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Letter to the Editor

Reducing Patient Aggression and Hostility in Primary Care with Urine Drug Testing

Jerome M. Sampson, MD, MSA, CPE, Wilfred W. Achololnu, Jr, MS, PharmD, BCPP
Volume: 97 Issue: 9 September, 2004

Abstract:

We wish to report a reduction in work place aggression and violence in our clinic after the implementation of regular urine drug testing in high-risk populations. Our primary care clinic is home to about 4,000 patients. We average 10 narcotic renewals a day for patients with chronic nonmalignant pain. Since the new JCAHO standards on pain, we have focused on meeting the standards and on our patients' pain needs.1 In March of 2003 we noticed an increase in nonscheduled workload, walk-in visits, more after-hours calls, and issues with medication renewals in our clinic. Patients' satisfaction went down and aggression in the clinic went up. There were increasing threats to our health care providers and support staff. Concern was so high that we requested a full-time security guard, and increased security measures for our clinic. We had several meetings to study the problem. We discovered these problems were related to pain medications. Through a literature search we found several papers on improving prescribing of opiates. We followed the recommendations, and implemented regular urine toxicological screening (UTS) in patients receiving controlled substances.

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References:

 
2. Merrill JO, Rhodes LA, Deye RA, et al. Mutual mistrust in the medical care of drug users; the keys to the “narc” cabinet. J Gen Intern Med 2002;17:327–333.
 
3. Rosenblum A, Joseph H, Fong C, et al. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. JAMA2003;289:2370–2378.

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