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13 Red Flags Your Pain Patient is a Drug Seeker

13 Red Flags Your Pain Patient is a Drug Seeker

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As doctors, we know the complications the opioid epidemic can cause. We have all seen patients who were seeking drugs, whether we recognized it or not. And I would hazard a good guess that we've all fallen for prescribing controlled substances to a seeker at one point or another in our careers.

Doctors and other healthcare providers want to do our best for our patients. When they are in pain, we want to alleviate it. But, we are often conflicted when we are treating a patient in pain because so many tried to scam us in the past and we cannot honestly tell which ones are telling the truth or not.

One sad case that I saw was a patient in her 20s who came to me as a new patient with a recurrence of her Non-Hodgkin's lymphoma. She wept because she knew the chemotherapy would make her long hair fall out again. Needless to say, after weeks of trying to retrieve her records, I learned that she never had any kind of cancer, but rather a history of drug seeking behavior. No one would conceive of denying a patient with cancer pain medications. Yet, who would expect any one to lie about having cancer?

As the opioid crisis flourishes in this country, we all need to be super-vigilant and help take these medications off the street and not fuel patients' addictions. Sadly, the true losers are patients who are suffering legitimate pain. Many of them cannot get the pain relief they need because of those who abuse or divert these drugs.

There is a finger pointing on who is to blame. The truth is as long as we hold the prescription pad, we are part of the problem. Thus, we need to be the solution and hopefully the others will join our side of the battle. One positive is that most states have prescription registries where we can look up controlled substances our patients have received and this has made our detective work much easier. However, it is not always up-to-date and often doesn't cross state lines.

As such, here are some red flags that can help you recognize when a patient is drug seeking.

Click here to view the entire slideshow.

Physicians Practice


Being on the drug seeking side for 13 years I understand it reminds me of a time on House where a man comes in screaming about the pain in his leg until they finally gave him pain meds while a quieter patient went on suffering and no relief is afforded him the lesson they were both addicts sometimes were set up for failure the less stigma we put on the drug and more on the disease the better chance Drs have to do what they were led which is heal

Justin @

The episode is from Season 1, second to last episode of the season.
Dr. House is filled in for another physician in teaching a class on "Diagnostics"
He only has 10 minutes before the class begins and so he gets up there and says "Three guys walk into the clinic. Each one is c/o leg pain. What's the diagnosis?"

It's called "Three Stories" I believe.

The students say that muscle strain is most likely.

Dr. House tells them at the beginning "Over the next 2 hours, one of these patients will be tossed out of the hospital because he was trying to score narcotics, and one will be very close to death."

Long episode short, Dr. House was the patient that was tossed from the hospital. Three days later, it was discovered that he had an aneurysm that clotted and lead to an infarction. After bypass (3 days of muscle death being released when the clot was removed), he went into wide complex tachycardia and after defibrillation, he had a large portion of the dead muscle surgically removed to try to save his life (too stubborn to allow amputation).

Before the medical malpractice that lead to a dangerous situation with the infarction, he was supposedly not a drug abuser, was in a long-term relationship... Blah blah blah... After he was profiled and tossed from the hospital, he was ironically placed in a situation where he needed (or thought so due to dependence & rebound pain) opioid pain killers for the rest of his life.

This episode sorta just really stuck to me... I have chronic pain from an ED screw up that was incredibly foreseeable! I got a small settlement that seems fair to me but I went through with the suit because I wanted that attending to think about what happened and the simplicity of the proper standard of care for the issue.
Luckily, I do not need any narcotics for my pain.... Thank God almighty!!

Clyde E @

NOT trying to spam anyone here. These are good columns! I am a Pain Patient that is ALL TOO FAMILIAR with this NOT an opioid crisis, its Heroin! And it appears a Chief Medical Officer at a LARGE Rehab business started PROP[aganda] and for the life of me it sounds like a business plan to get beds filled for his employer!

When the President of PROP, is Jane Ballantyne, MD, a professor at the University of Washington School of Medicine, recently co-authored a controversial article in the New England Journal of Medicine (NEJM) that said "reducing pain intensity should not be the goal of doctors who treat chronic pain. The article also suggests that patients should learn to accept their pain and move on with their lives", it makes me wonder how credible "PROP" is!

If you like here are some well researched objective articles on this! As a pain patient I am at your service if you have ANY questions, please ask! I believe both DOCTORS & PATIENTS MUST work together to overcome the intimidation of doctors and pain patients!






Steve @

This slide show doesn't work

Charles @

What is also needed is an article/program on activities and behaviors which help confirm the need for medications. Most doc's will provide a letter of introduction for a pt. moving to different area along with records. It is also pt's who do the opposite who usually are legit.
Never call early
Never lose their meds or drop them in toilet
Are still active (exercise and work full time)
Aren't NO shows
Don't drink
Expect to and readily sign narcotic agreement form.

Jeff @

Excellent points and I agree. The patients who need these meds are truly being harmed.

Linda @

Tahe boxing lessons, it a miracle anti-pain medication! I can't tell you how many patients have jumped up from wheelchairs walkers even when I tell them "the methadone program is on 3rd ave, the bus to the 24 hour detox at saint Barnabas is on the corner, I'll give you a Doctor's letter if you ain't got $3.00 so the driver let's you on free, I'll talk to you about Suboxone, but take that thug shut outside cause If you don't I'm a put my board certified foot in your ass and I ain't even gonna say shot when your parole officer calls 'cause I'm old-school, motherfucker and I don't rat on nobody for nothing".
They've call me outside, some have threatened me, one told an HMO that I was drunk! One called me a 'cabron' on Prospect Ave. I took off my shirt,
'No vas a hablar con migo assi"
He just waved me down, later that day he was hanging out drinking beer(!) in the front of the Clinic. 'Este Medici tiene pecho' I overheard to his pal. I must confess it was the among the most gratifying compliment of my medical career.
After that he became a model patient...

Joseph @

Might have been a good idea 30 years ago when I started. Or in high school. I started my adult career as a Marine infantryman, did practice martial arts for 25 years but then there is reality. Knives, guns, baseball bats, and groups of the thug's buds who were also hoping on a score. Oh, I almost forgot about driving over someone by "accident." Did I miss arson? And then there is the practice of going after someone's family to teach them a lesson.

No, I don't believe on planning to fight every patient who seems threatening as one of the more prudent suggestions. Perhaps being firm and respectful will allow you to practice longer and help to keep your family safe.

Eric @

Wellness checks by the county sheriff departments or local police departments assist when the RED FLAGS go UP......also.
Robert D. Shedden, D.O.


In some areas, I think the police are so overhwelmed, they don't have time unless it is a big drug ring they can bust. But yes, to solve this crisis, we need the police in many cases.

Linda @

Just to reiterate what others have said - this is a slideshow, you have to click the arrows on the slides or the thumbnail photos below the photos to move through it. If you are having trouble doing that, please email editor@physicianspractice.com and we will get this squared away. Sorry for any inconvenience and thanks for your interest in Physicians Practice.

Gabriel Perna, managing editor

Gabriel S @

Those who cannot read the article. It is not really an article except the overview comments. It is a PowerPoint type set of slides with the 1st one titled "13 Red Flags Your Pain Patient is a Drug Seeker." If you hover your mouse over the right edge in the middle of that 1st slide you'll see an ">" appear, you click on it and it'll take you to the next slilde. Repeat until you see all 13.

Having said this, for some reason folks think we like clicking through these to read them. I wish they'd just list them at the end of the authors comments so I too could just print them and share with our other Physicians and Providers. Are you listening, Physician Practice?

Donald @

Thanks for your comment and help in assisting others. We'll take your 2nd comment into consideration. We've been running slideshows for a quite a while and have never received a complaint about the format - just that people had trouble navigating it. However, if more people are feeling the same way, we'll talk about revising the format.

We're going to include a PDF that will feature all 13 slides, so you should be able to print that out. Hope this helps and we appreciate your interest.

-Gabriel Perna, managing editor

Gabriel S @

Wow thanks for teaching me all this! What a revelation the 13 slides are!!


R @

Why not put your full name so people can see who exactly throws insults like this? I bet you're a gem to work with!

Dan @

Thanks for reading it! I do realize the content is obvious for experienced clinicians. Howver, as a clinical professor, I have taught and trained hundreds of students and residents who often have trouble differentiating patients who truly need these medications from those who may be using them for other reasons (substance abuse, diversion). Physicians Practice has a diverse audience and while it may have not be helpful to you, there may be others less experienced who may have benefitted. I welcome you to provide your own tips as this is a national crisis and the system needs to do a better job in ensuring these meds are prescribed appropriately. Physicians Practice is full of articles and if you did not enjoy mine, I am sure there are others that may appeal to you. Best wishes!

Linda Girgis, MD, FAAFP
Private practice family physician
Clinical Assistant Professor at Rutgers Robert Wood Johnson Medical School

Linda @

I used to be able to read these articles and go through the slides but one day it just stopped working. Have thought all along it was my computer but obviously not if others have the same issue. Maybe someone needs to reevaluate their site so we can access this information.

Tonia @

Tonia - sorry you are having trouble accessing the slideshow. Can you let me know what browser you are using? We have had some complain they aren't able to click the arrows or the thumbnails to browse through the slide and I'd like to figure out why.

Gabriel Perna, managing editor

Gabriel S @

Hover your mouse over the "slide" - this will reveal left/right arrows, and you can then navigate to see the following slides

Richard @

Thanks for your comment and assistance with others.

Gabriel S Perna, managing editor

Gabriel S @

This are very common signals. However in the hospital the physician, PA, or NP does not get to be around when the patients' aggressive performances are at their best. The bedside nurse needs a protocol to enable a tapering of meds before discharge home. Especially IV!!

Leisa @

I agree. In one study I read, nurses are more often the victims of violence than doctors. The same happens in the out-patient setting as well. I have had to step in when I have seen patients get aggressive with my staff. We need better protocols. Nurses shouldn't be thrown to the task of dealing with aggressive patients.

Linda @

This publication always has this issue. I delete their emails now because the article is never complete or it can't be found! Their articles do catch my attention but I don't have a lot of luck finding them.

Phyllis @

HI Phyllis - are you having trouble navigating the slideshow? We will put a link to the PDF on this - if you can't navigate through the slideshow. Sorry about your trouble. If there is other feedback, you'd like to offer, feel free to email editor@physicianspractice.com


-Gabriel Perna, managing editor

Gabriel S @

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