And even if they do have access to the records, resistance and persistence from the patients can continue. Dr. Jeffrey Guy, an associate professor of Surgery at Vanderbilt University, said that when drug seeking patients show up in the burn clinic, he usually prints out a state database record with the patients' medication history, and then asks if they are getting medication from other providers.
"They universally deny other sources, and then I will present them with the information in our database," said Guy. "The usual response is that the claim in the database in wrong."
While the database is helpful in looking at a patient's history, many doctors still value that doctor/patient relationship. "I prefer to believe my patients and I prefer to act as a physician based on the relationship of trust," said Dr. Angela Gardner, assistant professor in the department of Surgery at University of Texas Southwestern Medical Center. "It's a touchy issue to talk about people's pain because it can't be measured in a blood test."
But the majority of patients seen in emergency rooms are in pain. They need medication. Suspicions aside, some doctors fear that reacting to their skepticism could lead to deserting a patient who is in severe pain and needs assistance.
Dr. Todd Knoxtarget ="external", director of the Pain and Emergency Medicine Institute, said that pain is the most common reason patient come to the emergency department and chronic pain is seen in 40 percent of these patients. Pain is far more common a problem than substance abuse in the emergency department, he said.
"I feel our potential contribution to the problem of drug diversion and misuse is small, but our opportunity to identify and treat patients with prescription drug abuse problems is much larger," said Knox.
"ER physicians are in a difficult position," said Mehrotra. "This is a larger issue, a societal issue, which we need to address. We have the tip of the iceberg here."
Dr. Paul Ragan, associate professor of psychiatry at Vanderbilt Medical Center, agrees strongly that substance abuse begins outside the hospital and within the communities that which we live.
"I have said for a long time, the emergency rooms of America see the problems that society at large does not want to address," said Ragan.