Street drugs

August 2010

FocusStreet drugs

Prescription drug misuse

Volume 39, No.8, August 2010 Pages 540-546

Benny Monheit


Recognising and dealing with patients who seek drugs for nonmedical purposes can be a difficult problem in general practice. ‘Prescription shoppers’ and patients with chronic nonmalignant pain problems are the main people who constitute this small but problematic group. The main drugs they seek are benzodiazepines and opioids.


To provide data on current trends in prescription drug abuse and to discuss different strategies on how to deal with this issue in the clinic setting.


Misuse of prescription drugs can take the form of injecting oral drugs, selling them on the street, or simply overusing the prescribed amount so that patients run short before the due date and then request extra prescriptions from the doctor. Currently oxycontin and alprazolam are the most abused drugs in Australia. Adequate prescription monitoring mechanisms at the systems level are lacking so we need to rely on our clinical skills and the patient’s behaviour pattern over time to detect problematic prescription drug misuse. Management strategies may include saying ‘no’ to patients, having a treatment plan, and adopting a universal precaution approach toward all patients prescribed drugs of addiction. Among patients with chronic nonmalignant pain, requests for increasing opioid doses need careful assessment to elucidate any nonmedical factors that may be at play.

The earliest known records of prescriptions for drugs were found on clay tablets, used by the priest/healers in ancient Babylon around 2600 BC. For many centuries all pharmaceutical products remained totally unregulated by government. By the 19th century even drugs such as morphine, laudanum and cocaine were readily available in Western countries through travelling vendors, via drug stores and through mail order. The problem of addiction to these drugs became increasingly recognised, and in 1914 the United States of America became the first country to introduce legislation which required the sale of narcotics to be restricted to licensed physicians or pharmacists.1,2 Since then, there have been small groups of people and organisations that have tried to sidestep the rules on prescribing for a range of reasons, primarily revolving around pleasure, comfort and greed.

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