Well, I am not even an official AC user (yet) but I had to add my $0.02 after reading these posts...

As I said, we take "walk-in" pts. - and here's a scenario that not infrequently pops up (it's usually on a Saturday or Sunday, at about 2:30 to 3 PM - note that we close at 3 PM those days)...

Two days ago, a "cash only/no insurance" pt comes in complaining of a "sprained neck". She actually tells me "If I could get some Vicoprofen for it, I'll be just fine..." (as if by couching the word Vicodin in Vicoprofen I won't notice it as much. Bwahahahah!)

So, I check the chart. 4 other visits total, spread out over about 3 years, and the last was 2008. All for "sprained neck/back" - and she got (big surprise) Vicodin and Soma every time.

I've been in Urgent Care for 21 years now- 10 in New Jersey, 11 in CA. I do think I've heard about every trick in the book, and know all the red flags. And she had them all:
"Allergy to Codiene"
"Can't take Tylenol because I had Hepatitis B and it hurts my liver"
"Can't take Advil because it hurts my stomach" (and just what did she think Vicoprofen was?)

I had noticed some of the red flags before I even went in to see her, and had already asked one of the MA's to call up Rite Aid and Walgreens and see when she last had Controlled Substances rxs (their pharmacies are all linked country-wide, so I always try them first)
Sure enough...#60 of Tramadol last month, 2 rxs. on the same day (another month) from different docs - one for #20 Percocet and another for #20 of Vicodin.

Well, I've developed my own little method over the years of how I handle drug seekers. After I have verified their recent use (always from different docs at different pharmacies, I go in (they are invariably over-the-top nice "Oh Doctor, I am just so grateful that you were working on this Saturday and could see me..." And, I go through the usual stuff. Take a history, examine them just as I would anyone else...

Then I lay the trap for them to walk into:
Me: "So, when was your last prescription for narcotics, SOMA, etc."
Them: "Oh, gee - that was a LONG time ago - maybe six months or more - I think maybe even the last time I was in here (in 2006)
Me: "I mean for any narcotics, like for dental procedures, surgeries, you know - anything."
Them: "Yes, it was months ago."

Now the bomb drops.
Me: "Well, gee. I'm confused...You see, I checked with a couple of pharmacies and they have a record of your picking up a prescription for this on such-and-such a date, and over here on this date, etc."

{The pt's deer-in-headlights look appears about here.}

Now the litany of excuses begin:
"Well, that wasn't ME, and I have NO idea what you are talking about"
"You know, doctor, my purse was stolen about a month ago. I think someone else has stolen my identity."
"You know, my niece is staying with us, and I suspected that maybe she was using my prescription csrd and getting medications."

And so on.

So now, it's time for the Grand Finale.
Me: "You know, my relationship with my pts. is based on trust, and I have some serious doubts about that with you right now. I don't think I can trust you - you lied to me about when you last obtained these meds, and so now I don't trust you. I cannot help you, I'm sorry. I can offer you alternatives" (which they usually refuse).

I always throw in, "You know, if you really do have issues with these meds, I really recommend that you go to the ER for an intake assessment by one of the counsellors there. They can help refer you to places where you can deal with it."

They are usually so p****ed off at this pount, they can't wait to get out of the room. They know the jig is up.

What really gets me steamed is when they refuse to pay the $75 for the office visit. That happened two days ago, after the woman refused to sign her CC receipt, because she didn't get what she wanted from me.

Arrggghh!!! Now I am out all that time I could have devoted to paying pts., and this idiot has completely wasted my time.

I hate the seekers, I really do...