1. Patient Disagreement with the Opioid Prescription
Opioid prescribing is a common source of conflict between patients and physicians. Physicians can minimize conflicts through the following actions:
1. Use treatment agreements routinely.
2. Provide explanations for changes in prescribing, e.g.,
- The prescribing is consistent with existing guidelines.
- The change is intended to help, not penalize, the patients, e.g., it is meant to reduce the pain and improve mood, activity, and safety.
3. Book a longer appointment to allow for more time to provide education and explanations.
4. Arrange consultations: patients may accept a “team decision” more readily than an individual one.
5. Document verbal agreements and past discussions.
2. Patient Unacceptable Behaviour
Physicians are strongly advised to acquaint themselves with applicable legislation and their provincial regulatory body’s policies/guidelines regarding standards and termination of the physician-patient relationship. It is important to know the obligations to the patient, staff, and society if illegal patient activities are suspected.
2.1 Aberrant Drug-related Behaviours
Behaviours that stem from opioid addiction, such as aggressively demanding higher opioid doses or double-doctoring, often resolve when the physician ceases prescribing and refers the patient to addiction treatment. If the patient refuses to accept treatment referral and continues to demand opioids, the physician may consider discharging the patient from the practice.
2.2 Non-violent Offences
If a patient has committed a non-violent offence, such as altering a script, the physician is not obliged to contact the police. The physician should assess the patient for opioid addiction, and (in most instances) cease prescribing opioids and refer the patient for formal treatment.
2.3 Threatened or Actual Violence
The physician could contact the police if the patient has, for example:
- threatened violence and there is perceived danger
- committed violence against clinic staff and other patients, or
- vandalized or stolen property.