Help with difficult patients!

[grumpy]

What do I do about a methadone patient who does not finish his dose because he 'doesn't need it' and says that he still has take home doses from his previous prescription. He's also a bully and not to be trusted! It's here'say of course, but we're told of his bullying and selling drugs/methadone.
I've spoken to his drug worker who has heard similar stories quite independently and at a similar loss as to what to do!
It makes me not want to do methadone, which is a shame. It makes me so angry! I may have to rip a tissue!

[admin]

What do I do about a methadone patient who does not finish his dose because he 'doesn't need it' and says that he still has take home doses from his previous prescription. He's also a bully and not to be trusted! It's here'say of course, but we're told of his bullying and selling drugs/methadone.
I've spoken to his drug worker who has heard similar stories quite independently and at a similar loss as to what to do!
It makes me not want to do methadone, which is a shame. It makes me so angry! I may have to rip a tissue!

Do you mean he leaves a bit in the bottom and doesn't drink it, leaving you to throw it away?

I ask because I've had plenty of them who seem to want to get off it, but the rate at which their GP drops them is so slow it will take them years, so they reduce it themselves by refusing to drink it all.

I have been asked by quite a few if the GP wants them to stay on it, and think it's only because it makes him more cash.

[grumpy]

Do you mean he leaves a bit in the bottom and doesn't drink it, leaving you to throw it away?

I ask because I've had plenty of them who seem to want to get off it, but the rate at which their GP drops them is so slow it will take them years, so they reduce it themselves by refusing to drink it all.

I have been asked by quite a few if the GP wants them to stay on it, and think it's only because it makes him more cash.

Yeah, he leaves some at the bottom. I know what you are saying, but this guy is just messing with the system, big time. I spoke to his worker and he is more than happy to accommodate withdrawl if that is the case - he attends a drug service not done through a gp surgery.

[admin]

Yeah, he leaves some at the bottom. I know what you are saying, but this guy is just messing with the system, big time. I spoke to his worker and he is more than happy to accommodate withdrawl if that is the case - he attends a drug service not done through a gp surgery.

I've met plenty of those types too! Just keep firm and stand your ground. If he starts trying to threaten you, don't listen to him - interrupt him and tell one of the staff to call the police and tell them a drug addict is threatening the pharmacist.

I've always found that a word along the lines of "any more trouble from you, and I'll call every chemist in this town, and you'll be going 30 miles a day to get your methadone - is THAT what you want????"

It's always best to try to keep them calm though. If you are polite you are on the winning side, so I've only ever used these in extreme situations!

Most methadone patients are not like this, so don't give up the service because of one rotten apple. The pharmacy I often work at with 150+ addicts only has a few that aren't very nice. Most of them are actually quite nice people, and tend to respond positively with gratitude if you treat them like a regular person. Just a simple "hi, how are you doing?" often goes a long way, as most people that they meet treat them like dirt. If you get to know them better, often their lives have been tragic really. One guy once lifted his shirt and showed me a back full of scars that looked like he'd been wipped with a cat of nine tails!

Stay cool, keep calm and polite, but be assertive. Let us know how you get on.

Good luck.

[Pharmanaut]

Stay cool, keep calm and polite, but be assertive. Let us know how you get on.

Good luck.

Spot on advice.
Sometimes the visit to the pharmacy is the only stability these folk have in their daily lives.

[grumpy]

Not to worry about me giving up the service - not my business for one - I've been doing the methadone service since I qualified 6 years ago and have dealt with many patients, I think it's just been a long time since I had to deal with one as a manager - been a locum for 2 years - and was trying to not think of possible 'consequences'. But, you're right about keeping a level head and being polite. I just need to not let the fear factor set in again, something I had control of after my initial management job. This guy though, I'm lead to believe can be a bit 'un-hitched'. I've just over analyzed the situation and should just get on with it.
Regards for your advice.
Dj

[admin]

Spot on advice.
Sometimes the visit to the pharmacy is the only stability these folk have in their daily lives.

Thanks. You are dead right, we are usually the health professional that sees them the most. Often we will be the only one who treats them like a person and not dirt in the whole day.

It's also a good feeling when someone does get off drugs, and shakes your hand and says "I couldn't have done it without your help". This has happened to me a few times, and is really very rewarding.