What to do if a patient reports their controlled medication, such as oxycodone (opioid) or hydrocodone (opioid), was stolen?

Management of Reported Stolen Controlled Medications

When a patient reports their controlled medication was stolen, do not automatically provide a replacement prescription; instead, conduct a thorough assessment to differentiate between legitimate theft, diversion, misuse, or undertreated pain, while maintaining appropriate monitoring and documentation.

Initial Assessment and Documentation

The first critical step is to carefully evaluate the claim within a broader clinical context, as "repeated lost or stolen medications" represents a concerning aberrant opioid-related behavior that warrants reassessment of the risk-benefit ratio of continued opioid therapy 1. However, it's essential to recognize that some behaviors that appear concerning may actually reflect undertreated pain (termed "pseudo-addiction"), which resolves with effective pain treatment 1.

Key Clinical Considerations

• Document the incident thoroughly, including the patient's account, timeline, whether a police report was filed, and any previous similar incidents 1
• Review the patient's opioid patient-provider agreement (PPA) to determine if this behavior violates the established plan of care 1
• Consider the differential diagnosis broadly: legitimate theft, diversion to others, personal misuse/addiction, undertreated pain causing increased consumption, or selling for financial gain 1

Risk Stratification and Monitoring

The prevalence of aberrant opioid behaviors is substantial—ranging from 27-42% in general chronic pain populations 1, with even higher rates (37-73%) reported in vulnerable populations 1. National data reveals that only 2% of misused prescription opioids come from theft from medical facilities, while 7.3% are taken from friends or relatives without asking 1.

Immediate Actions

• Check your state's Prescription Drug Monitoring Program (PDMP) to identify doctor shopping or multiple prescribers 1
• Conduct or schedule urine drug testing (UDT) to verify appropriate medication use and screen for undisclosed substances 1
• Perform pill counts if the patient has remaining medication from previous prescriptions 1
• Assess for signs of opioid use disorder: impaired control over drug use, compulsive use, continued use despite harm, and craving 1

Decision Framework for Replacement

Generally, do not provide an immediate replacement prescription. Instead:

For First-Time Reports with Low-Risk Patients

• Consider a limited bridge prescription (3-7 days maximum) only if the patient has no prior concerning behaviors and files a police report
• Increase monitoring frequency to monthly or more often 1
• Reinforce education about secure storage to prevent future incidents 1
• Document that future similar incidents will result in treatment modification or discontinuation

For Repeat Reports or High-Risk Patients

• Do not replace the medication 1
• Offer non-opioid pain management alternatives
• Consider referral to addiction medicine or pain management specialists 1
• If opioid use disorder is suspected, offer medication-assisted treatment (buprenorphine, methadone, naltrexone)
• Reassess whether continued opioid therapy is appropriate given the risk-benefit profile 1

Common Pitfalls to Avoid

Never assume the report is automatically fraudulent or automatically legitimate—both extremes can harm patients. Providers often have limited confidence (6/10 on visual analog scales) in recognizing prescription medication abuse, and their perceptions frequently don't align with patients' actual behaviors 1.

Avoid racial or age-based assumptions—studies show providers incorrectly use younger age and African American race as predictors of misuse, when the actual predictors are recent illicit substance use (cocaine, methamphetamine, heroin within 6 months) 1.

Don't ignore the possibility of undertreated pain—what appears as drug-seeking may resolve with better pain control 1.

Documentation and Follow-Up

• Document your clinical reasoning, the differential diagnosis considered, and the rationale for your decision 1
• Update the patient's PPA if continuing opioid therapy 1
• Schedule closer follow-up (weekly to monthly depending on risk level) 1
• Consider implementing or intensifying monitoring tools such as random UDT, pill counts, and PDMP checks 1
• Educate patients about secure storage and proper disposal of opioids to prevent future theft or diversion 1

The goal is to balance compassion for patients with legitimate pain against the serious public health risks of opioid diversion, which contributes to the epidemic of prescription opioid overdoses that have quadrupled since 1999 1.