Summary

  • It is important to talk about substance abuse, even if it makes you or the patient uncomfortable. Use simple questions in a non-judgmental fashion with empathy.
  • If a patient appears to be drug-seeking inappropriately, checking for other drugs in a urine test, calling back the patient for an inspection of remaining medication, and checking insurance records are some ways to detect signs of diversion.
  • Advise your patient to keep the medication in the original container and to travel with a copy of the prescription label.
  • Most opioid-dependent patients are stable and compliant, but it is best to inform all patients of clear ground rules and expectations.
  • Use a patient contract/agreement to spell out rules and expectations as well as consequences for not following them.
  • If a patient violate a treatment agreement, he or she may require referral for more intensive treatment; it is important to assure continuity of care.
  • Rural practices may experience special challenges that can be handled if anticipate, including more difficulty acquiring buprenorphine, higher poverty rates and less insurance, and difficulty maintaining confidentiality in a small community.