Had to go eighteen rounds with a drug-seeker just now.

[Aristus]

Man, they don't take 'no' for an answer, do they?

"I've been taking this for years and I'm not addicted yet!"

It's like they're not even listening to themselves...

[Dr Hobbitstein]

1. I've been smoking pot for 20 years. I am not addicted.

If I run out and can't find more, I don't have withdraw symptoms.

But I do like getting high.

[Aristus]

2. Pot isn't physically addictive like heroin.

But it can be psychologically addictive like cocaine.

I tell my patients I don't have an objection to cannabis other than that I prefer they don't smoke it. But when they want addictive pharmaceuticals for a diagnosis I consider to be sketchy at best, they're out of luck...

[CaliforniaPeggy]

3. Stay strong, my dear Aristus!

They don't take 'no' for an answer........the classic stance of the addict!

You are doing a great job!

[Aristus]

4. He must have thought that if he filibustered me, he could fatigue me into complying

with his request.

I couldn't get a word in edgewise, but if I had, I would have told him that I'm always fatigued, and this ain't no great shakes. I'm trying to arrange with the schedulers at the mainstream clinic that all requests for addictive medications go to the MD's over there. They're getting the big bucks; let them deal with it.

[discntnt_irny_srcsm]

12. Just my thought

You're position is to give medical advice and treatment.
Someone who won't let you reply with advice or a recommendation for treatment needs none of your services.
People who take up your time but need no service need to leave.
Those who refuse to leave are a problem for the police.

[Aristus]

13. You're right about that.

He kept berating me "Just tell me your objections to giving me my Adderall!" after I had already done so three times by that point. I finally walked out, because I had other patients waiting. He followed me back to my office to keep up the attempt. Patients are not permitted in my office because of the presence of confidential patient information in there. But he would not be deterred.

As it happened, my clinic manager had come to my office with a new provider he wanted to introduce me to. I'm trying to get to know her when my patient comes stalking in, babbling angrily about his Adderall. My MA managed to drag him away, but it was an awkward moment for everyone (except him, presumably).

[discntnt_irny_srcsm]

14. re: "Just tell me your objections to giving me my Adderall!"

I have no objections to giving you Adderall. I also have no objection to having a freight train drive up your ass but I am constrained by the law, my license, practice agreement and morals to only give you only what is medically indicated. Lobby the government to have Adderall available OTC and go get all you want. I can't help you.

[elleng]

5. OY!

[Control-Z]

6. Are you ok if they only use them on the weekend

if they need to carry around their kids or mow the lawn?

[zanana1]

7. What if they're in excruciating pain?

I have severe lower-than-low back pain. Now that they can't dispense pain medication, they put me on Gabapentin. (Five years now). I'm pretty much stuck sitting because walking is very, very painful. (The Gabapentin takes the edge off, but barely).

[Aristus]

8. No. He wanted Adderall.

For his 'adult ADHD'.

I'm an ADHD skeptic. What they call ADHD in kids is really just being a kid. Children aren't supposed to be cooped up indoors, chained to a desk, studying to take a standardized test. They're supposed to be outside playing. Play is how kids learn. No wonder they go crazy with boredom and restlessness.

For adults, ADHD just seems like a way to score amphetamine-based drugs. Actual clinical adult ADHD is so rare as to be statistically negligible. When patients come to me insisting that they have adult ADHD and demanding Adderall, I send them to Behavioral Health. They can get it there.

[Danascot]

9. A good friend works in emergency medicine

The drug seekers are endlessly persistent and creative about why they need Vicodin or Percocet or Oxycontin or whatever.

She has no problem prescribing for legitimate needs but the drug seekers are obvious. "Oh, I have excruciating dental pain and I'm allergic to everything but ... what's it called? Perca something? Pertadone?" She never gives in but they're exhausting plus there are other providers that just give in to get rid of them, which of course only encourages them to keep doing it.

It used to be if they couldn't get it at one ED they would just go to another one. Now there's a system where providers can check what prescriptions have been filled for the patient. ... "Hey, it says here the pharmacy gave you 40 on Tuesday. What happened to them?" "Oh they got lost, they got stolen and the dog ate them."

[Aristus]

10. Yeah, the state prescription monitoring system.

It's an invaluable clinical tool.

"But I really need this medication!" is a popular gambit. When they use it, I show them their record on the database of filling opioid or benzodiazipine prescriptions and tell them: "Looks like you've got plenty already."

I get that there are patients who have a genuine need for a certain amount of these medications. And I leave the prescribing of them to the appropriate providers: surgeons, orthopedic specialists, pain management providers, etc. I only prescribe opioids when I'm the one causing the pain; office procedures, for example.

[LuckyCharms]

11. I can't take NSAIDS, so my primary care NP prescribes...

Hydrocodone-Acetaminophen, 30 per script.

Bad thoracic spine.

Regimen is as follows:

Gabapentin every night.

Cyclobenzaprine on the bad nights.

Hydrocodone on the eye watering nights.

A bottle of 30 will last me 2 to 3 months.

[jmowreader]

15. Be glad you didn't get a guy like the one that tried it in St. Maries, ID

The guy showed up demanding refills on a bunch of opioid pills and an injection of Dilaudid.

(The hospital in St. Maries stocks no Dilaudid.)

The doc said no, so the guy drew a pistol and demanded even more loudly his pills and shot.

The doc grabbed the guy in a big bear hug so tightly he couldn't move his gun hand, and started screaming for help.

He's still in jail.

[Aristus]

16. A guy came in packing once when I was working at the clinic across town.

I wasn't there at the time, but an alert Medical Assistant called the police, and they landed on him like a runaway planet.