How to manage a patient selling their oxycodone (oxycondone hydrochloride)?

From the Guidelines

Managing a patient selling their oxycodone requires immediate action to prevent harm and ensure compliance with medical and legal standards, starting with a direct, non-accusatory discussion and implementation of a controlled substance agreement. When dealing with a patient suspected of selling their oxycodone, it's crucial to prioritize their health and safety while also addressing the legal and ethical implications of such actions. According to the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, opioids should not be considered first-line or routine therapy for subacute or chronic pain due to their association with small short-term benefits compared to placebo, uncertain long-term benefits, and potential for serious harms.

Key Considerations

• Documentation: Thoroughly document all concerns, discussions, and agreements with the patient, as well as any interventions or decisions made.
• Controlled Substance Agreement: Implement an agreement that clearly outlines expectations for medication use and the consequences of diversion.
• Monitoring Compliance: Consider more frequent office visits, random pill counts, and urine drug screens to monitor the patient's compliance with their medication regimen.
• Prescription Management: Prescribe smaller quantities of oxycodone with no refills to limit the potential for diversion.
• Alternative Pain Management: For patients with legitimate pain needs, consider alternative pain management strategies such as non-opioid medications (e.g., NSAIDs, acetaminophen, gabapentin), physical therapy, or referral to pain management specialists, as suggested by the guideline 1.

Addressing Diversion

If diversion is confirmed, it may be necessary to taper the patient off opioids while providing appropriate alternative pain management. The guideline emphasizes the importance of weighing the benefits of opioid therapy against its risks and considering exit strategies before initiating treatment 1. In cases of clear evidence of illegal activity, consulting with legal counsel regarding reporting obligations is essential.

Patient Education and Communication

Patient education and discussion before starting opioid therapy are critical, as emphasized in the guideline 1. This includes reviewing expected benefits, common and serious risks, and alternatives to opioids, as well as discussing the importance of taking only the prescribed amount and the risks associated with sharing medications.

By taking a structured and patient-centered approach, healthcare providers can address the complex issue of medication diversion while ensuring that patients receive appropriate care and support for their pain management needs.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Managing Patients Selling Their Oxycodone

To manage a patient selling their oxycodone, several steps can be taken:

• Monitor the patient's opioid use closely due to the potential for addiction, abuse, and fatal interactions 2
• Use urine-based immunoassay drug screens or gas chromatography-mass spectrometry to determine if the patient is taking the medication as prescribed 2
• Be aware of the signs of opioid misuse, such as negative urine test results or inconsistent stories about their pain levels
• Consider using a controlled-release formulation of oxycodone, which may be less prone to abuse than immediate-release formulations 3
• Educate the patient about the risks of opioid misuse and the importance of taking their medication as prescribed

Preventing Opioid Misuse

To prevent opioid misuse, the following strategies can be employed:

• Use a prescription drug monitoring program to track the patient's prescription history and identify potential misuse 4
• Monitor the patient's dose strength and adjust as needed to minimize the risk of overdose 4
• Consider alternative pain management options, such as non-opioid analgesics or behavioral therapies
• Provide the patient with a consent form and behavioral contract to outline the expectations and consequences of opioid therapy 5
• Conduct regular psychologic evaluations to identify patients at risk of opioid misuse 5

Identifying High-Risk Patients

Certain patients may be at higher risk of opioid misuse, including:

• Those with a history of addiction or substance abuse 5
• Those with current addiction or misuse of opioid medications 5
• Those with significant behavioral problems or psychologic issues 5
• Those who have been prescribed high-dose or high-strength opioids 4