Babysitting Adults

Seeing as how there is a massive prescription narcotics abuse problem in this country, in late 2013 the state of Indiana released guidelines for prescribing chronic narcotics.  Basically, anyone taking a certain amount of narcotic for greater than 3 months qualified for chronic pain management appointments.  These appointments included extra paperwork to determine levels of anxiety and depression, abuse potential, doctor shopping habits, and urine drug screens.  For various reasons I have been lax with these rules, until now.

By an overwhelming amount, the urine drug screen is by far the most interesting part of this process.  The paperwork is mostly a waste of time as people lie about their abuse potential and it's mostly busywork.  The urine drug screen is where the action is located.  The majority, I would estimate 80%, of the urine drug screens I perform have discrepancies.  Some people are taking others pain medicines.  Some aren't taking the medicines they're prescribed.  Others are taking street drugs, by far the most popular is marijuana.  I'm convinced half the population is smoking pot.  I'm to the point now where I expect people's drug screens to have inconsistencies.  And when they do, I stop prescribing them narcotics.  I absolutely should've been doing this from the beginning.

And yet I hate this aspect of my job.  I don't think I've ever been loose with prescribing these medicines.  But when people had pain complaints, and a reasonable response to the medicines, I would prescribe them.  This process has opened my eyes so much have essentially done an about face.  I've basically reached the point where I don't want to prescribe narcotics for any indication, especially as a primary care doctor.  This is because (A) I have long term follow-up with these people and can't get them off the medicines (until they fail their drug screen) and (B) I don't want to spend my whole day doing these lengthy, cumbersome appointments for pain.  I get asked several times per week to prescribe these medicines, usually for some benign condition or pain syndrome with an unknown diagnosis, and I just shake my head and politely offer them an anti-inflammatory.  They typically then ride off into the sunset, never to be heard from again.