II. Epidemiology

  1. Prescription Drug Diversion is common
    1. Prescription Drug Abusers get their medications from family or friends in over 70% of cases

III. Signs: Drug Seeking or Narcotic Addiction

  1. See Substance Abuse Evaluation
  2. Selling prescription drugs
  3. Prescription forgery
  4. Steeling or borrowing drugs from others
  5. Injecting oral Narcotics
  6. Obtaining Narcotics from multiple physicians
  7. Making appointments at the end of the day, weekends and evenings
  8. Concurrent use of psychoactive substances
    1. Illicit Drugs
    2. Alcohol
  9. Multiple dose increases
    1. Increase despite warnings
    2. Increase despite adverse effects
  10. Resistance to change therapy despite low efficacy
  11. Diminished work and home functioning
  12. Multiple episodes of prescription loss
  13. Excessive flattery of providers
  14. Refusing to grant permission to obtain old records from prior facilities
  15. New patients presenting for refill of long-standing use of controlled substances

IV. Signs: Pseudo-addiction (seeking adequate pain relief)

  1. See Chronic Pain
  2. Aggressive pursuit of more Narcotic
  3. Narcotic hoarding when symptoms are reduced
  4. Requesting specific Narcotics
  5. Dose escalation without physician consent once or twice
  6. Unapproved Narcotic use to treat other symptoms

V. Prevention

  1. Check prescription drug monitoring program (see link below under resources)
  2. Patient should sign a Controlled Substance Contract
  3. Random Urine Drug Screens every 3 to 6 months
    1. Drug screens should be positive for the medication prescribed
    2. Drug screens should be negative for other non-prescribed substances
  4. Discuss with patient the risks of sharing their controlled substances
    1. Risks include Overdose in a patient not tolerant to adverse effects (e.g. respiratory depression)
    2. Children are at particular risk of Overdose
  5. Patient's should properly dispose of unused controlled substances

VI. Resources

  1. Prescription Drug Monitoring Programs (alliance of states sites)
    1. http://www.pmpalliance.org/content/pmp-access

Images: Related links to external sites (from Google)