[NP-Clinical] Chronic Pain/Med Contract/Drug screen + cocaine

[Kay Schoeller]

Hi Priscilla,
  
  I work in pain management and our view is that we cannot control  interactions or side effects when we don't know what they are doing, so  illegal substance use buys an immediate discharge.  Of course, we  do give them contacts for  drug treatment.  The other  perspective is, would you want the DEA questioning why you gave opiates  when you knew they were using illicit substances?  I would have to  look it up, but I believe the DEA's latest 'guidelines' say its a no-no.
  Kay Schoeller, APN

Priscilla Merrill <prispunnyfnp at metrocast.net> wrote:          Chronic Pain/Med Contract/Drug screen + cocaine          How  do you all handle + cocaine on your random drug screens for chronic  pain pts?  I have a fairly new pt. who is just a wreck to look  at.  He was apparently hit by a car as a pedestrian in years  past.  This is at our community health clinic and we don’t treat chronic pain as a rule but manage till they get in.  Of course, he moved here recently and we can’t get his records which make me suspicious.  He does have a bunch of scars so this I believe.  It’s his wild-eyed manner that gave me pause so on the 3rd visit, still having a story of why he couldn’t get into pain clinic, per our med contract, I got a sample.  It showed + opiates, + oxycodone (He’s on oxycodone and that’s his only med) and cocaine.
    We had a long discussion about “firing him” or not.  No where on our contract does it specify illicit drug use so we are in process of changing.
    I  just wanted to ask the group how they handle this.  Of course he  has no insurance so this is his only resort in this area.  The doc  I work with thought we should dismiss him and give him substance abuse  contact info if he chooses inpt. Admission.
    As we’ve  said, these folks are our biggest challenge because most DO have  chronic pain and I DO feel for this guy.  Very heavy smoker too.
    Priscilla Merrill FNP
  
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