Drug-abusing patients - Can I refuse to treat them?

Abstract

In the past few months, there have been increasing numbers of drug-abusing patients attending my practice. More recently, an anorexic, very agitated and nervous 20-year-old presented at my consulting rooms requesting medication for pain. He reported using methamphetamine (‘tik’) for the better part of 5 years. When he was refused pain medication he became aggressive and violent towards staff members. What are my ethical obligations, and can I refuse to treat patients who abuse drugs?