Re: Need advice/ moral support, chronic narcotics case

[Guest guest]

I am not a physician, just married to one.  But when it goes against your gut and what you told them you would do, I think they will respect you more if you stick to your guns. 

Quick story: We had a friend who became a patient of Steve after he was already addicted to rx pain meds.  He was trying to get off.  Steve fell for all of the red flags because he was a friend and he trusted that what he was saying was true, and over a very short period of time, we watched him lose his marriage, his kids, and eventually his life.  He died in a tragic auto accident after we had moved away from the area.  I think that experience has made Steve stick strong to his convictions and he will not rx long-term narcotics at all.  Patients are referred to pain management specialists for that.  Not everyone's story, but if it helps you in your decision, there you have it.

Good luck, Pratt

 

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years.

Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.

This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there.

Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested.

Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients.

The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy.

Any opinions? What would you do?

[Guest guest]

i had somewhat a patient like this, failed neurosurgical case though and it

turned out that his pregnant wife was using his suckers.

and how did i find out? someone else had alerted the drug enforcement agency and

they in turn investigated me as well as all the other prescribers.

when i was interviewed by them, it totally changed my mind on 'help the patient

all the way through' angle. this investigation was exhausting and all

prescribing activity im sure was monitored by the state thereafter and im not

sure for how long.

withdrawal could be managed at the ER. draw the line, dont toe it.

two euros.

g

>

> > I have two patients, a couple. The 60s woman with a lot of chronic medical

problem, a shattered pelvis and hip, chronic pain for years. I had her on

Lortabs for years, but several years ago, when she was in the hospital for 4

months, she was discharged on fentanyl patches and dilaudid pills, and although

the doses were decreased, I was never able to get her off the patches. Husband

70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which

as originally prescribed decades ago. I have known both both at last 10 years,

although the man was only my patient for the last few years.

> >

> > Their adopted 30 something year old daughter, not my patient, has chronic

pain issues, narcotic addiction. A few years ago stole the woman's meds. On my

advice, they got her help, she was on the road to recovery, in a methadone

program even. Things were good for a while. Against my better judgement, I did

prescibe more meds to replace my patients supply,so she would not go into

withdrawal.

> >

> > This year, for some reason the dau quit the methadone program and was back

living with the parents, my patients. A few weeks ago they called me urgently

and told me that the dau stole the meds again. Even though we have a signed

narcotics contract, I did the compassionate thing, (probably the dumb thing) and

reprscribed to my patient. they had to pay cash for the meds, since the

insurance wouldn't cover it again. Our plan was the dau was kicked out and my

patients got a safe so that all meds and scripts could be stored there.

> >

> > Everything was fine until they called me again tonight at 9:30pm, saying

they let the dau back in the home because she didn't have a place to live ( my

suggestion previously was if she didn't have a place to go, she could go to a

homeless shelter) . Now all the meds are gone for the safe. They tell me the

town police and the state police are there and they fully expect to have their

dau arrested.

> >

> > Aside from these instances, the have never asked for scripts early, and they

have been trustworthy patients.

> >

> > The husband says he knows I won't want to see them anymore which makes me

feel bad and I am not sure if he says it out of anxiety or to try and manipulate

me. I feel really guilty. I don't want the wife to go into withdrawal from going

off the 125 mcg fentanyl patches which will probably happen tomorrow. But they

were warned last time that I wouldn't reprscribe again. I don't knw what to do,,

I feel I have already given them an extra chance. And if I prescribe again,

Give them more it's like when you threaten your children and don't follow

through. It makes my word garbage.. I think this problem is their fault, letting

a known addict into their home even though it is their daughter. . And I don't

want my license to be in jeopardy.

> >

> > Any opinions? What would you do?

> >

> >

>

[Guest guest]

This is a really tough case. I don't see that you have done anything "wrong" up to this point, but it does look as if you have to be consistent with your promise to stop prescribing, and it also looks as if the father is being manipulative. I can so relate to this, having been forced into/conned into/allowed to be talked into doing some temporary chronic opioid pain management at a couple of points in my career. I think these patients of yours will have to go elsewhere for their opioids.

This won't really help you, either, but I think primary care physicians in general have to stop accepting that chronic opioid pain management is a normal component of primary care. It should be considered a specialty in and of itself, with offices dedicated to nothing but chronic pain management run by clinicians trained in that field and supported by widely accepted guidelines which, if followed, should be mandated to keep the DEA and other authorities off the prescribers' and patients' cases. I have started to push back vigorously against patients and partialists who are trying to push me into chronic opioid pain management.

My state of NM has the highest per capita opioid pain reliever overdose death rate in the US. The DEA's eyes are relentlessly on everyone here.

Felix, MD

Need advice/ moral support, chronic narcotics case

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years.

Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.

This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there.

Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested.

Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients.

The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy.

Any opinions? What would you do?

[Guest guest]

You could write a 30 day prescription for meds and at the same time discharge them from your practice with 30 days notice. You would need to give them names of other internists or family docs along with pain clinic referral they could see in your area. Alternatively, you could give them the scripts, 30 days notice that you will no longer prescribe pain meds or Klonopin, and referral to pain clinic. This way you will not feel that you abandoned the patients and they can take their codependent problems elsewhere.Straz

This is a really tough case. I don't see that you have done anything "wrong" up to this point, but it does look as if you have to be consistent with your promise to stop prescribing, and it also looks as if the father is being manipulative. I can so relate to this, having been forced into/conned into/allowed to be talked into doing some temporary chronic opioid pain management at a couple of points in my career. I think these patients of yours will have to go elsewhere for their opioids.

This won't really help you, either, but I think primary care physicians in general have to stop accepting that chronic opioid pain management is a normal component of primary care. It should be considered a specialty in and of itself, with offices dedicated to nothing but chronic pain management run by clinicians trained in that field and supported by widely accepted guidelines which, if followed, should be mandated to keep the DEA and other authorities off the prescribers' and patients' cases. I have started to push back vigorously against patients and partialists who are trying to push me into chronic opioid pain management.

My state of NM has the highest per capita opioid pain reliever overdose death rate in the US. The DEA's eyes are relentlessly on everyone here.

Felix, MD

Need advice/ moral support, chronic narcotics case

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years.

Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.

This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there.

Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested.

Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients.

The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy.

Any opinions? What would you do?

[Guest guest]

This sounds to me like there's a high potential for the husband to have a little 'problem' of his own. Why would the daughter have any access to the safe which was specifically installed to keep her out of the meds? Was the couple robbed at gunpoint? Anything less would be an invalid excuse. I was originally going to suggest that you might show a little mercy if you saw an official police report showing the daughter had been arrested for her role in this, but really, in this scenario you describe how you've now been burned not once, not twice, but THREE times. Sorry. You could still represcribe the meds when it's time to renew them if you're still so inclined, but for your narcotics contract to mean anything, you have to draw a line somewhere. If they go through withdrawal in the meantime... ...bummer.

This is a really tough case. I don't see that you have done anything "wrong" up to this point, but it does look as if you have to be consistent with your promise to stop prescribing, and it also looks as if the father is being manipulative. I can so relate to this, having been forced into/conned into/allowed to be talked into doing some temporary chronic opioid pain management at a couple of points in my career. I think these patients of yours will have to go elsewhere for their opioids.

This won't really help you, either, but I think primary care physicians in general have to stop accepting that chronic opioid pain management is a normal component of primary care. It should be considered a specialty in and of itself, with offices dedicated to nothing but chronic pain management run by clinicians trained in that field and supported by widely accepted guidelines which, if followed, should be mandated to keep the DEA and other authorities off the prescribers' and patients' cases. I have started to push back vigorously against patients and partialists who are trying to push me into chronic opioid pain management.

My state of NM has the highest per capita opioid pain reliever overdose death rate in the US. The DEA's eyes are relentlessly on everyone here.

Felix, MD

Need advice/ moral support, chronic narcotics case

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years.

Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.

This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there.

Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested.

Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients.

The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy.

Any opinions? What would you do?

[Guest guest]

I don't know. We are talking about stolen meds here. We are also talking about family dynamics. Sounds like the husband is afraid to lose you more than being manipulative. Withdrawal may trigger off other medical conditions. Might be a perfect time to see if a decrease in meds is effective. Maybe there is another alternative to dismissing them. Might be worth a conference to determine that. I once had a patient who needed narcotics but had a history of addiction connected with visiting nurses. They would fill this locked box that had a timer on it which only released the medication at the time specified. Cool use of technology! I would want to put the solution back on the couple and see what they can come up with. Do let us know what happens. It's

always a fine line for compassion and boundaries and juggling how to keep both. You are wise to reach out and see what else could be a possibility. To: " " < > Sent: Friday, April 27, 2012 6:36 PM Subject:

Re: Need advice/ moral support, chronic narcotics case

This sounds to me like there's a high potential for the husband to have a little 'problem' of his own. Why would the daughter have any access to the safe which was specifically installed to keep her out of the meds? Was the couple robbed at gunpoint? Anything less would be an invalid excuse. I was originally going to suggest that you might show a little mercy if you saw an official police report showing the daughter had been arrested for her role in this, but really, in this scenario you describe how you've now been burned not once, not twice, but THREE times. Sorry. You could still represcribe the meds when it's time to renew them if you're still so inclined, but for your narcotics contract to mean anything, you have to draw a line somewhere. If they go through withdrawal in the meantime... ...bummer.

This is a really tough case. I don't see that you have done anything "wrong" up to this point, but it does look as if you have to be consistent with your promise to stop prescribing, and it also looks as if the father is being manipulative. I can so relate to this, having been forced into/conned into/allowed to be talked into doing some temporary chronic opioid pain management at a couple of points in my career. I think these patients of yours will have to go elsewhere for their opioids.

This won't really help you, either, but I think primary care physicians in general have to stop accepting that chronic opioid pain management is a normal component of primary care. It should be considered a specialty in and of itself, with offices dedicated to nothing but chronic pain management run by clinicians trained in that field and supported by widely accepted guidelines which, if followed, should be mandated to keep the DEA and other authorities off the prescribers' and patients' cases. I have started to push back vigorously against patients and partialists who are trying to push me into chronic opioid pain management.

My state of NM has the highest per capita opioid pain reliever overdose death rate in the US. The DEA's eyes are relentlessly on everyone here.

Felix, MD

Need advice/ moral support, chronic narcotics case

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years.

Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.

This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there.

Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested.

Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients.

The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy.

Any opinions? What would you do?

[Guest guest]

I agree! Sitting in a boundaries class all weekend, have the lawyers in today. May ask some questions re this. I have lesser, but similar issue now myself. Had 13 chronic pain patients, decided to stop all chronic RX, 2 wk or 1 month for any acute issue, nothing recurring beyound that. Gave the patients 3 months written notice in Nov. It is now end of April, many still coming in with " I can't get in anywhere", I haven't called yet, I didn't like the first one, etc. I have to draw the line. 3 that went away quietly, that I had no suspions on, turned up on the new statewide database, we got in Jan, getting duplicates from me and 1 other doctor, for 1 year!. You really can't trust anyone. That is 1/4 of them!. Narcotic withdrawal doesn't kill anyone they just wish they could die. But overdoses do, and plenty of doctors get burned, when the family sues, after someone dies, that you didn't realize was overusing or getting somewhere else, etc.

I say draw the line, I have had to.

Cote

To: Sent: Friday, April 27, 2012 5:36:39 PMSubject: Re: Need advice/ moral support, chronic narcotics case

This sounds to me like there's a high potential for the husband to have a little 'problem' of his own. Why would the daughter have any access to the safe which was specifically installed to keep her out of the meds? Was the couple robbed at gunpoint? Anything less would be an invalid excuse. I was originally going to suggest that you might show a little mercy if you saw an official police report showing the daughter had been arrested for her role in this, but really, in this scenario you describe how you've now been burned not once, not twice, but THREE times. Sorry. You could still represcribe the meds when it's time to renew them if you're still so inclined, but for your narcotics contract to mean anything, you have to draw a line somewhere. If they go through withdrawal in the meantime... ...bummer.

This is a really tough case. I don't see that you have done anything "wrong" up to this point, but it does look as if you have to be consistent with your promise to stop prescribing, and it also looks as if the father is being manipulative. I can so relate to this, having been forced into/conned into/allowed to be talked into doing some temporary chronic opioid pain management at a couple of points in my career. I think these patients of yours will have to go elsewhere for their opioids.

This won't really help you, either, but I think primary care physicians in general have to stop accepting that chronic opioid pain management is a normal component of primary care. It should be considered a specialty in and of itself, with offices dedicated to nothing but chronic pain management run by clinicians trained in that field and supported by widely accepted guidelines which, if followed, should be mandated to keep the DEA and other authorities off the prescribers' and patients' cases. I have started to push back vigorously against patients and partialists who are trying to push me into chronic opioid pain management.

My state of NM has the highest per capita opioid pain reliever overdose death rate in the US. The DEA's eyes are relentlessly on everyone here.

Felix, MD

Need advice/ moral support, chronic narcotics case

I have two patients, a couple. The 60s woman with a lot of chronic medical problem, a shattered pelvis and hip, chronic pain for years. I had her on Lortabs for years, but several years ago, when she was in the hospital for 4 months, she was discharged on fentanyl patches and dilaudid pills, and although the doses were decreased, I was never able to get her off the patches. Husband 70, with multiple medical problems, chronic anxiety, on SNRI and Klonopin, which as originally prescribed decades ago. I have known both both at last 10 years, although the man was only my patient for the last few years. Their adopted 30 something year old daughter, not my patient, has chronic pain issues, narcotic addiction. A few years ago stole the woman's meds. On my advice, they got her help, she was on the road to recovery, in a methadone program even. Things were good for a while. Against my better judgement, I did prescibe more meds to replace my patients supply,so she would not go into withdrawal.This year, for some reason the dau quit the methadone program and was back living with the parents, my patients. A few weeks ago they called me urgently and told me that the dau stole the meds again. Even though we have a signed narcotics contract, I did the compassionate thing, (probably the dumb thing) and reprscribed to my patient. they had to pay cash for the meds, since the insurance wouldn't cover it again. Our plan was the dau was kicked out and my patients got a safe so that all meds and scripts could be stored there. Everything was fine until they called me again tonight at 9:30pm, saying they let the dau back in the home because she didn't have a place to live ( my suggestion previously was if she didn't have a place to go, she could go to a homeless shelter) . Now all the meds are gone for the safe. They tell me the town police and the state police are there and they fully expect to have their dau arrested. Aside from these instances, the have never asked for scripts early, and they have been trustworthy patients. The husband says he knows I won't want to see them anymore which makes me feel bad and I am not sure if he says it out of anxiety or to try and manipulate me. I feel really guilty. I don't want the wife to go into withdrawal from going off the 125 mcg fentanyl patches which will probably happen tomorrow. But they were warned last time that I wouldn't reprscribe again. I don't knw what to do,, I feel I have already given them an extra chance. And if I prescribe again, Give them more it's like when you threaten your children and don't follow through. It makes my word garbage.. I think this problem is their fault, letting a known addict into their home even though it is their daughter. . And I don't want my license to be in jeopardy. Any opinions? What would you do?