Thorough Documentation Paired with Periodic Monitoring Will Deter Drug Diverters

Commander John J. Burke details how pain management practitioners can adequately protect themselves from prescription drug diverters without hurting their legitimate patients.

Though the practitioners who needed to attend John J. Burke’s PAINWeek 2013 session were probably out and about on the Las Vegas Strip, those who were present in the packed audience still listened intently to the law enforcement officer’s perspective on protecting medical practices from drug diversion.

According to Burke, who’s commander of the Greater Warren County Drug Task Force in Ohio and president of the National Association of Drug Diversion Investigators, the typical prescription drug diverter is “every bit as addicted as the heroin and cocaine addict” and “spends all day and night thinking about how they’re going to scam you.”

“If you have a picture of your family in your office, then your family will be the most beautiful family the prescription drug seeker has ever seen,” Burke explained during his “Protecting Your Medical Practice: A Law Enforcement Perspective” presentation.

To avoid getting scammed by those compliments, Burke strongly recommended requiring all new patients to fill out a form asking for specific answers, such as the last time the patient saw a physician and was prescribed prescription drugs, as well as the name of that practitioner and the drugs prescribed.

“This form really can have an impact if we need to charge somebody … and you help yourself in the long run by sending the message that ‘Dr. Jones has thorough documentation, and if he finds out you’re drug seeking, then you’re out the door,’ ” Burke said. “So, document, document, document, because if you don’t document, it’s almost like it didn’t happen.”

Burke also suggested obtaining a complete medical history directly from former physicians, instead of relying on photocopies from the patient, which he noted is the “greatest scam in the world” pulled by out-of-town patients. If a prescriber can access a prescription monitoring program, Burke said that’s an even better tool to use, as it provides a complete list of what doctors a new patient has seen and what drugs he or she had received.

But Burke said it’s not enough to collect and file thorough documentation, because physicians also need to maintain “really strict patient monitoring” via periodic urine drug testing with a witness and unanticipated pill counts in order to fully safeguard their practices from drug diverters and potential legal issues.

“You might not want to do this to an 80-year-old lady, but 80-year-old ladies might be drug diverters, too,” Burke warned. “I had a case where we tried to get an elderly lady to put a camera up in her home. She refused, but it turned out that she did have someone stealing her meds, and he was her caregiver. She was thinking that if we arrested him, ‘Who’s going to take care of me?’ These people are truly victims.”

While Burke recognized that physicians will “get duped from time to time,” he emphasized that “it’s not illegal to be deceived; it’s only illegal if you continue prescribing controlled substances once you know you’re being deceived.”

After detecting opioid addiction in a patient, physicians need to “do something within three days,” such as trying to get that patient into a drug addiction rehabilitation program, and then “after that, treat their symptoms and monitor them closely, but don’t give them any controlled substances,” Burke said.

“Do not be known as an easy mark for drug seekers … because then your legitimate patients are going to suffer big time, and those are the vast majority of your patients,” Burke said. “You need to keep in mind that good pain management requires a balance between reducing diversion and providing legitimate patients with appropriate pain care.”