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 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

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

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

Unprofessional Conduct Rule (handout)

DEA controlled substance schedules FDA/DEA Potential for abuse and dependence Accepted medical use “Closed” system of distribution Incomplete? ml

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

Alternative therapies Sleep Weight loss ADD Pain

Food Makeover

Exercise

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

The Prescribing Contract

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

Discussion Cases 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 4 th 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 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

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