Wednesday, November 20, 2013

Drug Seeking Behavior: Identifying and Managing Patients

Author: Wendy Perdomo, MS-4
Universidad Iberoamericana (UNIBE)

The most common reason patients visit the emergency department (ED) is due to pain of which represents 75% of complaints in the ED, and the third most common health care
problem.[1] Of these visits to the ED, about 20% of these patients are categorized as “drug-seeking,” which is defined as
anyone seeking prescriptions for recreational purposes or addiction problems.[2] It has been estimated, each time one of these patients comes to the ED, approximately $100 billion is spent to provide appropriate care.[3]

Although it can be difficult to identify these patients there are a few key points to look for during their visit to the ED. First, knowing many of these patients are experts at faking symptoms and pain in order to obtain their reason for visiting the ED: pain medication. Common traits of these patients are visiting the ED several times a month, doctor shopping, and frequent visits to different healthcare centers. These patients will use the same claims such as, they lost their prescription, someone stole their prescription, or they finished the medication. Additionally, it is very common for patients to demand a drug by its specific name versus taking any drug prescribed by using excuses such as having an allergy or that no other drug works. Lastly, they will allege they just moved into town, so there is no primary care provider to contact.[4-5]

Once a drug seeking patient has been identified, the next step is to manage their visit to the ED. First, most EDs have a policy in place for enrolling patients in a pain management contract, so it is useful to familiarize oneself with these guidelines. Second, a letter must be written to the patient’s primary care physician explaining the patient will be enrolled in a pain management contract limiting the number of times the patient can visit the ED. Third, a letter is written to the patient explaining the pain management policy and the number of times he or she can visit the ED for a prescription. It is still imperative the patient receive a proper evaluation to rule out any acute conditions exacerbating a primary condition or pain. This process must be carried out professionally, discretely, and in a non-discriminatory approach. Additionally, it is also helpful to refer the patient to a pain management specialist if you find the patient’s pain has worsened, so that their medication can be readjusted or  changed as deemed necessary by the specialist.[3-4]

References
1) Downey, L. & Zun, L. (2010). Pain management in the emergency department and its relationship to patient satisfaction. Journal of Emergency Trauma Shock, 3(4), 326-330.

2) Grover, C., Elder, J., Close, R., & Curry, S. (2012). How frequently are “Classic” Drug-Seeking Behaviors Used by Drug-Seeking Patients in the Emergency Department? Western Journal Emergency Medicine, 13 (5), 416-421.

3) Baker, S., Schynoll, W., Smith, D., Kennedy-Oehlert, J., Shupe, R., & Sullivan, F. (2011). Managing Drug-Seeking Behaviors & Super Users in the Emergency Department. Retrieved from: https://az414866.vo.msecnd.net/cmsroot/studergroup/media/studergroup/pages/what-we-do/learning-lab/aligned-process/ed-strategies/ed_whitepaper_super_users.pdf?ext=.pdf

4) Steenburg, J. (2002). Tips to spot patients who abuse prescription drugs. Retrieved from: http://www.acpinternist.org/archives/2002/04/drug_abuse.htm

5) American College of Physicians. (2002). 10 Questions to Identify Drug-Seeking Patients. Retrieved from: http://www.acpinternist.org/archives/2002/04/drug_seeking.htm.

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