By Russell Herring, DNP, FNP-BC, CSCS
As a new prescriber, there are some patient trends that I may still be naïve to, but I was an Air Force officer and I’ve been around the block and I didn’t just fall off the turnip truck, as my mother would put it. I’ve witnessed and learned from experienced and new providers over time, as to why they prescribe a certain way. Just as with all experiences and lessons in life, the prescriptive, treatment and practice habits of healthcare providers aren’t inborn. We study for years, and then the real world happens. Different experiences result in different thoughts, habits and approaches.
Most patients approach the provider-patient relationship honestly, without deceit or any intent to misrepresent themselves. Most people are good and honest. I’m a devout “House” fan, and sometimes his philosophy of “people lie” really rings through, but I’m also a small-town kid who wants to believe that most people are inherently good. Drugs with abuse potential – street drugs, prescription drugs, over-the-counter drugs, whathaveyou, can distort the intentions and motivations of otherwise good human beings into something unrecognizable. It can be extremely difficult to separate the person from the behavior.
This doesn’t mean that a person has become inherently bad or broken. Some of the most abused prescription medications are pain medications. These prescription medications possess a double-whammy for abuse and addiction potential. First, no one wants to live in pain, and if a medication makes the pain go away, or at least turns the volume down to something a person defines as livable, that in itself can be addictive. However, these medications can have a pleasant high, which is independently addictive. Finally, many medications are physiologically addictive, and transcend the idea of being high – the individual will get sick, and experience symptoms as severe as seizure and death if they quit using.
For these reasons, individuals who are treated with certain medications can exhibit behaviors, or commit actions which aren’t representative of their norm. With this in mind, prescribers utilize certain medications sparingly, and under well-defined rules.
Thankfully, the State of Montana maintains the Montana Prescription Drug Registry, a service which links prescribers and pharmacists in an online database which monitors individual patients’ use of Drug Enforcement Agency Schedule II-IV medications. The Registry doesn’t care about your Tylenol, your Robitussin or your Nyquil. The Prescription Drug Registry tracks drugs the DEA has deemed to have abuse potential. These particular medications combine potentially dangerous side-effects with an addictive abuse potential, which could lead patients to taking them at dangerous doses, and going to erratic lengths to obtain them.
Though it’s certainly upset some, The Prescription Drug Registry certainly wasn’t created to be a killjoy. The Registry isn’t just keeping tabs on good, law-abiding citizens and it doesn’t exist to keep you from receiving the medications you truly need. At its most basic level, the Prescription Drug Registry serves to save patient lives. Sometimes, it serves to save patients from themselves.
The Prescription Drug Registry links prescribers and pharmacies, across several participating states, so that we can verify, with a minimal level of confidence, that patients are only taking the medications each of us have prescribed, and that they aren’t “doctor shopping”. Patients who are seeking treatment, and obtaining potentially dangerous medications from multiple providers are not being honest with their providers or themselves. When a provider sees a patient that has six different prescribers, in several different towns, and filled prescriptions at multiple pharmacies, we worry about their health and safety. Addicts are real, yes. But there are also good, honest, hard-working people who engage in reckless behavior with prescription medications. People in pain or people being treated for other conditions, can sometimes behave differently and sometimes, even dangerously.
Other times, patients have shown addictive behavior and violated provider trust simply to obtain drugs and a high. But for those patients who desire to obtain illegal, dangerous, and ill-advised levels of medications by ”doctor shopping” – we still want to help you. As providers, we have to use the tools at our disposal and we have to sometimes be stern in our efforts to help our patients. To all of the patients dealing with addiction, we are here for you and we want to help you.
About Russell Herring, DNP, FNP-BC, CSCS
Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers and prescribers in the State of Montana. He works alongside Dr. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600.