts. When physicians are notified by a pharmacist of forged or altered prescriptions, law enforcement authorities should be called, and physicians should cooperate with the legal investigation. Ihe prosecution of many fraudulent behaviors, such as using aliases to obtain narcotics, requires the involvement of the state bureau of investigation or a similar agency of the state. Physicians may inquire about the legal proceedings with either the hospital attorney or the police. Finally, the primary care provider or pain specialist can be contacted to establish a contract with the patient. Such contracts may include specific directions for ED treatment and usually stipulate that prescriptions will only be given by the primary care provider. Such contracts ease the burden for emergency physicians and set realistic expectations for the patient.

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