“There is no question that patients may have a range of adverse reactions to various medications. If there becomes pattern of expressed preference for specific narcotics, this should be 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 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 0.25 mg of Xanax twice per day but strives to be prescribed 2.0mg four times per day.
Since pain and anxiety are difficult to directly assess, reasonable clinical judgment must be consistently applied. For example, the patient has had rotator cuff repair, 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 in the way of domestic falls 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?
Has the family lost private health insurance as a result of this injury, 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 physicians and case managers to be alert to these potential signs of dependency/misuse of prescription medication.