“The take away is that as long as prescriptions are written in good faith based upon an examination of the patient and if the doctor has established a legitimate medical purpose, there is no reason for concern,” says Lynch.
Diversion Occurs All Along Supply Chain
“Diversion can happen at so many places along the chain,” says Rusty Payne, a spokesman for the DEA drug diversion program in Washington, D.C. “People think it is just a doctor issue or a pharmacy issue, but it is that and much more.”
Specific to the diversion of narcotics, it can take the form of patients who “doc shop,” pharmacy theft, and stolen prescription pads. Payne notes that around 70% of all abusers get their pills from friends or family.
He also stresses that the focus of the diversion project is not to stand between the patient and needed pain help. Much of their work involves inadequate record keeping and is dealt with administratively.
“It is important to understand that the laws are also there to protect the physician,” he notes. “We are law enforcers and do not get involved in legitimate doctor/patient relationships or decisions made about medical treatments.”
If physicians think there may be diversion problems occurring in their practice, they can contact the area DEA office and ask for the Office of Diversion Control. They can also visit www.deadiversion.usdoj.gov or call 1-800-882-9539.
Some of the signs of drug abuse and possible diversion of narcotics include:
- Demanding immediate attention;
- Having an unusually deep knowledge of controlled substances;
- Frequently giving a medical history with textbook symptoms or a vague medical history;
- Often will have no family doctor or health insurance;
- Will often request a specific drug and is reluctant to take or says they have an allergy to other options;
- Failing to keep appointments for further diagnostic tests or refusing to see another specialist;
- Cutaneous signs of abuse such as track marks or related scars on the body;
- Having to be seen right away, often near the end of or after normal office hours; and
- Needing a replacement for a prescription that has been lost or stolen.2
Physician Interventions
Brian Daikh, MD, is a private practice physician with Rheumatology Associates in Portland, Maine. In his personal practice, he uses a patient contract to address diversion issues.
“With a contract, patients agree to get their pain medications from only one physician,” he says. “I also require that they use no nonprescription medications, such as marijuana or cocaine, and will drug test randomly if I suspect abuse. If there is evidence of a breach I would stop prescribing to them, and I have fired patients from my practice.”
