Drug-seeking Patients: How to Spot Them, Treat Them, and Protect Your Practice
By Nancy Young, director of Risk Management, Crozer-Chester Medical Center
Drug seeking behavior describes the presentation of people falsely reporting symptoms in order to obtain a prescription or requesting a drug in order to maintain dependence. Behaviors of patients that may lead to them being referred to as “drug-seekers” include, going to different emergency departments to get opioids, telling inconsistent stories about pain or medical history, or asking for a refill because the prescription was lost or stolen.
Drug seeking is a common and serious problem, and the inability to identify and manage drug-seeking patients can make a physician’s practice unpleasant and frustrating. Physicians face a dilemma in their desire to treat a patient versus the concern of sanction. Most patients who take prescribed narcotic analgesics; sedative-hypnotics or stimulants use them responsibly, as directed. However, drugs of this type generate scrutiny from the U.S. Drug Enforcement Agency (DEA) and other authorities because of their abuse potential. According to the American Society of Addiction Medicine, physicians’ concerns about possible legal, regulatory, licensing or other third-party sanctions related to the prescription of controlled substances may contribute significantly to the under treatment of pain syndromes and anxiety disorders.
According to the President’s National Drug Control Strategy report of March 2004, a National Survey of Drug Use and Health found that the misuse of psychotherapeutic drugs-pain relievers, tranquilizers, stimulants and sedatives- was the second leading category of illicit drug use in 2002, following marijuana. An estimated 6.2 million Americans (approximately 2.6 percent of the population age 12 and older) had used a psychotherapeutic drug for non-medical reasons in the month prior to the survey.
Under the Controlled Substances Act, these Schedule II or III drugs are the most alarming form of prescription drug abuse. These drugs, by definition have a high potential for abuse, but they also have an accepted medical use. The challenge is not to ban these substances, which would undermine the legitimate medical purposes, but to suppress the abuse of prescription drugs.
Drug addicted patients are not always easy to spot. College students, executives, suburban moms and even physician themselves can all become addicts. Besides those who self-medicate to ease emotional pain, “dual diagnosis” mental health and substance abuse issues, there are many addicts who started taking narcotics for a legitimate reason, possibly after an injury or major surgery. Since these patients may be more motivated to kick their habit, physicians would do well to talk to them about getting into treatment for their addiction or referring them to a pain management specialist.
There are also individuals you might encounter who are dependent on illicit opioids and use prescription drugs to relieve symptoms of withdrawal, to enhance other drugs or they may be professional drug dealers.
“Drug- seeking behavior” may consist of vague symptoms of pain, conditions that are difficult to prove or disprove, such as low back pain, migraine or toothache; a request for medication by name and dose, allergies to nearly everything except the drug of choice, and losing prescriptions or medication are signs of concern.
If you are seeing a patient for the first time and suspect drug abuse, you can tell him or her that you don’t prescribe narcotics, etc. for new patients until you have reviewed their old records. It’s important that you ask for a list of all previous doctors on the new patient intake form. Ask about all current medications and those from the recent past. Get a medical record release and let the patient know you’ll be reviewing records from their previous doctors.
The physician is in a unique position not only to prescribe needed medications appropriately, but also to identify prescription drug abuse when it exists and help the patient recognize the problem, set goals for recovery, and seek appropriate treatment when necessary. Protect your practice by documenting thoroughly, and always keep the best interest of the patient first. It’s the physician’s responsibility to prescribe the right drugs for the right patients at the right time.
Drug-seeking Patients Quiz and Answers
Drug-seeking Patients Quiz (July 2006)
Drug-seeking Patients Answers (July 2006)