Medication lists

[Brady]

Where I live there is an area that I work by. Once in a while we get called out to assist with the local area's EMS group. I have noticed that on one or more occasions that one person will be prescribed multiple narcotics for pain. when the pt is asked if they are in any pain they say no. And they might have a hx of a broken ankle or something along that line from years ago that they state keeps bothering them and that is why they take the meds. This area also has a high problem with medication misuse and alcohol issues. On one particular call the pt had 7 scrips for pain pills and they were all by the same doc! I was thinking that they might be playing the system but was very suprised to see that they were all recent and had many refills. I felt like on this particular call something was wrong here...when can you or should you say something, and to whom would you say it to?

[SeaBee25]

When you get the patient to the ER pull a nurse or doctor off to the side and tell them, the patient may have circled for multiple refills.

[Brady]

When you get the patient to the ER pull a nurse or doctor off to the side and tell them, the patient may have circled for multiple refills.

What gets me is that its the same doc writing so much for one person, I know its not my business to say weather a person is in enough pain to need all of that. But on the other hand the one pt told me that they had no pain at all, only once in a while. Also I forgot an important part is that this one pt was being picked up for attempted suicide.

[Eydawn]

Tell the hospital you're handing off to and they'll contact Social Services as necessary from there... just do me a favor and don't harass someone who's ill/having a bad moment about it in your ambulance. That doesn't do anyone any favors and is rather cruel...

Wendy

CO EMT-B

[AnthonyM83]

If you can, I'd probably chat with the doctor. He's going to be the one calling his primary care physician, doing any additional prescribing, and reviewing his records, so probably good for him to know (in case nurse don't relay all the meds, or he overlooks it, etc)

[Doczilla]

Prescription drug abuse is an exploding problem nationwide. The safety, purity, and predictability of prescription meds is an attractive option for the junkie who knows full well what can happen to you when you OD on heroin. While many police departments handled few of these cases a few years ago, now many have detectives assigned solely to combat prescription fraud.

Dealing with this issue on a nearly daily basis now, there are a few possibilities here:

1) The patient has a problem with chronic pain, and the multiple pain medications are part of a comprehensive pain control strategy. Many of these patients will have one medication for a chronic "base" level of pain control, other narcotics for breakthrough pain, and others to complement their base pain control medication. They may be trying out different medications to see what works for control of the patient's pain.

2) The patient has chronic pain and an unpredictable income, so they "hoard" pain control meds when they can afford them. Hoarding can also be seen in patients with chronic pain that is undertreated.

3) The doctor is unaware that the patient has multiple scripts with multiple refills, and is prescribing what he feels is appropriate based on the patient's complaint without having access to the record or knowing that the patient should be GTG on refills for now.

4) The doctor is well aware that the patient has multiple scripts, and doesn't care or makes his living scripting these chuckleheads for narcs. Some drug pushers have an MD license.

5) The patient or someone the patient knows is forging scripts. One recent antidrug operation I did with involved someone who was filching DEA numbers from his girlfriend at an insurance company, then writing scripts for people under a physician's license. Pay $40 and get yourself a script for some vikes or perkies. Obviously that only got him so far, since the SWAT team was breaking down the door.

The best course of action is to notify the ER nurse/doctor. Bring the meds to the ER with the patient if able. If your state has a prescription registry, they can look the patient up and figure out how legit those scripts are. We'll contact the PCP is able and see if we can verify the scripts are right. We also can tell if a pattern of narcotic prescription is legit or not. Social Services does not handle this sort of thing in my area. Obviously there are certain tricks to this trade that I would prefer not to discuss on an open forum, since many drug seekers work to avoid the methods we use to detect them.

'zilla

[itku2er]

We have that alot around here, Pain pills on top of pain pills. I am with the rest of the group here speak to the ER MD and Nurse they would be the best bet to help.

And it pains me to say this but Zilla is right.

Edited April 13, 2009 by itku2er

[RomeViking09]

I tell the ER Doc or nurse but not in view of the PT or Family, we have an issue with it around here and have a good number of both attempted suicide by OD and accidental OD, I have seen a PT who got refills b/c they could not find the bottle (could not remember where it was) and then found it two days latter then took meds from one latter that day could not remember if the took it and took them from the other.