Over the years, North Carolina Physicians Health Program has expanded the services it provides, in order to help physicians and physician assistants deal with areas of impairment other than chemical dependency.

One area of concern that has resulted in more frequent referrals to NCPHP is that of the physician who has a problem with inappropriate prescribing. Most of these cases deal with the prescribing of controlled drugs, although erratic or excessive prescribing of non-controlled substances are also cause for concern.

The etiology of the inappropriate prescriber can be broken down into four major categories:

(1)   Deficient (dated practitioner)

a.       Too busy to keep up with CME

b.      Unaware of controlled drug categories

c.       Not aware that methadone is only for chronic pain or for use in a methadone clinic

d.      Prescribes for friends or family without a patient record

(2) Duped

a.       Always assumes the best about his patients and is gullible

b.      Leaves script pads lying around

c.       Hydrophilic medicine – fell into the toilet or the sink

d.      Patients only want specific medications (i.e. oxycontin or percocet)

e.       Co-dependent – cannot tell patients “No” when they ask for narcotics

(3) Deliberate (dealing)

a.  Practitioner becomes a mercenary

b.  Sells drugs for money, sex, street drugs, etc.

c.  Office becomes a pill factory – full of drug seekers

d.  Prescribes for known addicts who will likely sell drugs to others

(4) Drug dependent (addict)

a.       Starts by taking controlled drug samples

b.      Asks staff to pick up medications in their names

c.       Uses another doctor’s DEA number

d.      Calls in scripts in names of family members or fictitious patients and picks them up himself

NCPHP can do an evaluation of a physician or PA who is exhibiting inappropriate prescribing habits to help determine the category into which they fit. Except for the dealing physician (who would have to be reported to the North Carolina Medical Board), NCPHP would devise treatments plans to address the area causing the inappropriate prescribing. Examples of treatment could include chemical dependency treatment, competency testing, co-dependency treatment, or CME educational courses on prescribing of controlled drugs.

Inappropriate prescribing is one of the most common problems that medical boards deal with each year. Hopefully, through early recognition of the problem, and an early referral to NCPHP, remediation can decrease this trend.