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.
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.
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