Dealing with Drug-seeking

Doctors need to be aware of behaviours that may indicate patients are drug seeking, such as doctor shopping or asking for drugs by name, and should have practice policies in place to help them say 'no', according to an Australian expert. The authors say there is strong evidence in Australia of increasing harms from prescription drugs of dependence including deaths from overdose. The authors highlight signs of drug-seeking to watch for and point out that dependency on prescription drugs may occur at any age, within any cultural group, and across any educational class.
Dr Jenny James, Medical Coordinator for the Substance Misuse Program at the Sydney West Aboriginal Health Service, calls for all GPs to develop practice policies that clearly state their approach to prescribing drugs of dependence. “All general practices should have a practice policy on prescribing drugs of dependence, as appropriate and safe prescribing is not possible unless there is a team approach.”
“I see how the harms of prescription-drug misuse extend far and wide into the community,” Dr James says. “Between 2001 and 2012 more than 800 Australians died from use of the prescription painkiller oxycodone, and more than half of these people died accidentally. Options such as opioid substitution therapy, controlled prescribing and controlled dispensing should be considered.”
Indicators of drug-seeking behaviour include;
- aggressive complaining about the need for a drug
- asking for specific drugs by name, and
- anger when questioned about symptoms such as pain.
The author says, “Harms from prescription drugs, including deaths from overdose, continue to rise in Australia. Dependency on prescription drugs can occur at any age, within any cultural group and across any educational class.”
Dr James says, “GP practices need to respond to the strong evidence that serious harms can result from misuse of prescription drugs of dependence.”
People who misuse prescription drugs are most commonly seeking prescriptions for opioids and benzodiazepines. Other misused prescription drugs include the new antipsychotics such as quetiapine and olanzapine, and stimulants such as dexamphetamine and methylphenidate. Anabolic steroids are also increasingly misused.
There have been large increases in opioid prescribing in Australia, with the total number of prescriptions on the Pharmaceutical Benefits Scheme (PBS) increasing threefold between 1992 and 2007 (2.4 million to 7 million). Oxycodone was the seventh leading drug prescribed in general practice in 2014.
Dr James recommends that general practices have a practice policy on prescribing drugs of dependence. All Australian GPs should register with the Prescription Shopping Information Service, where they can ask if a patient has been identified as a prescription shopper in the previous three months. The patient’s consent is not necessary for this inquiry.
“When a patient is asking for a drug of dependence, it is a challenging situation, with GPs put in a difficult position. GPs can say ‘I don’t prescribe drugs of dependence’, then shift the focus towards seeing what other strategies can be used to help the patient with their presenting problem If a patient requires an ongoing prescription for a drug of dependence, a full biopsychosocial assessment needs to be done. Clear boundaries need to be set with prescribing as well, such as no telephone requests for extension or allowances for ‘lost’ scripts.”
The latest issue of Australian Prescriber also provides an update for dentists by Christopher Daly, Chair of the Dental Therapeutics Committee, Australian Dental Association, on drug-seeking behaviour. Dentists should be aware that patients may seek prescriptions for benzodiazepines or opioids in order to misuse or sell those drugs. And they need to be suspicious of requests for opioid prescriptions from patients who claim to have severe dental pain, present with self-inflicted intra-oral injuries, or who have deliberately irritated previous dental work