Prescribing drugs of dependence in general practice

Part A - Clinical Governance Framework

Appendix F. Drug misuse behaviours

Last revised: 01 Nov 2019

Identifying behaviour related to drug misuse

There is a wide spectrum of drug misuse behaviours – many will not be obvious during the consultation. Behaviours are described below.

Drug-seeking patients can often provide very well-developed clinical histories and those histories may seem very ‘real’. There is often a strong aim to work on the desire of doctors to minimise the distress of patients. Rather than being aggressive, many will be very pleasant with a credible story. In addition, not all drugseeking patients are faking symptoms. They may have a legitimate complaint and, over time, have become dependent or tolerant and require larger doses of medication to function in their daily life.80,81

To minimise the resultant harms and risks occurring with drug-seeking behaviour, a practice of never prescribing drugs of dependence to new patients to the practice and a sign in the practice regarding this in the waiting room is advised.

We also advise a one doctor policy within the practice for prescribing any drugs of dependence unless special arrangements are made to cover leave. The aim of this practice is to minimise drug-seeking behaviour and its resulting harms and costs to the healthcare system. A consistent change across all of general practice to these recommendations would result in a shift in drug-seeking behaviour and provide the possibility of a future where doctor shopping may cease.