thank you for your detailed posting. As I read your posting, the one thought that keep coming to me was the importance of communication and detailed assessment.  Was it ever asked how often Patricia was taking the narcotic and how long ago did she take it?  Perhaps she has not needed a strong narcotic every day and has found other alternatives to pain relief. Perhaps she only needs it occasionally. It would be helpful if people monitored on narcotics would have an electronic sign in and out system whereby they could only get x number of doses in one day. Of course this would be expensive but may in the end save not only money but lives as well. What do you think? This way, the practitioner would have access to each patient’s pattern of use.