Mount Carmel Health Partners Clinical Guidelines Chronic Pain Management | Page 6

Table B: Common Fraudulent Techniques Used by Drug Seekers and Recommended Management
Technique
Characteristics
Management
Lost prescription Calls or returns stating that opioid prescription Establish a policy: no opioid prescriptions refilled.
was lost before being filled
Notify patients of policy at discharge as they
receive prescriptions.
Impending surgery Wants temporizing opioids; doctor
“unavailable”; previous surgery; patient from
out of town Call physician. Check medical records. Offer
substitute for opioid.
Carries own records
and x-rays Suspicious or forged records; doctor’s written
permission to receive opioids; patient from
out of town Make phone calls. Check records. Offer substitute
for opioid.
Factitious hematuria
with complaint of
kidney stones Appears comfortable or overacting; pricked
finger dipped in urine; lip/cheek bitten and
blood spit into urine Examine fingers and mouth. Obtain witnessed
urine sample. Offer non-narcotic pain medicine.
Obtain confirmatory test before giving opioid.
Self-mutilation Done with dominant hand; requests
opioids for pain Use bupivacaine for local block. Do not prescribe
opioids without indications. Offer substitute for
opioids.
Dental pain Dental caries only Give local nerve block with bupivacaine. Refer to
dentist.
Factitious injury Old injury; old deformity; self-massaged to
produce erythema; patient from out of town X-ray before treatment. Check records. Check for
erythema that dissipates over time.
Partner waiting near
telephone at home “Call my doctor” and handwritten number
offered: partner answers, “Doctor so-and-so” Question respondent for medical knowledge.
Verify number with telephone company or
Internet search.
Partner in ED Confirms history; urges opioids Check records. Send to waiting room if verbally
abusive.
Table C: Characteristics of Drug-Seeking Behavior
More Predictive of Drug-Seeking Behavior*
Less Predictive of Drug-Seeking Behavior
Sells prescription drugs Admits to multiple doctors prescribing opioids
Forges/alters prescriptions Admits to multiple prescriptions for opioids
Factitious illness, requests opioids Abusive when refused
Uses aliases to receive opioids Multiple drug allergies
Current illicit drug addition Uses excessive flattery
Conceals multiple physicians prescribing opioids From out of town
Conceals multiple ED visits for opioids Asks for drugs by name
*Behaviors in this category are unlawful in many states.
References:
1. UptoDate. Definition and pathogenesis of chronic pain. 2015. Retrieved from: www.uptodate.com
2. UptoDate. Evaluation of chronic pain in adults. 2016. Retrieved from: www.uptodate.com
3. UptoDate. Overview of the treatment of chronic non-cancer pain. 2017. Retrieved from: www.uptodate.com
4. Chronic Pain Medical Treatment Guidelines. The American Academy of Pain Medicine. 2013.
5. UptoDate: Use of opioids in the management of chronic non-cancer pain. 2017. Retrieved from: www.uptodate.com
6. Dowell, D., MD, Haegerich, T., PhD, Chou, R., MD. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep 2016;65 (No.1):
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This clinical guideline outlines the recommendations of Mount Carmel Health Partners for this medical condition and is based upon the referenced best practices.
It is not intended to serve as a substitute for professional medical judgment in the diagnosis and treatment of a particular patient. eecisions regarding care are
subject to individual consideration and should be made by the patient and treating physician in concert.
Original Issue Date: September 2015
Revised: October 2017
Chronic Non-Cancer Pain Management - 6