To share medication: Patients may have a range of adverse reactions to various medications. If there is pattern of expressed preference for specific narcotics, this is, of course, a warning flag. And when that preference becomes a demand, and the demand begins to increase, there may be some unexamined factors at play:
a. Is the patient stockpiling the drugs for later share or use
b. Is the patient sharing the drugs with friends and family
c. Is the patient trading prescription drugs for recreational drugs
d. Is the patient engaging in sale and distribution of prescribed narcotics
Stepping away from narcotic analgesia (Vicodin, Percocet….Oxycontin) and looking at anxiolytics (Valium, Xanax, Ativan, etc), you may see a pattern in which a patient will not consider BuSpar and directly or indirectly demands Xanax.
That same patient may not accept lower dosages of Xanax twice per day but strives to be prescribed more than is indicated by the symptoms.
Since pain and anxiety can be difficult to directly assess, reasonable clinical judgment must be consistently applied. For example, the patient has had surgery, is in pain and is anxious. However, do the medications prescribed exceed that which would be expected from patients undergoing a similar procedure? Ask these questions:
Is their mood increasingly labile or volatile?
Are they gaining or losing an unusual amount of weight?
Does this patient report new injuries that result in increased demand for medication?
Is medication being prescribed by more than one physician?
Is there a family member with a history of injury or (physical or mental) illness to share the medication?
Has the family lost private health insurance, impacting other members” access to health care and ability to pay for medication?
The above problems may arise within any family structure, but it is incumbent upon us to be alert to these potential signs of dependency/misuse of prescription medication.