Should you report a patient who misuses a prescription?

Current Psychiatry. 2013 September;12(9):18-21

September 1, 2013|Current Psychiatry

Think before breaching confidentiality. Second, Dr. L should recognize that, unless she is reporting a crime that is legally mandated (as is true for child abuse), doing so might create a breach of confidentiality. Psychiatrists can be sued successfully—even if they think they have done the right thing—if their actions needlessly violate their professional obligations to protect patients’ privacy.²¹ Protecting society and preventing imminent harm to others are considerations that might override a psychiatrist’s confidentiality obligation,¹⁴ but these grave factors don’t seem to apply in Ms. X’s situation. Dr. L may feel used and offended by what has happened, but hurt feelings don’t justify breaching a patient’s confidentiality.

Should the patient take the lead? Learning more about the situation might suggest that Ms. X should report what has happened herself. If, for example, the roommate has coerced Ms. X to engage in illegal conduct, Dr. L might help Ms. X figure out how to tell police what has happened—preferably after Ms. X has obtained legal advice.¹⁴

Consider implications for treatment. Last, what Ms. X reveals might significantly alter her future interactions with Dr. L. This is particularly true if Dr. L concluded that Ms. X would likely divert drugs in the future, or that the patient had established her relationship with Dr. L for purposes of improperly obtaining drugs. Federal regulations require that doctors prescribe drugs only for “legitimate medical purposes,” and issuing prescriptions to a patient who is known to be delivering the drugs to others violates this law.²²

The State Medical Board of Ohio recently advised physicians that a patient who uses “deception to obtain narcotics from a physician” and “is engaged in fraudulent and criminal misconduct” does not have a doctor-patient relationship, so “the physician is required (under Ohio law) to report the matter to law enforcement officials.”²³ Such a requirement probably would not apply to physicians who practice elsewhere, because few if any other states have laws that require reporting of all types of felonies. Other state medical boards, however, do encourage physicians to consider telling legal authorities about persons who pose as patients to fraudulently obtain controlled substances, noting that such reporting does not violate the Health Insurance Portability and Accountability Act or other patient privacy protections.²⁴

Bottom Line

Growing concern about prescription drug misuse has led to nationwide implementation of systems for monitoring patients’ access to, and receipt of, controlled substances. Psychiatrists are expected to be more vigilant about patients’ use of scheduled drugs and, when they believe that a prescription has been misused, to take appropriate clinical or legal action.

Related Resources

Office of National Drug Control Policy. Epidemic: responding to America’s prescription drug abuse crisis. www.whitehouse.gov/sites/default/files/ondcp/issues-content/ prescription-drugs/rx_abuse_plan.pdf.
California Department of Alcohol and Drug Misuse. Preventing prescription drug misuse. www.prescriptiondrugmisuse.org.
U.S. Food and Drug Administration. Combating misuse and abuse of prescription drugs: Q&A with Michael Klein, PhD. www.fda.gov/ForConsumers/ConsumerUpdates/ ucm220112.htm.

Drug Brand Names

Clonazepam • Klonopin Hydrocodone/acetaminophen • Vicodin

Methylphenidate • Ritalin Hydromorphone • Dilaudid

Disclosure

Dr. Mossman reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

References

Download Article