An interesting article titled “Addressing after-hours requests for prescription drugs,” appears in the April, 2014, issue of JADA written by G. J Muller II (vol. 145, no. 4, pp. 389-390). The article discusses how the oral and maxillofacial surgeon has had several instances of after hours or weekend phone calls from people claiming to be current or past patients who have had a sudden onset of a toothache and want narcotic pain medication. The surgeon says that the people always agree to be seen in his office the next day or following Monday if it is a weekend. However, often the person will not follow up with the surgeon and not show up for the appointment after having received the medication. The surgeon says occasionally he checks if the person is a patient of record and sometimes the person is not, other times it may have been someone who was last seen a long time ago. The surgeon is concerned that many of these people who call are drug seekers and are not legitimate.
In the article, tips to handle such a situation are discussed. The first thing to determine is if the person has an emergency. This is easy to determine if the patient has recently been treated and under current care. When the person has not been treated recently or may not even be a patient of record determining if there is an emergency can be more difficult. The article describes how a dentist should follow the ADA code and the principles. One of the principles is that of nonmaleficence (do no harm). It is mentioned that prescribing narcotics to someone in pain can be beneficial and not harmful. However, prescribing narcotics to a drug seeker is not beneficial and can be harmful.
The article recommends that a dentist in these situations asks several questions to better determine what is going on:
Are you seeing or have you been seen by any other provider for this problem?
If so, by whom and when?
What medications are you currently taking for this problem?
When did you receive the most recent prescription for this?
Who prescribed it and where was the prescription filled?
Asking these questions may help the dentist catch the person in a lie for which they then can legitimately refuse treatment.
The article says that in many situations prescribing a prescription drug to the caller and then setting up a time for follow up care can be justified. However, if the follow up care never occurs and repeated calls for prescription drugs occur then there is likely a problem and a drug seeker in need of intervention.
One of the problems described in the article is that dentists often don’t have access to their patient records after hours. Clearly remembering all their patients and records is not realistic. Having electronic records and being able to access them remotely can be a potential solution and aid.
In a past blog post I have touched on the issue of oral surgeons prescribing narcotics and how it could lead to non-medical use see http://blog.teethremoval.com/do-oral-surgeons-prescribe-too-many-narcotics-for-use-after-wisdom-teeth-removal/.