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Discussion:
Drug seeking behavior
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What is drug seeking behavior? I hear this term used, but what is the intent? It obviously an entrenched label. It works against those of us who are established with a physician and seek a medication change. It makes starting pain management more dificult for the new patient, even when our complaint is validated by tests.

If I buy a laxative, I am engaging in drug seeking behavior, but I don't suffer sanctions.

This term contributes to predjudicial treatment at the hands of health care professionals; it is perpetuated on other health care professionals by those in authority who use the term loosely.

I've been a nurse for nearly 27 years, and have seen the compassionate nurse labeled as an "enabler" or otherwise incompetent by refusal to apply the term to patients.

Is it simply a justification for providers to call on when faced with a difficult problem? Does it have an ego-saving function for the provider?

Just wondering...-Snake
Posted on 11/16/09, 01:33 pm
32 Replies | Most Recent Add Your Reply
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Reply #1 - 11/16/09  2:44pm
" There are so many people abusing the system, and so many doctors being sued by family of the abusers. Doctors are afraid to let down their guard and because of the abuser, and WE suffer.
What the doctors DON"T understand. Is WE don't want their drugs, WE want treatments to stop the pain. Drugs are their answer for a treatment because they don't know how to repair the damages we have. "
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Reply #2 - 11/16/09  2:45pm
" Interesting Subject Snake..... I found this on the internet to open our discussion, enjoy.

The term "drug seeking" is rarely defined, leaving the reader to infer the meaning by the context in which it is used. A recent article on definitions related to the medical use of opioids did not even include the term "drug seeking" (Savage, Joranson, Covington, Schnoll, Heit, & Gibson, 2003).

Goldman (1999) defined drug seeking as "individuals who knowingly break the law by seeking and obtaining controlled drugs in order to sell them on the street" (p. 99). He identified three categories of drug seekers: (1) those who have chemical dependency, (2) those who seek drugs to sell on the street, and (3) those who are hired by drug dealers to obtain prescriptions they can sell.

Another example of an attempt to define drug seeking is, "Drug-seeking may be seen with either active addiction or pseudoaddiction, or as part of deviant behavior such a drug diversion. A way to distinguish between these conditions is by giving the patient appropriate pain medication..." (Weaver & Schnoll, 2002, p. 6). Pseudoaddiction is defined as behaviors that appear to indicate addiction but actually reflect undertreated pain (Weissman & Haddox, 1989). The authors also stated that some types of drug-seeking behavior may be more predictive of opioid abuse than of pseudoaddiction.

One recent article discusses patients with pain who are also addicted to opioids, referred to as user/ abusers, and suggests that both pain control and abuse disorders are responsible for drug-seeking behavior (Mitra & Sinatra, 2004). These same authors identify what they call a subset of drug seekers who have undertreated pain, or pseudoaddiction. The authors state that in these patients drug-seeking behaviors may resemble addiction but actually reflect the patients' efforts to seek adequate pain relief.

The term "drug seeking" is also defined by Compton (1999) as "a set of behaviors in which an individual makes a directed and concerted effort to obtain a medication... behaviors may include 'clock watching,' frequent requests for early refills, or hoarding analgesics" (p. 429). The point is made that these behaviors are not necessarily evidence of addiction and may be pseudoaddiction.

In the Core Curriculum for Pain Management Nurses, Cox (2003), quotes from Compton (1999), above, stating the same definition and related behaviors. Cox, as did Compton, emphasizes that these do not necessarily mean addiction and possibly are behaviors that indicate pseudoaddiction. Thus, according to Compton and some of the above authors, drug-seeking behavior could be for legitimate or illegitimate purposes.

Clearly, there is no agreement on the definition of drug seeking. In general, it seems that drug seeking is considered any one of a number of seemingly inappropriate attempts to obtain opioids. Without a clear definition of drug seeking, it is difficult to say what behaviors constitute drug seeking. "
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Reply #3 - 11/16/09  3:19pm
" Good citations, Tipper!

This leaves the question of definition of the term "inappropriate". How does a practitioner know what is appropriate until exhaustive testing is done, excluding the obvious broken leg or other trauma?

Doctors did not take an oath to perform the almost "judicial" role of deciding difficult cases discretionally within certain rules. Nor are they necessarily competent to do so.

The time limits imposed on them in their practice, and expense of tests to indicate the appropriateness of treatment often rule out deep thought over a given case of deciding that a patient really needs relief.

If a person presents for relief and has little or no insurance, does it justify expensive testing to determine that he is not trying to get opiates to sell on the street?

Does the fact that some people obtain opiates inappropriately justify stigmatizing patients or witholding needed treatment?

-Snake "
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Reply #4 - 11/16/09  4:23pm
" I've aIways disIiked that word "inappropriate." A word that is nearIy aIways in the eyes of the behoIder rather than any objective criteria. When I was a sociaI worker supervising others, I asked them to avoiId this word unIess it was further defined (for exampIe, "Susie Iaughed inappropriateIy when she saw others crying at the news of the death of a friend's mother.")

MY daughter was IabeIIed "drug-seeking" when she requested something for anxiety during a psychiatric hospitaIization. The staff appIied the IabeI because they "didn't see any signs of anxiety." Not aII anxiety is expressed by pacing or other outwardIy visibIe behaviors.

Nor can pain be judged by anyone other than the person experiencing it. Maybe I have had an amount of medication that is adequate for most peopIe with the same diagnosis. But if I stiII have pain, and continue to ask for reIief, to many that is "drug-seeking."

Even when I have medication that is generaIIy adequate, there are stiII reaIIy bad days, often because of stress or Iack of sIeep, where I need more than my usuaI amount of pain medication. Granted, I shouId have strategies other than increased medication for deaIing with those times, but sometimes, in emergencies, there isn't much of a choice. "
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Reply #5 - 11/16/09  5:11pm
" Wow! Does this hit the mark today!

I've suffered from Chronic pain for about 35 years. Twice, I had an ER doc label me as "drug seeking" when I came to the ER in indescribable pain. At the time I was about 19 yrs old. I was being treated for severe TMJ pain, but the ER doc was too lazy to call up my chart or my private physician. They wouldn't allow my mother to stay with me to "interpret". If you've had pain in that 9.5 to 10 area, you know what I mean when I say, I NEEDED an interpreter. When they refused me pain meds, I threatened to leave Against Medical Advice. I even signed the stupid form. Then they suddenly decided that I "deserved" the med. They immediately came and gave me a shot of demerol. What's that about? Control?

Now I've been a registered nurse since I was 22 yrs old. I haven't been able to work these last 13 of those years because of chronic low back pain and Fibromyalgia. I'll tell you, I was always a compassionate nurse. I KNEW what it felt like to suffer from severe pain. I still occasionally get a stupid doc who will suggest that if I really wanted to, I could just bite my tongue and deal with the pain. "Srug Seeking", huh. "
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Reply #6 - 11/16/09  6:13pm
" Isn't it more advantageous if they page your PM doc, not the alternate, to get the info they need to validate a complaint of pain?

Wouldn't it be more advantageous to have PM docs submit "guidelines" (not standing orders) as to how the E/R is to treat their patients?

I don't use E/Rs anymore, I would have to be willing to be hospitalized to use one. I note that some physicians try to sell services such as C/T, MRI before they order pain meds.

Is this not an attempt to enter into an unfair contract (ie an adhesion contract)or at worst coercion or duress? If I'm out of my mind with pain, I may agree that I started the Great Chicago Fire.

-Snake "
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Reply #7 - 11/16/09  7:53pm
" here's my 2 cents
er doctors are not there to treat chronic conditions. They simply apply whatever band-aid they can. a good e.r. doc should not prescribe anything for more than 30 days,max. narcotics should only be given for a very short time. then a referral to the appropriate specialist, as well as ones pcp are in order.
in the case that one has no pcp(shame on you!!!!) there are appropriate "free" clinics everywhere. If you are in that much pain, and want real help, you'll get the money to go.
now, primary docs are usually useless, unless you need a physical or antibiotics. that being said...a few regular visits and they should be able to tell if you're a junkie. a simple drug test on the spot should clear that one up right away.

to the phrasing of "drug seeking behavior" i have been told by doctors that it refers to a patient seeking a certain type of drug, or a very specific one(like oxycontin for instance). again, this is where a drug test, as well as a comprehensive narcotic contract should straighten out any confusion. once a patient breaks certain guidelines, it is put in their medical records.

patients need to assert that they are being undertreated if that is the case, and demand acceptable answers from their docs as to why they are not being given a drug or a certain strength.

remember, COMMUNICATION. these guidelines(reformed slightly to be applicable to the general population) should be mandatory. every doctor should implement on the spot drug testing and narcotic contracts. and this is coming from a marijuana user, and recently reformed self medicator(no hard stuff, just don't want to pay docs to tell me stuff i know already) "
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Reply #8 - 11/16/09  11:02pm
" I work in the medical field so I compiled a list of comments that I've heard drs and nurses make referencing a patient that is exhibiting "drug seeking behavior".

1. Calling on a Friday to get a narcotic refill and being abusive to the staff about it.

2. Leaving multiple messages for a refill.

3. Calling and telling the dr's nurse he/she they "lost" there Rx or someone has stolen it. Or there pain meds were stolen or lost, more then one time.

4. Going from one drs office to another asking for narcotics.

5. Atempting to change the Rx to reflect more pills or a higher doseage.

6. Attempting to forge a prescription.

7. Running out of your meds earlier then you should be and calling the drs office and demanding a refill.

8. Going to multiple ER's asking for pain meds.

9. Providing the drs office with false information like, bad address, phone number. And writing a bad check to pay for the visit of the visits copay.

10. Providing the dr with false medical records to make your condition look worse then it really is.

I don't agree with all of the above because I've had to call and leave multiple messages due to the nurse not calling me back for days. I just thought I'd share some of the comments I've heard drs make about this. I think drs do tend to use that term loosly at times and I also think alot of good genuine people have had to suffer because of people who are abusing pain meds. Just my opinion.. "
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Reply #9 - 11/16/09  11:37pm
" I agree with that Kmiller.... A lot of us that are in real pain suffer because of those that take prescription medications to get high. I remember after my first surgery some of my "so called" friends came to visit me at home, and the first thing that one of them asked me was; "So Millie, what kind of drugs do they have you on??? I will buy some from you, hehe"
Grrrrrrrrr! I got so pissed! I immediately told him, my medications are not for sale and this are for me and for my pain, not for recreational usage!!!

So yes, there are people out there that want to get a hold of narcotics to use recreation ally, and that is why some of us suffer, because Doctor's have to be on guard from people like that. It is what it is.... "
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Reply #10 - 11/17/09  8:29am
" Interesting list,kmiller. I read some of tipper’s previous citations, and it seems that there is a certain amount of prejudice that varies among specialties. I noted that it is not advisable to use the term “drug seeking” in writing. That says a lot about the term. As far as the nurses go, this is the realm of addiction medicine. As nice as it might be to practice this specialty without attending medical school, nurses lack that qualification.
Commenting on your list:
1. “Calling on a Friday to get a narcotic refill and being abusive to the staff about it.” My provider stipulated that a request (from the pharmacy, not me) should be at least a week in advance, and have an intervening Thursday. I’ve never been abusive, but I’ve had a to-do multiple times with an office girl that was too big for her britches. This rule is a hassle because there can always be a missed pharmacy fax, and you must check to see if it was received and/or faxed. When I was new to my PM doc, the PA told me this office rule AFTER the fact on one of my visits, and delayed a script that he could have written right then on the premise “We don’t know you that well.” Whatever that means.
“2. Leaving multiple messages for a refill.” Whoever put this one on the list didn’t notice that you must treat some of these practitioners like Kindergarteners. If I don’t keep up with mine, I not only miss a refill date, but get blame for not being timely. See above.
Remember that a doctor is never wrong, so don’t bother arguing. This may account for seeking help from another doc on a rare occasion. Some of the situations cited are quite valid, or even criminal, like prescription forging. Others seem to be attributable to ignorance or office efficiency. It is fair to assume that most patients are too naïve about medicine and the language used to “cook” a record so that it looks worse than it is.
-Snake "

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