No Narcs Warning Posters


This came in from a loyal reader of this blog:

You may find this follow up to be interesting, regarding the issue of various hospitals in South Carolina posting posters that say, “No Shirt, No Shoes, No Narcotics”  with a red “X” across a bottle of prescription medication, that were designed to be posted in hospital emergency department waiting rooms.

It seems that rather than focusing on the potential benefit of discouraging the inappropriate seeking of narcotics, such posters were viewed at the Federal level as potentially deterring patients with legitimate need for pain meds from seeking care.

Check out the article here.

I find it very interesting.  The truth is, though, that they could have come up with better posters.   How about some of you other readers submit some ideas here?


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  14 comments for “No Narcs Warning Posters

  1. Lady McCoy
    February 5, 2014 at 1:28 pm

    “Your medical problem will be evaluated by a professional. Our choice of treatment may not be identical to yours.”

  2. Liana
    February 5, 2014 at 1:06 pm

    Better Living through Positive Chemistry (In Big Bold Letters)

    Anyone requesting narcotics will be required to recite or draw the Krebs Cycle (tiny print)

  3. John Parkin
    February 5, 2014 at 9:55 am

    The best poster I’ve seen recently reads “Ask your doctor if watching pharmaceutical ads on TV is right for you.”

    • Doug Farrago
      February 5, 2014 at 10:00 am

      LOVE IT!!!

  4. Chris Rhody D.O.
    February 5, 2014 at 9:19 am

    As a Family Practitoner a lot of pain patients get pushed to me. Even so called “pain specialists” will not prescribe pain pills. Only injections. Apparently those make a lot of money. So here are my tools to successfully treat pain. First, an objective pain scale that works. I’ve seen these published in the past. For example Childbirth is an 8, Kidney stones are a 9, If you can walk (however poorly) the max is a 6. If you can accomplish your ADLs the max is a 4. I use this and it works. Drug seekers will never admit any lessening of their pain! Therefore the pills do not work, do something else. Second, specialist who do not do what they claim to should be black balled and the list shared, we do. Those who do what they claim are to be rewarded with more work. I once sent a patient with Familial Pancreatitis who came to me already on high doses of narcotics (his old Doctor was going to prison), who went to a “pain specialist-board certified” and was told he could not help because there was nothing to inject. Third, universal medical records. At least across your healthcare system. I would prefer nationwide then eventually world wide. You can have whatever interface you prefer, but the data fields need to be standardized. And while we are at it, meaningful use is when the medlists, allergies, and active diagnoses are right up front not 8 clicks deep. That used to be a rule with paper charts, why does EHR get a pass. And SOAP format, it’s how we were trained to think. These things slow me down a lot just trying to find things I need to see, not tomention crashing everytime I try to open a new note, and just plain freezing for 10 seconds with every keystroke. I volunteer to personally shout down and embarrass any Doctor who says Universal records are bad for health care. With all the forced changes in ACA, I’m sure this is one we all want. I always use the example that Heath Ledger would still be alive if we had this. Fourth, do a DOT standard UDS at least every 60 days. Insurance companies will balk at first. Just inform that you cannot safely treat pain without this. Offer to refer to a “pain specialist” it is much more expensive. I’m not saying to be an MRO, but at least read the latest text. If you do not know what those acronyms mean, strongly consider not prescribing narcotics ever.
    Fourth, understand some people have legitimate chronic pain not from a malignancy. They will be the ones that tell you the med helps but does not totally relive their pain. They will always have your drug in their urine, and no others. If any one ever “fails” a test dismiss immediately. Otherwise you will get a whole lot of seekers as they all tell their friends. Read the text to define failure. Lastly, have a policy that spells all this out. AAFP has a good starting point example. Make sure the patient takes a copy with them.

  5. Pat
    February 4, 2014 at 8:03 am

    “Ask about our free Narcan samples!”

  6. Ryan
    February 3, 2014 at 3:02 pm

    “We don’t have early refills”

    “If you need treatment for your chronic pain, we will gladly schedule with your primary ”

    ” Yes, our doctors have checked with the ER across town ”

    ” Free naltrexone with(in) every pill ”

    ” Our narcotics are IV only “

    • Doug Farrago
      February 3, 2014 at 7:32 pm

      Good ones!

  7. February 3, 2014 at 12:09 pm

    It is unbecoming to an ER to display such a hateful, stereotype-reinforcing poster. As Lance-a-Lot said, a simple policy statement regarding non-emergency drugs could be posted without inviting trouble. That said, the poster could have been a lot more creative.
    How about, “We treat life-threatening withdrawal, but NOT with your drug of choice. You may be admitted for detox.”

  8. Sir-Lance-a-Lot
    February 3, 2014 at 6:08 am

    Well, Duh.

    One might observe that the posters would apear to deter patients without shirts or shoes from seeking care as well, which would also be a violation of EMTALA.

    Other than a simple statement that the ER will not prescribe narcotics for chronic conditions, and will not renew them because they were lost or stolen, I don’t see how you could post any information like this.

    Every patient must be evaluated by a physician, PA, or NP, no matter what his or her complaint is, so you can advise them that this is the policy, but if they’re feeling lucky today, you still have to see them.

    Honestly, this was just a really stupid idea.

    • Doug Farrago
      February 3, 2014 at 11:41 am

      I agree. So let’s get smart. Give me an idea for a poster that is EMTALA clear but gets the point across. Or, just give me a funny poster. I need a laugh.

      • Sir Lance-a-Lot
        February 3, 2014 at 2:08 pm

        Funny poster? But that’s *your* job Doug! 😀

        Just kidding. I’ll think about it…

      • Sir Lance-a-lot
        February 3, 2014 at 10:55 pm

        Here’s one for starters, Doug:

        NO WORK? NO PERCS!

        For the protection of our community, we will prescribe narcotic medicines only in very small quantities, and only to people whom we can verify are gainfully employed.

        • Pat
          February 3, 2014 at 11:10 pm

          there you go “reinforcing hateful stereotypes” again,Lance.

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