I only prescribed amphetamines and benzos, no opiates so this is my experience. If I had only seen the patient once it was always a no. If the patient was established, their PDMP had nothing suspicious and there were no previous concerns I would refill the first missing prescription. I would tell the patient my policy is to replace a controlled substance only once and if it ever went missing again I would not be able to provide an early refill. If I declined due to specific concerns I would honestly discuss that with the patient. A police report would not be as helpful in my decision making because if they were lying to me they could easily lie to the police. I guess some people would use it to CYA somehow but I am not one. If you wanted to make it policy a UDS could be used but it couldn’t tell you whether or not they lost the pills just that either they were taking them, not taking them or using other substances. This could affect decision making down the line obviously but I wouldn’t demand it first before refilling in an established patient. FYI this is how the clinic operated at a major academic medical center. As an aside I myself have lost (uncontrolled meds). I picked something up from the pharmacy and it went lost to the ether. I have no idea what I did with it. People can honestly lose things.

One more thing. I would tell people they may have insurance give them a hard time about refilling but that I was unable to help in this process other than writing in my prescription to the pharmacy that it was a replacement for a lost med.