Case Five: Patients Who Divert Medication


Betty, a 67 year old widowed woman with chronic arthritis, has been maintained on a regimen of Lortab for the past decade.

Recently her adult grandson has come to live with her, and she complains that she needs an increase dose because of the added physical and mental stress of having additional people in her home.

You are concerned that she has already run through the 90 day prescription you gave her six weeks ago, and is requesting a new prescription.

Questions For Health Care Providers 

A. How would you approach the patient (either cooperative or resistant)?

(The goal is to develop a positive, non-judgemental rapport with the patient?)
  1. Use your rapport. Wait to address her Lortab refill request until after you've discussed less threatening issues.
  2. Don't be afraid to explore the issue.
  3. Display compassion and concern
  4. Ensure confidentiality
  5. Use a neutral, matter of fact, tone of voice
  6. Acknowledge it may be difficult for the patient to share this information.
  7. Be nonjudgmental. Remember this is a disease. The more nonjudgmental you are the more likely the patient is to reveal information.
  8. Allow any resistance, pre-contemplation, and minimization to be okay. Remember to be nonjudgmental and avoid any power struggles. At this time it is unnecessary for the patient to admit that he has a problem.
  9. If patient is resistant, acknowledge that it is difficult and uncomfortable and explain that you believe this is a health issue and is part of your over all approach to patients. Continue to gently ask questions.
  10. Be redundant. If your questions are not being completely answered ask again.
  11. Phrase the question appropriately. For example, ask, "Tell me why you think you need more Lortab?"

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