Identifying the Prescription Drug Abuser

The dental office can be a target for a prescription drug abuser as they may be seeking prescriptions from the office. Paying special attention to medications listed on the medical history may not be sufficient for the patient suspected of abusing prescription drugs as the patient may downplay their use of substances in order to obtain new prescriptions. A key indicator that a patient may be “prescription seeking” is if they skillfully ask for drugs by name, dosage and number of tablets. This should alert a clinician to investigate further. One can call local pharmacies or look up statewide databases which track doctors' prescription-writing, pharmacy prescription-dispensing, and patients' prescription filling activities (Figure 11).

Figure 11. Questions to Identify the Drug-seeking Patient.

If you think a patient may be inappropriately asking you for drugs, consider the following questions:

How often does this patient present?
Has the patient told you that he has moved, but doesn't want you to talk to his previous doctor?
Is the patient paying with cash?
Does the person have a last known address?
Have you had trouble contacting the patient between visits?
Are your prescription pads disappearing?
Does the patient say that only a particular drug will work, or that no other drug he has tried has worked?
Does the patient refuse to go to one primary care physician?
Does the patient frequently report losing medications?
Does the patient demand drugs with high street value?
Does the patient have prescriptions from multiple doctors or have prescriptions filled at multiple pharmacies?
Is the patient cooperating with the full treatment plan-physical therapy, alternative medicines, etc.?

An Introduction to Substance Use Disorders for Dental Professionals
Identifying the Prescription Drug Abuser