Controlled drugs: How to minimize the risks to you and your patients

Key Points

Almost every physician who treats patients with scheduled drugs has been faced with a patient who needs those substances to treat a chronic condition. Such patients risk becoming dependent on those medications, if not addicted to them, yet without these drugs, they may face intolerable pain or be unable to function. Given the choices, what should you do, and what potential liability issues do you face?

Although a patient has the right to accept or reject your recommended treatment, he or she does not have the right to demand that you accede to his or her choice of treatment. If it becomes evident to you that a patient wishes to elect a course of treatment that is not consistent with appropriate medical care, you must not yield to the patient's desires. This approach is especially important considering the risks of creating or maintaining an addiction to controlled substances.

No recognized standard of care exists for prescribing controlled substances, but it certainly is accepted that the prescription of medications to control pain, reduce anxiety, or assist in sleep often is appropriate and medically indicated. Indeed, withholding these drugs when required could well constitute inappropriate care.

Patients are entitled to be relieved of their pain, even if relief requires the use of controlled drugs, and even if that use may cause or continue an addiction. Unfortunately, most effective pain medications are highly addictive. Therefore, you must try to balance the risks of potentially prescribing a medication for a patient who is seeking to use the physician to maintain an addiction against the risks of potentially denying a patient a needed medication for a justified medical purpose.

STEPS TO REDUCE YOUR LIABILITY

These actions can help reduce the risks associated with such decisions: