Identifying drug-seeking behaviors in your patients
Key Takeaways
Drug-seeking behaviors is a term describing patients’ attempts to obtain specific medications. These may be prompted by addiction to prescribed medications for other conditions.
Know your patient and their conditions, so you can verify their needs. Learn about their substance abuse history, and look out for “doctor shopping,” when they visit multiple physicians to get the medications they want.
Watch for signs of drug-seeking behaviors such as claiming prescriptions were lost, exaggerating symptoms, or requesting higher doses. If you suspect substance abuse, work with the patient to address their problem, and seek treatment for them.
As physicians, we have likely seen drug-seeking behaviors from patients, whether we knew what it was at the time or not. Often, drug-seeking patients can be so convincing that we may even believe they need the drug.
"Drug-seeking behavior" is a commonly used (but poorly defined) term to describe a patient's manipulative or demanding behavior to obtain specific medications. Such patients may imply that the only possible solution to their medical problem is a prescription for a controlled substance.
Opioid analgesics, sedative-hypnotics, and stimulants are the most common prescription medications that are misused and abused this way. As a result, patients with acute or chronic pain, anxiety disorders, sleep disorders and attention-deficit disorder are at risk of addiction due to the pharmacological properties of these substances, and therefore are at increased risk of this behavior. Monitor for this when prescribing medications with such addictive potential. The following tips can help to detect addictive behaviors.
Get to know your patient
Part of our job is to ensure our patients’ safety, which includes recognizing any warning signs associated with drug-seeking behavior.
A 2017 study published in PLoS One found that the most common rationale for deciding a patient wasn’t drug-seeking was that they appeared truthful and “their story fit.”[]
To assess if their story fits, look for clues in the patient's symptom demeanor, presentation, and (possibly) employment status to judge if they’re being truthful. Ask the right questions, do a thorough physical exam, inquire about their mental health, be in tune with their body language, and educate yourself on drug-seeking behaviors.
‘Doctor shopping’
We must always inquire about our patients' substance use history, including alcohol, illicit drugs, and prescription medications. Patients who abuse prescription drugs may exhibit specific patterns such as escalating use, drug-seeking behavior, and “doctor shopping.”
Doctor shopping refers to patients who visit at least two (and sometimes more) physicians to obtain an adequate (or increasing) supply of controlled prescriptions. These patients will often role play with well-intentioned but naive physicians to get multiple prescriptions for either personal use, or to sell for the purposes of supporting other drug habits.
This behavior is most commonly seen in acute settings such as emergency departments or urgent care clinics where the staff doesn’t know the patient.
These patients often present after hours and claim to be from “out of town.”
Warning signs
The PLOS One study showed that one of the most tell-tale signs of drug-seeking behavior is requesting a specific prescription medication by name. They may ask for a particular opioid or benzodiazepine. When presented with an alternative medication, they may make excuses such as "I have tried this medication, and it does not work" or "I am allergic to this medication."
Other warning signs associated with drug-seeking behaviors include:[]
Claiming prescriptions were lost or stolen
Exaggerated descriptions of pain symptoms
Requesting to have the dose increased or asking for a specific drug by name
Refusing to consider other drugs or non-drug treatments
Addressing drug-seeking behavior
It’s essential to have open, honest relationships with patients when prescribing controlled medications.[] Always discuss the addictive qualities of medications with your patients, inform them that you’ll be carefully monitoring them when they’re taking these medications, and discuss alternative treatment approaches.
A strong physician-patient relationship increases the likelihood that your patient will be honest with you if they struggle with addiction or feel they’re misusing controlled medications.
When treating patients on controlled substances, the earlier you can identify red flags, the better.
Watch for changes in behavior or warning signs they may be under the influence:[]
Dilated pupils
Slurred speech
Mood changes
Disheveled appearance
Poor concentration and judgment
Noticeable weight gain or loss
If you suspect your patient may be abusing prescription medications, express your concerns in a non-judgmental manner as soon as possible.
Explain why you’re concerned, describe why it may be risky for them to continue taking the medication, and commit to working with them to help them overcome this misuse and find alternative treatments to help treat their underlying disorder.
If you believe it’s necessary to stop prescribing the controlled substance, educate your patient about potential withdrawal symptoms, and attempt to refer them to a formal addiction-treatment provider.
If they refuse to stop taking these medications, do your best to help manage potential withdrawals and provide addiction resources or referrals as appropriate. If they still deny a problem, document your attempts to manage their concerns, alongside their reactions and/or resistance to suggested treatment options going forward.
What this means for you
Drug-seeking patients will go to great lengths to try and get the prescription medications they want. They may imply that a controlled substance is the only solution to their problems. Do your research and read up on the tell-tale signs of substance abuse and tactics commonly employed by drug-seeking patients. If you suspect your patient may be abusing prescription medications, express your concerns in a non-judgmental manner, and work to help them overcome this misuse and find alternative treatments for their underlying disorder.