Watch out for these drug scams

They can be extremely crafty, but this veteran physician has learned to spot the tricks.

By John Egerton, MD
Family Practitioner/Friendswood, TX

The other evening, a man called me at home, saying he had hurt his back. "You gave me some pills the last time I did this," he said. "Let me get the bottle." I knew what was coming next: the slight pause as he picked up the imaginary bottle, a clearing of the throat, and the hesitant spelling as he pretended to read from the label. I mentally spelled with him as he began, "V-I-C—"

Then there was the man who called late on a Saturday afternoon. His wife had this terrible cough, and she had to fly to Chicago to her grandmother's funeral. She had been prescribed this cough medicine before; could she have a refill? Again there was a reading of the label, and again I spelled along with him, "T-U-S-S—"

I didn't have these patients' charts with me at home, and it didn't surprise me to find that we didn't have a record of them in the office, either. After-hours requests for narcotics always ring a loud alarm bell. In fact, I have a policy not to prescribe narcotics over the phone: If a patient is sick enough to need such powerful medicine, then he or she needs to be examined.

Every day, doctors are duped into prescribing drugs that will be abused in one way or another. So how do we spot these people who want our signature on a script? Over the years, I've learned to recognize seven distinct tricks. After-hours calls might be the most common, but the following are close behind.

The unavailable colleague. If you share call with other practices, watch out. You're a prime target. Here's a request I got several years ago, when I used to share call:

"Dr. Brown prescribed these codeine pills for me," the man told me over the phone one evening. "I wonder if I could get a refill."

"Was that the Dr. Brown with the beard, or the one with the bald head?" I asked.

"Oh, the one with the beard," was the immediate reply.

Dr. Mary Brown was neither bald nor bearded.

An aversion to other drugs. I am always suspicious of a request for a specific narcotic medication. "Drug X is the only thing that works for me" is rather blatant, even if it is sometimes a true statement. A more subtle approach is to admit to an allergy to aspirin and NSAIDS, or to tell me, "codeine makes me deadly sick," "I broke out in this rash with X," and "Y didn't help at all." Until the only drug left is the one of choice—the patient's choice.

Unbearable pain. This one may be the toughest call of all; it's unfortunate that any new patient complaining of severe pain should be suspect, because most are genuinely in need of help. But, sometimes, a healthy dose of skepticism is called for. The man with the renal colic, writhing in agony, and with urine loaded with red blood cells, got his shot of analgesic. And so he should have, shouldn't he?

It wasn't until later that I discovered the blood in his urine had come from a self-administered finger stick in the bathroom. Ah well, better the odd unnecessary shot than that someone with genuine symptoms should suffer.

Then there was Bill Travers, a new patient from the other side of town. He had scars to prove previous surgery to his neck, and a vivid story to describe the pain he was now having. He was working on a construction project and needed just a few codeine tablets so that he could make it through the next few days. No, I couldn't check with his own doctor as he had just retired. I believed him. Until he came in several weeks later with the same request.

"I'll need to see some of your medical records before prescribing any more narcotics," I told him. "You see, the FDA is clamping down on narcotic prescribing, and, since you live in a different area of town, this prescription will be flagged automatically." I was lying, of course, but the look in his eye told me that I had guessed right. I never saw him again.

It isn't only the furtive stranger that should make us suspicious. Some of our own patients are drug abusers, and we may not know it.

David Smith was a respectable family man. He often brought his two young children in. He sometimes wrenched his back. "I don't like to take medication," he said, "but it's really killing me." And he was obviously in a great deal of pain. It had been almost a year since I had last given him a prescription for 20 codeine pills. I refilled it.

Several weeks later, his wife called to tell me that she'd found David semicomatose in the bathtub and had been scared that he could have drowned. I spoke to them both and discovered that David would go to several doctors in the area, get a small prescription of codeine from each, and then go on a codeine binge. It didn't happen often, but, on this occasion, his wife had been shocked into doing something about it. I referred David to a specialist to get help for his habit.

The overly creative request. Perhaps more obvious to spot are the innovative requests for refills. "The dog ate my prescription," or "The dog chewed up the bottle." "The baby threw the bottle down the toilet." We all know that good parents give their children dangerous medication to play with!

Mrs. Jones called to say that her purse had been stolen at the mall and that her sleeping pills were in it. Could she have a refill, please? My nurse pointed out that it was strange that anyone would take sleeping pills with them when they went shopping.

The wearing-you-down ploy. Phil Mine was a man of middle age with several complaints. He also had verbal diarrhea. After almost half an hour of his nonstop monologue I was feeling desperate. "Oh," he said, as he seemed to be coming to the end of his recitation, "I get these terrible headaches, not often, though I've had them for years. The only thing that seems to help is codeine. Could you prescribe a few?" I was so relieved to be getting out of the exam room that I gave him a prescription for a handful of pills. I missed the warning sign—the request for a specific narcotic.

A few weeks later Phil came in again. His verbosity had not lessened. This time I managed to get in some questions about his headaches early on. I explained that I wasn't happy to continue to prescribe codeine for an ongoing problem and that he should perhaps consult a specialist.

I wasn't the least bit surprised when he abruptly ended the consultation and left—without showing any interest in what specialist I had in mind. His trick was to wear me down so that I would give him a prescription just to get rid of him. And it worked—once.

The quick-change artist. Perhaps the most audacious patient I had was a woman who had come from out of state carrying a copy of her medical records, which showed a history of epilepsy. According to the records, after prolonged investigations and trials of several medications, she had been controlled on Dilantin and Valium. She appeared genuine, so I gave her a prescription for both medications.

But for some reason, I checked with the pharmacist later in the day to see if she had filled the prescription. "She took the Valium and said she would be back tomorrow for the Dilantin," he said. Of course she never returned. She had also played the same trick with every other doctor in town and with every pharmacy, too.

A year later, another woman from out of state came in with her medical records and the request for a refill of her prescription for an antidepressant and Ativan. This was not something I was entirely happy to do, but her records did show that her depression and anxiety had been very hard to control with anything else. It was my nurse again who recognized this lady as the one who had got the Valium the year before. She was wearing a wig and different makeup, and I hadn't recognized her. Neither had several other local doctors; she had already filled a couple of prescriptions for Ativan, promising to return to the pharmacy the next day to pick up the antidepressant.

We shall never be entirely dupe-proof when there are such tricksters around, but we can learn to spot the more obvious ploys to get an inappropriate prescription. And there are good reasons to do so: Abusers need help.

 

John Egerton. Watch out for these drug scams. Medical Economics 2002;5:81.