A patient demands a prescription for oxycodone and states they will not leave the office until the dentist writes one. What is the appropriate management?

Correct answer: B. Attempt de-escalation; if the patient will not leave, call 911 or security

• A. Ignoring someone who is refusing to leave leaves your staff and other patients exposed to an escalating situation. The obligation to maintain a safe environment is not discharged by walking away.
• B. CORRECT. Refusing to leave the premises after being asked converts a clinical encounter into a safety problem. The correct approach is to attempt calm de-escalation and clear limit-setting first, and to summon law enforcement or security if the patient still refuses to leave. Prescribing under duress is never acceptable — it is coerced, clinically unindicated, and generates a documented pattern that drug-seeking individuals actively look for.
• C. Deceiving a patient about what you have prescribed violates veracity and informed consent outright. Substitution may sometimes be clinically right, but it must be disclosed honestly.
• D. Prescribing a controlled substance because you feel threatened is prescribing without a clinical indication. It is unethical, exposes you to licensure action, and marks your practice as a source, which reliably brings repeat demands.

Note: For prescription-seeking behaviour generally: check your state PDMP before writing any controlled substance, document objective findings, offer NSAID/acetaminophen combinations (which outperform opioids for most dental pain), and treat refusal to leave as a security matter rather than a negotiation.