The murder of an Indiana doctor who was gunned down after he refused to prescribe opioids has shaken many physicians and left them wondering how they should react if faced with a potentially violent patient.
Todd Graham, M.D., was killed by the husband of a patient who had asked him earlier that day for opioids to treat her chronic pain. The man, who later killed himself, went back to confront Graham for refusing to prescribe the painkillers, tracked him down in a parking lot, pulled out a gun and shot him.
Physicians around the country have grown increasingly accustomed to disputes over opioid prescribing. That comes in light of the country’s opioid epidemic and the direction to doctors to cut down on prescribing opioid pain medications.
Pain medicine specialists have their guard up, with efforts underway to train clinicians on how to avoid and de-escalate confrontations with patients, according to Medscape Medical News.
"Nobody would be surprised to hear that a pain-medicine physician was killed," Edward Michna, M.D., who serves on the board of directors of the American Pain Society, told the publication.
RELATED: Mandatory prescriber education among immediate steps recommended by Trump's opioid commission
So what can doctors do to protect themselves from angry patients who may be addicted to opioids? Here are a few suggestions:
Be upfront and set honest expectations. For instance, if you do not prescribe opioids on a first visit and only use them after trying other treatments, let patients know that from the start. Informing patients of that policy can lower the level of conflict and anger, pain management doctors told Medscape.
Provide caring communication to patients. Steve Stanos, D.O., president of the American Academy of Pain Medicine, suggests that doctors take the time to explain to patients why they are not candidates for opioid therapy. You want the patient to know you are looking out for their best interest, not denying them opioids.
Use state prescription drug monitoring programs (PDMP) to check a patient’s history of opioid prescriptions, according to STAT. Some doctors want their peers to use the PDMP, a requirement in many states.
Have a plan for your practice. If a patient becomes upset and verbally abusive, have an action plan, suggests STAT. Is there a backup social worker or psychologist you can bring in? Is there a point at which you want staff to call in security or the police?
Graham’s funeral took place on the same day that a White House Commission studying the opioid problem issued a report in which it called on President Donald Trump to declare a national emergency. In a tweet this morning, Trump said he planned to hold a major briefing on the opioid crisis this afternoon when he speaks in Bedminster, New Jersey.
I will be holding a major briefing on the Opioid crisis, a major problem for our country, today at 3:00 P.M. in Bedminster, N.J.
— Donald J. Trump (@realDonaldTrump) August 8, 2017
The commission outlined a number of immediate steps to reverse the country’s opioid epidemic, including a call to mandate prescriber education.
And, tired of the number of opioid deaths, Multnomah County in Oregon joined a list of other counties, cities and states across the country in filing a lawsuit against major U.S. pharmaceutical companies, accusing them of pushing doctors to overprescribe opioids despite addiction risks, according to The Oregonian. The county filed a $250 million lawsuit, seeking payback from drug companies for the lives lost and millions spent fighting the opioid crisis.