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…repeatedly lie to a doctor/nurse/paramedic etc to obtain drugs of abuse? I mean it feels like a crime, but I’ll be damned if I can find the specific offence it would become under. I suppose proving it would be somewhat challenging, mind you. Asking for a frustrated colleague…
No. Assume it's a colleague who is a prescriber. Suggest they speak to their clinical lead for support.
Thank you, appreciated.
In theory it could be fraud - obtaining property by deception. But that depends on the nature of the lie(s), and the value of pursuing it in those terms if you're dealing with a patient with addiction issues is debateable. Seems like the police would be unlikely to be interested unless it was fraud on a much bigger scale, or involving health professionals.
It may be better practice as suggested above to involve more senior colleagues and approach it from a patient protection perspective, aiming to avoid future prescribing. If the lying progresses to threats etc then it is a more clearcut criminal issue.
I’m a doctor, not a lawyer. We do have some teaching on how to identify and manage drug-seeking behaviour, but not in the context of the law.
This is not something that comes up in our teachings. Which makes me think it’s either vanishingly rare, or not illegal, or more likely it could be illegal (fraud) but it’s impossible to prove and doesn’t justify breaking doctor-patient confidentiality.
Part of the issue is that drugs of abuse have a weird place in the medical realm. They’re almost all very cheap to supply, though the supply is tightly controlled. So an abuser is only really harming themself, unless of course they were selling them or giving them to someone else, but that’s not a particularly lucrative rouse so I’m not convinced it’s worth anyone’s bother.
If medical professional is aware of what is happenning then surely if they or another person is being harmed by these actions then the Hippocratic Oath is being broken. That's a bad thing I believe.
That’s a bad thing I believe.
IMO it depends what the alternatives are.
The police will be too busy responding to burglary and theft calls. I wouldn't worry..
how to identify and manage drug-seeking behaviour,
We have no such guidance in our field, perhaps because of being prehospital and largely not doctor led. I’d be really curious to read any info you could link to in order to help me figure out a plan for this individual. Appreciate it.
I can’t go into specifics for obvious reasons but this individual is IMO cynically exploiting treatment protocols and the fact that they never get the same ambo clinicians twice in order to be given pain relieving medication; they claim certain injuries that are hard to rule out in the prehospital setting and this often leads to the administration of some fairly heavy duty medication. They repeatedly get conveyed to hospital, yet never get admitted following investigations in ED. Indeed on some occasions due to offloading delays they have taken there own discharge from the ambulance before making it through the doors. This behaviour is taking ambulances away from people who really need them for hours at a time, which in normal times is bad, but right now is absolutely criminal (literally IMO).
I’m aware that the police won’t be interested, but I’m hoping that the NHS counterfraud authority can be persuaded to get involved. There’s an not inconsiderable financial implication to the NHS because of the individuals behaviour, and NHS resources are kind of at a premium right now.
That's so hard - it's not even the self-harm through drug abuse (although that's a big issue), it's the waste of a scarce resource and societal cost of that waste. 🙁
As above, that's a tricky one. Do they always use the same ambulance service?
It seems to me to be one for their senior management to sort out, e.g. brief crews on the individual and their actions and come up with a plan. Maybe start with numbers gathering, crew hours wasted and outcomes, perhaps followed by intervention by drug counsellors, that sort of thing
Criminal-level intervention doesn't feel appropriate to me
Could you involve drug and alcohol colleagues and look at prescribing for this person. Is there any drug and alcohol presence in your ED they can be seen by next time they call an ambulance? If they are looking for pain meds I’m assuming opioid based meds so pharmacotherapy options are available. I’m not a prescriber but work in drug and alcohol.
How often are they calling, does it trigger your services frequent caller profile? If so that could be a way in to explore why they use your services & look at any alternatives / additional support.
Ah, that makes more sense. There are laws to address people who waste emergency services time/resource by repeatedly ringing up and demanding an ambulance when there is nothing wrong with them. The offence is using a public electronic communications network to cause annoyance inconvenience or anxiety.
This report covers a fairly extreme timewasting case.
One thing of note is that East Midlands Ambulance appears to have a 'frequent caller team', so it is worth investigating if the ambulance trust in question in your case has something similar.
@drac might have a perspective on this.