6 ways to spot prescription drug-seeking behaviours
Large increases in opioid prescribing in Australia have led to calls for there to be more awareness about the challenges of dealing with patients who are seeking prescription drugs.
There has been a threefold increase of the total number of opioid prescriptions on the Pharmaceutical Benefits Scheme between 1992 and 2007 and oxycodone was the seventh leading drug prescribed in general practice in 2014. Disturbingly, over 800 Australians died from the prescription painkiller oxycodone between 2001 and 2012.
The most common drugs that people seek prescriptions for are opioids and benzodiazepines.
According to an article in Australian Prescriber, GPs should be aware of typical drug seeking behaviours, such as:
- Aggressively complaining about a need for a drug.
- Asking for specific drugs by name.
- Asking for brand names.
- Requesting to have the dose increased.
- Claiming multiple allergies to alternative drugs.
- Anger or irritability when questioned closely about symptoms such as pain.
The authors note that some patients seeking drugs of dependence may present without these behaviours. They say common contexts for drug-seeking behaviour includes those who develop dependence after taking opioids, benzodiazepines and other psychotropic drugs, those dependent on illegal opioids such as heroin who have an unmet demand for treatment of those illicit substances, people who want to sell drugs of dependence and people who would never associate themselves with ‘people who use drugs’ but may self-medicate to feel better.
Dr Jenny James, Medical Coordinator for the Substance Misuse Program at the Sydney West Aboriginal Health Service says all GP practices should have a strategy to outline their approach to prescribing drugs of dependence.
“GP practices need to respond to the strong evidence that serious harms can result from misuse of prescription drugs of dependence.”
The authors say an advantage of a practice policy is that it gives GPs a response when they find it difficult to refuse requests for drugs of dependence.
“A GP can say ‘I don’t prescribe drugs of dependence’, or ‘It is our practice policy not to prescribe drugs of dependence’, or ‘It is recommended by health guidelines that we do not prescribe these medicines’. Further explanations are not needed. The GP can then suggest that the focus is shifted to seeing what other strategies can be used to help the patient with their presenting problem,” the authors wrote.
All GPs should register with the Prescription Shopping Information Service, where they can find out 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.