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For Doctors and Physicians: How To Treat Patients in a Drug Seeking World

When it comes to catching a buzz, drug seeking addicts will do anything to get high. This includes making unnecessary trips to the doctor or emergency room hoping some unsuspecting healthcare provider will administer them a narcotic drug that will get them loaded. If you are a doctor or a nurse, you need to know what to look for when it comes to drug-seeking behavior.

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Opioid Abuse and Pain Med Seekers are At An All-Time High

It’s no secret that the United States is in the middle of an opioid crisis. Millions of Americans are addicted to legal opioids like Hydrocodone, Oxycodone, and Fentanyl. Because these drugs are so addictive and are now regulated by the Drug Enforcement Agency, opioid addicts are having a difficult time obtaining these drugs by doctor-shopping and going to multiple providers. Their solution is to frequent emergency rooms with “legitimate” injuries that would prompt healthcare providers to write a prescription for pain pills or administer drugs intravenously. In this blog, we will help you identify drug-seeking behavior and give you some suggestions for responding to those who are at the hospital to get high.

Prescription Drug Monitoring Programs Help Doctors Curb Drug-Seeking Behavior

Prescription drug monitoring programs (PDMPs) are one of the most effective tools to help prescribing doctors identify drug-seeking behavior. According to Centers for Disease Control, “a PDMP is a statewide electronic database that tracks all controlled substance prescriptions. Authorized users can access prescription data such as medications dispensed and doses. PDMPs improve patient safety by allowing clinicians to identify patients who are obtaining opioids from multiple providers, calculate the total amount of opioids prescribed per day, and identify patients who are being prescribed other substances that may increase risk of opioids—such as benzodiazepines.” Currently, 49 states use PDMPs. It is recommended that every doctor who is prescribing opioids use the PDMP before they write a prescription. If someone is flagged in the system, you should not ignore this. This no doubt means that the person who has sought pain relief is an addict.

For Doctors: Identifying Drug-Seeking Behavior

According to Sean – who is an expert on drug-seeking behavior because he has employed it effectively dozens of times in a hospital setting – here are some tell-tale signs that you are dealing with a drug-seeker:

  • A patient will complain of extreme pain and beg for relief. “Please, doc, I am in the worse pain I have ever been in. I need some relief. Please give me something for pain.” While many people who are in extreme pain might say this, an opioid addict will be insistent and become angry if they don’t get their way.
  • Patients will direct the doctor to use specific drugs. “I don’t respond to non-narcotic pain medication. I have a high tolerance. I need something strong like Fentanyl.”
  • They will say they are allergic to specific drugs. “I can’t take Tramadol. I am allergic to it. And, I can’t take NSAIDs because they upset my stomach.”
  • They will play dumb. “I have had this injury before. Last time I can to the hospital, they gave me something that really worked for pain. I think it started with the letter ‘d.’ Something like diluted. Dilaudid? Yes, that’s it!”
  • A patient will act concerned about getting pain meds. “I really need help with this pain, but I don’t want to go through opioid withdrawal. This won’t happen to me, will it?” Although this might be a legitimate concern for people who aren’t drug addicts, you should be on the lookout for this as a manipulative tool employed by addicts.
  • They will demonstrate no evidence of real symptoms. Although they will say they hurt their back, for instance, an MRI will show no injury.
  • Someone will show positive on a drug screen for opioids and other drugs. If someone already has opioids in their system, they don’t need any more.
  • Their injury will seem strange and unexplained. For example, they might have a bad burn of some kind but can’t offer a reasonable explanation for how it got there.
  • They might say they were in a car accident a few days ago and they are hurting, but they can’t produce any proof that there actually was an accident like a police report.
  • They report that they are experiencing 10/10 pain, but they are not acting as if they are in pain. They might talk on their cell phone or gobble down food and sodas from the snack machine instead of demonstrating real pain.
  • The person may seem to be particularly knowledgeable about different pain medications. If they know names of certain opioids and ask for them specifically, or reject a different type of opioid, they are probably an addict.
  • If you suspect drug-seeking behavior and offer a non-narcotic pain medication, the person will get angry and throw a fit. Someone who doesn’t have a drug problem really won’t know the difference and will accept what you give them.
  • Many heroin addicts go to the hospital to get a fix on legal opioids. If you see track marks on your patient’s arms, they are probably there looking for you to give them a “get well” shot.

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How To Handle Drug-Seeking Behavior If You Are A Doctor

As a doctor who has a sincere desire to help patients be pain-free when they present with pain, it can be difficult to make a decision about when to administer opioids. You certainly don’t want to treat a patient who doesn’t have a drug problem as though they are an addict. This would be insensitive and unprofessional. However; it is better to err on the side of caution if you suspect someone is guilty of drug-seeking behavior. If you think someone is at the hospital to obtain drugs, it is best to offer a non-narcotic medication. Someone who is in real pain will probably say something like, “I don’t care what you give me, as long as it takes my pain away.” As Sean explained, someone who is there to get a buzz will likely react with hostility and anger. Check the statewide PDMP. If you get a flag, you know you are dealing with someone who is there to get high off opioids or narcotics. In this case, you should recognize the situation for what it is. If someone has visited a number of different providers, or has filled prescriptions for a lot of different drugs in recent months, they are undoubtedly a drug-seeker. Administer a drug test. A toxicology screen can provide irrefutable evidence that someone in your care has a drug problem. Someone who is there to use you to get high will most likely show positive for opioids, but they may also have marijuana, cocaine, methamphetamines, or other drugs in their system.

One Man Shares His Story On Opioid Addiction

My name is Sean and I am a recovering addict. I am recovering from the use of opioids. I have a year-and-a-half clean. I am still ashamed of the lengths I would go to so I could get drugs. Hydrocodone was my favorite. I found that it was much easier to get than the harder stuff like Oxy or Fentanyl. I got hooked on opioids because I had chronic knee pain. I was prescribed Hydrocodone from my doctor for the first time in 2012 and I fell in love with the stuff. I started abusing it and taking it five or six times a day. I ignored the prescription, which told me I should take it every four to six hours. Before long, I was doctor-shopping. I found what they call a “pill mill.” All I had to do was pay the doctor for a visit, get my height and weight taken, and he would write me a prescription. I went there at least three times every month and would get a script for 90 Hydrocodone and 60 Xanax like clockwork. Within a year, they shut him down and I was terrified. What was I going to do without my magic pills? I ended up being what they call a “frequent flier” at the emergency rooms around town. I would go for a number of reasons. Like, I would tell the staff I fell off a ladder and hurt my back or that I pulled a muscle at the gym. They would give me an IV with pain meds and then send me home with a prescription. But, after awhile they got wise and started prescribing me non-narcotic medication like Tramadol. That infuriated me.

Sean Shares His Experience With Doctors To Identify Drug-Seeking Behavior

After a lot of terrible experiences – I will spare you the details – I got clean after throwing up blood and hitting bottom. I went to rehab for ninety days and went through the pain of withdrawal. I am lucky to be alive. Now, I spend a lot of my time educating doctors about how to look for drug-seeking behavior. Except for the pill mill doctor who obviously just dispensed large quantities of pills to make money, I believe the doctors I visited were victimized by me. They genuinely wanted to help me, but I just manipulated them. I don’t want this to happen to you. I want doctors to understand that people who are addicted to opioids will do anything to get more of their drug of choice. They will even injure themselves to have a real injury to present to the emergency room staff. Once time, I actually sliced my finger with a knife and had to get stitches. It’s crazy, I know. Doctors should be warned that drug addicts are highly manipulative and can make healthcare providers into enablers.

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As Always, A Doctor Should First Do No Harm

Recent statistics show that there has been a more than 34-fold increase in fatal opioid overdoses since 1999. This should give treating doctors cause for concern. Doctors have a responsibility to help prevent opioid overdoses by prescribing pain medication only when it is absolutely necessary. If you identify that someone as a drug seeker, you should be honest with the patient. For instance, if they are flagged by a PDMP, tell them. Explain that you have learned that they have been taking large amounts of opioids and that you don’t feel comfortable giving them narcotics. If they show positive on a drug screen, talk to them about it. Approach these situations with compassion. Ask the person if they are ready to get help for their addiction and educate them on the dangers of opioids. If the patient says they need help, have resources available for them so they can get treatment.