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Appropriate Prescribing of Controlled Substances

Appropriate Prescribing of Controlled Substances. Sense and Sensibility with the Drug Seeker Suzanne J. Ferree, MD, owner/physician, Cambridge Medical Group. Objectives. Identify a potential personal weakness in your post-training practice of medicine Identify the drug seeker

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Appropriate Prescribing of Controlled Substances

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  1. Appropriate Prescribing of Controlled Substances Sense and Sensibility with the Drug Seeker Suzanne J. Ferree, MD, owner/physician, Cambridge Medical Group

  2. Objectives Identify a potential personal weakness in your post-training practice of medicine Identify the drug seeker Empower you to have a seeker-free practice Become prepared to assist the drug seeker in getting help Understand what our Georgia Medical Board considers unprofessional conduct Gain basic understanding of controlled substances and the roles of the FDA and DEA

  3. The New Physician • Jack of all trades, cavalier • Altruistic • Relational • Growing business, big loans • Trusting • Inexperienced, unempowered • Unprepared

  4. The Drug Seeker • Knows all that about you! • Timing • Personality • History • Physical

  5. Unprofessional Conduct • Rule 360-3-.02 (handout)

  6. DEA controlled substance schedules • FDA/DEA • Potential for abuse and dependence • Accepted medical use • “Closed” system of distribution • Incomplete? • http://www.usdoj.gov/dea/pubs/scheduling.html

  7. What to look for (and document) • Stimulants • Benz and Barbs • Narcotics

  8. Alternative therapies Sleep Weight loss ADD Pain

  9. Food Makeover

  10. Exercise

  11. Avoiding and confronting pitfalls • Copay • New patients • Drugs • Physical • Document, document, document • Their inconvenience, your license

  12. The Prescribing Contract

  13. The Last 10% • Addiction therapist • Psychiatry specialist • AA/NA • Safety

  14. 28 year old WF long history of well-documented ADD presents 5 days early for her refill and has lost 5 pounds. She’s stressed over her wedding in 2 months, and is going out of town for the long weekend and needs her prescription now 36 year old WM with 4th severe headache this semester, unresponsive to triptans. Has been unwilling to take a daily prophylactic medication and “doesn’t like neurologists” because of previous bad experience. Discussion Cases

  15. 38 y/o WM executive in a suit, always irritable about the wait, looking at his watch, being treated for resistant high blood pressure comes in smelling of alcohol and slurring his words 42 year old stay at home mom with shaking anxiety, her mom took something that begins with a Z her whole life, and Mom says that’s what she needs Discussion Cases

  16. Conclusions • We are susceptible • They are out there • Boundaries are in everyone’s best interest • Know what’s legal and what’s not • Use a prescribing contract

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