Background 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.
Objective 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.
Discussion 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.
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