Trick of the Trade: Prescribing opiates

As emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”.

Trick of the Trade

When writing opiate prescriptions, you might consider developing a system. Some people dispense these medications in increments of 10’s. Some choose increments of 10, but starting with 8 (8, 18, 28, or 38 tablets). In fact, I have heard of one attending use only prime numbers!

I used to write “Do not drive while taking medications” on the prescriptions, and so when prescriptions didn’t have this additional recommendation, I knew that I did not write them. I’m unfortunately not as consistent doing this and so now it’s not a helpful screening approach for me.

What system have you used or heard of?

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