A few weeks ago I saw a guy in my clinic who had to evacuate from Louisiana during Katrina. He lived in a trailer in the woods in a backwater parish two hours from New Orleans, and was seriously wondering what he would have to go back to. He happened to have some friends in a nearby town who offered to put him up, and he was making plans to stay around once he found a place of his own.
(I was suspicious, but his accent was authentic, and when I tried to trip him up on Louisiana geography (since I know the state a bit), he didn’t hesitate.)
He was a young guy–younger than me–with a wife and three kids, but he had a couple of bad car and work accidents a few years ago with some serious joint injuries. He had been accelerated to some pretty hefty long-acting pain meds, far more than I’m usually comfortable writing. He had all his medical paperwork with him, and he didn’t set off a single one of my (usually) well-calibrated alarms, so I went ahead and wrote him a month’s worth of his medicine. I would ordinarily have sent him to the pain clinic, but this was a guy who lost everything, and we’re one of the few clinics in the area that sees patients on a sliding scale.
Fast forward…today he walked in to be seen, ostensibly for abdominal pain, but he told the nurse that he had been working so hard moving that he had to use extra pain medicine and was already out. He was at least two weeks early, and I was about to go and explain to him that it didn’t work that way, but first I ran a KASPER on him. (KASPER is the system we have in Kentucky in which every scheduled prescription filled is sent to a central database in Frankfort, available to physicians almost instantaneously.) In addition to the script I had written for him, he had one filled on the very next day, for the very same dose and amount of Oxycontin, from a different physician, filled at a pharmacy about an hour and a half away.
I went in, and he told me the same story about running out early and needing extra pain meds. “We won’t be doing that,” I said, “and I’ll tell you why.” I explained to him what KASPER is, and that we had run one on him, and (very diplomatically) informed him that someone with his (very unique) name and his birthday had filled a script for the exact same medication the next day in a nearby town. If he could get that straightened out, I said, with a letter from the doctor and the pharmacy convincing me that there has been some mix-up, I’d be happy to re-start his pain meds, but not before.
I went away to order some labs to work up the abdominal pain…and got back just in time to see him go out the door.
I’m used to the bullshit. People lie and exaggerate and manipulate to get pain meds all the damn time, both to take themselves and to sell, and getting mad about it is like getting mad at the sky for raining. But something about him playing on my sympathies about the hurricane…I can’t even find words for how much that pisses me off.
I still think his story is legit, up to a point; his documents were too good to be a forgery by someone stupid enough to come in for more narcotics two weeks early. My guess is that it’s all true, but he saw an opportunity to make a bundle in the wake of his family’s tragedy and he took it. I’m not calling the police…but I’ll be checking another KASPER on him every week or so, in case he’s dumb enough to try again.