5 drug-seeking behaviours


What are the most common behaviours in people with dependencies?

The Royal Australian College of General Practitioners (RACGP) and Australian Prescriber have together provided advice on how to recognise and manage patients who misuse drugs of dependence.

People who misuse prescription drugs most commonly seek prescriptions for opioids and benzodiazepines, they say.

Behaviours of concern include:

  1. Typical requests and complaints

  • 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
  1. Inappropriate self-medicating

  • Taking a few extra, unauthorised doses on occasion
  • Hoarding drugs
  • Using a controlled substance for non-pain relief purposes (e.g. to enhance mood, aid sleep)
  • Injecting an oral formulation
  1. Resistant behaviour

  • Unwilling to consider other drugs or non-drug treatments
  • Frequent unauthorised dose escalations after being told that it is inappropriate
  • Unwilling to sign controlled substances agreement
  • Refusing diagnostic workup or consultation
  1. Manipulative or illegal behaviour

  • Claiming to be on a waiting list for, or unable to afford, dental work and needing to manage dental pain
  • Obtaining controlled drugs from family members (including stealing from older relatives)
  • Using aliases
  • Forging prescriptions
  • Pattern of lost or stolen prescriptions
  • Selling drugs
  • Obtaining controlled drugs from illicit sources
  1. Other typical behaviours

  • Being more concerned about the drug than a medical problem
  • Deterioration at home or work or reduction of social activities because of adverse drug effects

 

Dr Richard O’Regan, an addiction medicine consultant from WA, says healthcare practitioners may come up against resistance when dealing with addiction. Excuses include “nothing else works”, “I can’t sleep without [drug], “I can’t afford a psychologist”, “I’ve done it all before”, and “I haven’t got time to see a physio”.

He says healthcare workers need to be polite, respectful and assertive in response; communicate clearly; and set boundaries regarding prescriptions.

For further information, see below contacts for state and territory legislative frameworks and clinical advisory services:

Australian Capital Territory

Legislative framework:

Pharmaceutical Services Section, ACT Health – 02 6205 0998

24-hour clinical advisory service:

Drug and Alcohol Clinical Advisory Service – 03 9418 1082

South Australia

Legislative framework:

Drugs of Dependence Unit, SA Health – 1300 652 584

24-hour clinical advisory service:

Drug and Alcohol Clinical Advisory Service – 08 8363 8633

New South Wales

Legislative framework:

Pharmaceutical Services Unit, NSW Health – 02 9391 9944

24-hour clinical advisory service:

Drug and Alcohol Specialist Advisory Service – 02 9361 8006 (Sydney) 1800 023 687 (rural)

Tasmania

Legislative framework:

Pharmaceutical Services Branch, Department of Health and Human Services – 03 6166 0400

24-hour clinical advisory service:

Drug and Alcohol Clinical Advisory Service – 1800 630 093

Northern Territory

Legislative framework:

Poisons Control Unit, Department of Health – 08 8922 7341

24-hour clinical advisory service:

Drug and Alcohol Clinical Advisory Service – 1800 111 092

Victoria

Legislative framework:

Drugs and Poisons Regulation, Department of Human Services – 1300 364 545

24-hour clinical advisory service:

Drug and Alcohol Clinical Advisory Service – 1800 812 804

Queensland

Legislative framework:

Medicines and Poisons, Queensland Health – 07 3328 9890

24-hour clinical advisory service:

GPs can phone Alcohol and Drug Information Service – 1800 177 833 to be put through to Alcohol, Tobacco and Other Drugs for clinical advice

Western Australia

Legislative framework:

Pharmaceutical Services Branch, Department of Health – 08 9222 6883

24-hour clinical advisory service:

Clinical Advisory Service – 08 9442 5042

For more information see:

Australian Prescriber 2016, ‘Dealing with drug-seeking behaviour’.

Dr Richard O’Regan 2012, ‘Drug Seeking Behaviour: Identifying & Dealing with the Issues’.

RACGP 2015, ‘Prescribing drugs of dependence in general practice, Part A: clinical governance framework’.

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