Narcotic Seeking Behavior

1. See Also
   1. Opioid
   2. Narcotic Addiction
   3. Somatization
   4. Chronic Pain
2. Epidemiology
   1. Prescription Drug Diversion is common
      1. Prescription Drug Abusers get their medications from family or friends in over 70% of cases
3. 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
4. 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
5. 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
6. Resources
   1. Prescription Drug Monitoring Programs (alliance of states sites)
      1. http://www.pmpalliance.org/content/pmp-access
7. References
   1. (2012) Presc Lett 19(4): 23
   2. Portenoy (1996) J Pain Symptom Manage 11:203-217
   3. Standridge (2010) Am Fam Physician 81(5): 635-40