Expert: Glenn A. Dorfman - 11/5/2009

Question
QUESTION: My sister is a recovering pain pill addict, during her initial sobriety her Dr. prescribed SUBOXONE which can be described plainly as an opiate blocker.  Four years later her Dr. is still filling her prescription without office visits and charging her an office visit copay for each refill.  She is now trying to get off the pills and going through a very traumatic withdrawal.  While her Dr. isn't forcing her to swallow the pills doesn't he have some sort of ethical responsibility to monitor and advise her?  Its very distressing that he would refill a script without seeing her and then charge her a office copay, any advice you could dispense would helpful.  I personally believe she should file a complaint with the state board.

ANSWER: I agree that the doctor is probably violating protocols for writing prescriptions and is technically in violation of ethics and professional regulations, not be mention opening himself up to a potential malpractice situation.  It seems that the doctor should have long ago started weening her off the drug but maybe your sister has resisted that. He certainly should see her on a regular basis to track her progress, make sure there are no interactions with other medications etc. But what the heck is the point if you go from one drug to another. The goal should be to get her off all such drugs. The doctor is not doing that and failing to help the patient. She should be trying to ween herself off on her own or perhaps see another doctor. If she reports the problem to the State Board, then she will probably get cut off and I bet she is afraid of that. Other option is, why doesn't she insist on having an office visit with the doctor and talk about tapering off from the drug?

---------- FOLLOW-UP ----------

QUESTION: Thanks so much!  I agree and she is trying actively to get herself off the pills.  I'm so mad at this point I am trying to push her into an action, whether be it a complaint or legal.  I have heard so many stories about pill pushing doctors and now that its right in front of me I understand the frustration.  Thank you again!

Answer
But don't let your sister off the hook. She may have been begging the doctor to keep writing the prescriptions, telling him she is feeling fine, but he is too lazy or unconcerned to do more than just keep providing the pills, which we agree in inexcusable. And billing for an office visit where there was none is a big "no no" of course.