Event 4: Managing Suspected Abuse or Diversion of Opioids

Charlie's mom Sarah visits her primary care physician to ask for an early refill of her prescription.

Thought Starters

Question 1

What action would you recommend the physician take?

Incorrect
Correct. There is no one right answer here. Most providers would try to get Charlie help rather than reporting him to the police. Some providers, based on their long relationship with Charlie’s mother, would be willing to give her an early refill, with the understanding that she will get help for Charlie. However, the initial treatment agreement that both she and the doctor signed indicated that she would not receive early refills. In order to maintain that agreement, this is the suggested correct answer.
Incorrect
Incorrect

Question 2

When should a prescriber should most strongly suspect diversion?

Incorrect
Incorrect
Correct. All of these signs would make a provider concerned for diversion. However, the only way to confirm a concern about diversion is to require a patient to appear for a pill count to prove that he or she still has the appropriate amount of medication.
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When You Suspect Opioid Abuse or Opioid Use Disorder

  • Express empathy
  • Express concern for medical risks
    • Overdose of patient or others
    • Opioid Use Disorder is a disease
  • Avoid argumentation
  • Set clear limits
  • Seek to continue to engage the patient in care

It’s often difficult for providers to discuss suspected opioid misuse, abuse, or opiate use disorder with their patients.  However, to help the patient receive the appropriate treatment, it’s important that we directly express concerns about the risks that opioids are posing.  Opiate Use Disorder in itself is a disease that needs to be addressed and treated. Providers should be caring, and offer to help with both pain and opiate use disorder, while making it clear that ongoing prescription of opioids is not an option.

Clinical Pearl 4

Next: Resolution 

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