A patient with a history of opioid abuse demands a narcotic prescription. Clinical examination is within normal limits and you do not believe one is indicated. He refuses to leave until he receives it. What should you do?

Correct answer: A. Do not prescribe; if he refuses to leave and the situation escalates, contact security or law enforcement

• A. CORRECT. Two things must both be true. First, you do NOT prescribe a controlled substance that is not clinically indicated — that is illegal diversion regardless of pressure. Second, a patient refusing to leave the premises is a SAFETY and property matter: try de-escalation, offer alternatives (non-opioid analgesia, referral, addiction resources), and if he still will not leave, contact security or law enforcement. Document everything.
• B. A reduced quantity is still an unindicated controlled substance prescription. The problem is that no prescription is justified at all, not the amount.
• C. Prescribing under duress is both illegal and harmful to a patient with opioid use disorder. It also establishes the practice as a soft target.
• D. Referral is appropriate and should be offered — but it does not resolve the immediate situation of a patient refusing to leave, which still requires action.

Note: Practical protections: check the state prescription drug monitoring programme, adopt a written practice policy on controlled substances, and offer NSAID plus acetaminophen combinations, which outperform opioids for most dental pain.