IS MY PATIENT

DRUG-SEEKING?
MATTHEW HATHAWAY
COURTNEY SAMANIPOUR
AMANDA SEEDS

OBJECTIVES
RECOGNIZE PRESCRIPTION DRUG ABUSE CRISIS
IDENTIFY JOINT COMMISSION (JCAHO) STANDARDS OF PAIN
MANAGEMENT
DEFINE DRUG-SEEKING BEHAVIOR
IDENTIFY PATIENTS WITH DRUG-SEEKING BEHAVIORS
UNDERSTAND METHODS OF COMMUNICATION WITH A DRUGSEEKING PATIENT

PRESCRIPTION DRUG ABUSE PROBLEM

FORTY FOUR DEATHS EACH DAY IN THE U.S. ARE CAUSED BY OVERDOSE OF
PRESCRIPTION PAINKILLERS
FLORIDA HAS THE 11TH HIGHEST RATE OF PRESCRIPTION DRUG OVERDOSE
DEATHS IN THE NATION (2013)
DRUG OVERDOSE DEATHS EXCEED MOTOR VEHICLE ACCIDENT RELATED
DEATHS IN 29 STATES

JCAHO STANDARDS
RECOGNIZE THE RIGHT OF PATIENTS, RESIDENTS OR CLIENTS
TO APPROPRIATE ASSESSMENT AND MANAGEMENT OF PAIN
SCREEN PATIENTS, RESIDENTS OR CLIENTS FOR PAIN DURING
THEIR INITIAL ASSESSMENT AND, WHEN CRITICALLY REQUIRED,
DURING ONGOING, PERIODIC RE-ASSESSMENTS
EDUCATE PATIENTS, RESIDENTS OR CLIENTS SUFFERING FROM
PAIN, AND THEIR FAMILIES, ABOUT PAIN MANAGEMENT

DRUG-SEEKING BEHAVIOR
DEFINITION

FACTORS

PATIENT HISTORY OR BEHAVIOR

THAT LEADS THE PROVIDER TO
BELIEVE THE PATIENT IS SEEKING
AN OPIOID PAIN RELIEVER FOR
THE PURPOSE OF DRUG ABUSE OR
DRUG DIVERSION

FOUR OR MORE OPIOID PRESCRIPTIONS

FROM FOUR DIFFERENT PROVIDERS OVER
THE LAST YEAR
REQUEST FOR A SPECIFIC OPIOID BY NAME
REPORTING A NON-NARCOTIC ALLERGY
REPORTING LOST OR STOLEN MEDICATION
REPORTING 10/10 PAIN
REPORTING >10/10 PAIN
PRESENTING WITH A CHIEF COMPLAINT OF
HEADACHE, BACK PAIN OR DENTAL PAIN

SIGNS/SYMPTOMS

(S/S)

EVIDENCE OF PHLEBITIS
EROSIONS OF THE NASAL SEPTUM
CHANGES IN PERSONALITY,
SOCIAL HABITS OR ROLE
FUNCTIONING
NEEDLE TRACK MARKS
WITHDRAWAL SYMPTOMS
OPIOID-RELATED ADVERSE
REACTIONS

DRUG-SEEKING ASSESSMENT
SCREENING TOOL TO IDENTIFY DRUG-SEEKING PATIENTS IN THE
EMERGENCY DEPARTMENT
SCORE ASSIGNED BASED UPON DRUG-SEEKING FACTORS AND S/S
SCORE OUT OF 18
ONE POINT GIVEN TO FACTORS AND TWO POINTS GIVEN TO S/S
SCORE >12 POINTS IDENTIFIED AS HIGHLY PROBABLE FOR DRUG-SEEKING

COMMUNICATION WITH A DRUG-SEEKING

PATIENT
ASK CLEAR AND DIRECT QUESTIONS ABOUT DRUG USE IN A RESPECTFUL,
NONJUDGMENTAL MANNER
INFORM PATIENT OF IMPORTANCE OF FULL DISCLOSURE OF DRUG USE SO AS
TO RECEIVE THE MOST OPTIMAL OF CARE
ASK ABOUT BOTH ILLICIT AND PRESCRIPTION DRUGS CONSUMED OVER THE
LAST MONTH
ASK ABOUT QUANTITY AND PATTERN OF DRUGS USED

OPPORTUNITIES AND CHALLENGES

IMPLEMENTATION OF
STANDARDIZED ASSESSMENT TO
IDENTIFY DRUG-SEEKING
PATIENTS
RESOURCES FOR TREATMENT
EVALUATE ACCURACY OF
ASSESSMENT

ASSESSMENT IS VERY SUBJECTIVE

INACCURATE IDENTIFICATION OF
PATIENT AS DRUG-SEEKING
IMPROPER PAIN CONTROL

SUMMARY
PRESCRIPTION DRUG ABUSE IS A GROWING CONCERN
PROPER PAIN MANAGEMENT IS AN IMPORTANT ASPECT OF NURSING
IDENTIFICATION OF THE DRUG-SEEKING PATIENT CAN BE DIFFICULT
OPEN COMMUNICATION WITH THE DRUG-SEEKING PATIENT IS PARAMOUNT

QUESTIONS
HAVE YOU ENCOUNTERED SOMEONE YOU THOUGHT TO BE DRUG-SEEKING
IN YOUR CLINICAL PRACTICE?
WHAT LED YOU TO THIS CONCLUSION?
WAS YOUR IDENTIFICATION ACCURATE?

REFERENCES

ARNSTEIN, P. (2010). IS MY PATIENT DRUG-SEEKING OR IN NEED OF PAIN RELIEF?. NURSING, 40(5), 60-61.
DOI:10.1097/01.NURSE.0000371136.70791.13
CENTERS FOR DISEASE CONTROL & PREVENTION (2015, SEPTEMBER 16). PRESCRIPTION DRUG OVERDOSE. RETRIEVED
FROM HTTP://WWW.CDC.GOV/DRUGOVERDOSE/
GROVER, C. A., CLOSE, R. J., WIELE, E. D., VILLARREAL, K., & GOLDMAN, L. M. (2012). ORIGINAL CONTRIBUTIONS:
QUANTIFYING DRUG-SEEKING BEHAVIOR: A CASE CONTROL STUDY. JOURNAL OF EMERGENCY MEDICINE, 4215-21.
DOI:10.1016/J.JEMERMED.2011.05.065
MCCAFFERY, M., GRIMM, M. A., PASERO, C., FERRELL, B., & UMAN, G. C. (2005). ORIGINAL ARTICLE: ON THE MEANING
OF DRUG SEEKING. PAIN MANAGEMENT NURSING, 6122-136. DOI:10.1016/J.PMN.2005.08.002
THE JOINT COMMISSION. (2015, FEBRUARY 2). FACTS ABOUT PAIN MANAGEMENT | JOINT COMMISSION. RETRIEVED
FROM HTTP://WWW.JOINTCOMMISSION.ORG/PAIN_MANAGEMENT/
TRUST FOR AMERICA'S HEALTH (2013, OCTOBER 7). DRUG ABUSE 2013 DATA FOR FLORIDA. RETRIEVED FROM HTTP://
HEALTHYAMERICANS.ORG/REPORTS/DRUGABUSE2013/RELEASE.PHP?STATEID=FL
WEINER, S. G., GRIGGS, C. A., MITCHELL, P. M., LANGLOIS, B. K., FRIEDMAN, F. D., MOORE, R. L., & ... FELDMAN, J. A.
(2013). PAIN MANAGEMENT AND SEDATION/ORIGINAL RESEARCH: CLINICIAN IMPRESSION VERSUS PRESCRIPTION DRUG
MONITORING PROGRAM CRITERIA IN THE ASSESSMENT OF DRUG-SEEKING BEHAVIOR IN THE EMERGENCY
DEPARTMENT. ANNALS OF EMERGENCY MEDICINE, 62281-289. DOI:10.1016/J.ANNEMERGMED.2013.05.025