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Posted: Fri Feb 19, 2016 5:51 am
by drpasser
I leave everything open and on the table.
Keep em guessing.
I find, I do far fewer pill counts than I used to.
I individualize....

Posted: Fri Feb 19, 2016 5:51 am
by robertsonjon
Thanks for the help, everyone. It gives me a lot to think about. I may just do selected pill/film counts on patients suspected of diverting (not testing positive for norbuprenorphine (metabolite) in quantitative lab results).

Posted: Fri Feb 19, 2016 5:51 am
by catschollmd
We call them for random pill/strip recons & poc UDSs +/or orals (send out to Aegis), (poc- point of care); and in their initial treatment agreement they are told this, plus not being reachable or comimg in counts as an abnormal and may result in more frequent visits and counseling. They know it's their responsibility to keep their voice mail open.
We give them 24-48hrs to appear. (Usually 36 hrs)
Pts can still fool you for awhile, renting pills or selling films but keeping wrappers so the lot numbers match. The random UDS and ODS (oral) can yield some surprising results and helps you see who is struggling vs. who is just "cheating". The later usually dropout.

Posted: Fri Feb 19, 2016 5:51 am
by fishdoc
All of our patients are instructed that they MUST respond to a phone call from our offices within 2 hours. We also make them bring film/pills remaining as well as wrappers to each visit and to random pill counts. Oral fluid and/or UDS is also performed at these random checks. When they call back they are instructed to come in the SAME day as the call; we will give them a Dr's letter to give to work if needed.

Failure to respond is automatic discharge from the practice. In over 5 years at 3 separate offices, we have had only one patient not call back. They are instructed that if the leave town, they must advise us the dates they will be gone so we will not call those days.

Posted: Fri Feb 19, 2016 5:51 am
by NoDrugs4u
That's why I only order the strips and do wrapper counts each visit. I know there are ways to circumvent that, but I don't make it easy. Of course, I am a bit of a hardliner.

Posted: Fri Feb 19, 2016 5:51 am
by peterorrin
Methadone clinics seem to be able to call people, and at the drop of a hat (2 hours), the clients return. I dont know how they do it. Probably," If you dont respond, no methadone.!"

We don't bother with pill/strip counts because, let's face it, they are a lot of trouble. what what do you get for the effort (Robertsonjon, you answered that!!). Instead, we..the doctor and the counselor..use clinical information: are they no shows for our required weekly counseling sessions, do they call for make-ups, how do they look, even, are they smiling (an early sign of recovery), do they finish their Rx's early etc

Posted: Fri Feb 19, 2016 5:51 am
by entjwb
If can't reach I count as failed count. They then come in weekly for Uds and get weekly Rx.