Although, pain management physicians often have patients who are prescribed powerful drugs, they are not the doctors who most often fire patients, Whitehead says. "They are pretty well organized in their practices, and do drug testing," she says. "We are seeing more of the prescribing abuses [originating in] the general practice and specialties."
California runs databases known as Controlled Substance Utilization Reviews and Education System (CURES) and the California Prescription Drug Monitoring Program (PDMP) to help physicians monitor the drug use of patients who may visit several physician practices. "We are educating physicians to query the database when they are prescribing. If they see a large number of prescriptions out of the ordinary, they can see if their patients are getting them from other sources," Whitehead says.
While this resource is helpful, Whitehead concedes that the database isn't used by physicians as often as it should be. California's budget problems undermined the efficiency of the database at one point, she says: "That has turned some doctors off. They can't get the information they want and don't go back to it."
The potential for physical harm to physicians and other healthcare employees remains a constant concern about disruptive patients. Whether in physician practices or in the hospitals, "healthcare institutions today are confronting steadily increasing rates of crime, including violent crimes, such as assault, rape and homicide," according to a 2010 report from the Joint Commission Sentinel Alert.