Drug-Seeking Patients in the Emergency Department: 10 Effective Management Strategies

Dealing with drug-seeking patients in the Emergency Department (ED) is a common challenge for healthcare providers—according to the Substance Abuse and Mental Health Services Administration (SAMHSA), there were over 9.9 million prescription pain reliever misusers in the U.S. in 2018 alone. Many of these individuals present in the emergency department with complaints that would typically require prescription medications but they are in reality seeking these drugs for non-medical purposes. Managing these cases effectively requires a delicate balance of empathy, clinical judgment, and adherence to best practices. Here are ten tips to help emergency medicine providers navigate encounters with drug-seeking patients:

1. Non-judgmental Approach: In the article Empathy: Talking to Patients About Substance Use Disorder, the CDC recommends adopting a non-judgmental attitude when interacting with drug-seeking patients. Avoid making assumptions or casting blame, as this can undermine trust and hinder effective communication. Treat every patient with dignity and respect, regardless of their medical history or presenting complaint.
2. Thorough Assessment: Conduct a comprehensive assessment to evaluate the patient’s medical condition objectively. Look beyond the stated symptoms and consider the possibility of underlying medical issues or coexisting conditions. Utilize validated screening tools to identify substance use disorders and assess the risk of opioid misuse.
3. Establish Boundaries: Clearly communicate the expectations and limitations of treatment to the patient from the outset and articulate the reasons for diagnostic tests, treatments, and medication prescriptions. Establishing firm but compassionate boundaries helps prevent manipulation and ensures that care is provided based on clinical need rather than patient demands.
4. Collaborative Approach: Involve multidisciplinary team members, such as social workers, addiction specialists, and pain management experts, in the care of drug-seeking patients. SAMHSA cites the effectiveness of using case managers to coordinate comprehensive care and support services to ensure that patients receive the continuity of care they need to achieve long-term recovery goals. It’s important to include the patient in the treatment planning as well -engaging in shared decision-making fosters patient buy-in and enhances treatment outcomes.
5. Education and Counseling: According to a study published in the Western Journal of Emergency Medicine, emergency department visits often provide an environment in which a patient may be more open to substance abuse education and referrals. Take the opportunity to educate drug-seeking patients about the risks and consequences of substance misuse and offer counseling and resources for addiction treatment and support services. Empowering patients with knowledge about healthier coping strategies and treatment options can motivate positive behavior change.
6. Documentation: Accurate and detailed documentation is crucial when managing drug-seeking patients in the ED. Document the patient’s history, clinical findings, and treatment rationale thoroughly to facilitate continuity of care and mitigate legal risks. Include any agreements or contracts regarding opioid prescribing and follow-up plans in the medical record.
7. Utilize Prescription Drug Monitoring Programs (PDMPs): Accessing PDMP databases can provide valuable insights into a patient’s prescription history and help identify patterns of drug-seeking behavior. Check the PDMP before prescribing controlled substances to screen for potential misuse, diversion, or doctor shopping and incorporate PDMP data into clinical decision-making to ensure safe and appropriate opioid prescribing practices. You can find additional information from the CDC about PDMPs here.
8. Alternative Pain Management Strategies: Explore non-opioid analgesic options and alternative pain management modalities for drug-seeking patients. Adjunctive therapies such as physical therapy, acupuncture, or cognitive-behavioral therapy offer potential ways to address pain and improve function without relying solely on opioid medications.
9. Follow-up and Referral: It’s important to provide clear instructions for follow-up care and facilitate timely referrals to appropriate outpatient resources for ongoing management of substance use disorders. A 2018 Maryland Hospitals Report outlines a facilitated referral approach which relies on social workers and peer recovery coaches to make initial treatment appointments with subsequent follow up to make sure they made it to appointments.
10. Self-care and Support: Managing drug-seeking patients can be emotionally taxing for healthcare providers. To maintain resilience and prevent burnout in the face of these challenging clinical experiences, it’s important to practice self-care strategies and seek support from colleagues, supervisors, and mental health professionals.

Recap

Effective management of drug-seeking patients in the emergency department requires a holistic approach that prioritizes patient safety, compassionate care, and evidence-based practices. By implementing these ten strategies, emergency medicine providers can navigate complex clinical scenarios with confidence and professionalism while promoting the well-being of both patients and healthcare teams.