An Easy Choice

Brett Norén is a man in his late 50s with multiple medical problems. He also has chronic pain, anxiety and ADHD. He scored high on the Prescription Monitoring Website. He came to me on opiates, a stimulant and a low dose benzodiazepine. I saw him for a while and his drug tests were always on target. Then I didn’t hear from him for a few months.

His prescriptions expired. The pharmacy sent renewal requests. I refilled everything except the controlled ones.

Then he reappeared in my schedule.

“I’d like to get back on my meds”, he said. “I’m not doing well without them. My nerves are shot, I can’t sleep because of my pain and I can’t finish anything I start.”

“Well, you’d have to start from scratch with a drug test right now”, I said.

“Oh, I tell you, Doc, it wouldn’t be good.”

“So, what would be in it?”

“Meth”, he answered without hesitation.

“That can cause anxiety and insomnia”, I said.

“Not for me. I feel no pain, I sleep at night and my nerves are doing better when I use.”

“How often?”

“Couple of times a week.”

“So you have a choice. Meth or meds.”

“Meth.”

“Your choice.”

“Even the lorazepam?”

“Yes, it’s a controlled substance.”

“All right, I hear you. I guess I’ll see you in three months for my diabetes”, he said, rose from his chair and started moving toward the door without making eye contact again.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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