Addiction: part II. Identification and management of the drug-seeking patient.
The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chronic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask patients about their substance-use history, including alcohol, illicit drugs and prescription drugs. Patients who abuse prescription drugs may exhibit certain patterns, such as escalating use, drug-seeking behavior and doctor shopping. A basic clinical survival skill in situations in which patients exert pressure on the physician to obtain a prescription drug is to say "no" and stick with it. Physicians who overprescribe can be characterized by the four "Ds"-dated, duped, dishonest and disabled. Maintaining a current knowledge base, documenting the decisions that guide the treatment process and seeking consultation are important risk-management strategies that improve clinical care and outcomes.
Longo
L P
LP
University of Wisconsin Medical School, Milwaukee, USA.
Parran
T
T
Johnson
B
B
Kinsey
W
W
D000208:Acute Disease; D001008:Anxiety Disorders / Q000150:complications; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications; D002908:Chronic Disease; D008192:Deception; D011307:Drug Prescriptions; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D005194:Family Practice / Q000331:legislation & jurisprudence / Q000379:methods*; D006801:Humans; D008403:Mass Screening; D008487:Medical History Taking; D010146:Pain / Q000150:complications; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010817:Physician-Patient Relations; D012307:Risk Factors; D012308:Risk Management / Q000331:legislation & jurisprudence; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D014481:United States