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Characteristics of Drug Seeking Patients

A study in the Annals of Emergency Medicine (.pdf file) lists what it believes are several characteristics of drug seeking patients:

A patient requesting opioid medications by name doubled chances of the patient being a drug-seeker
Multiple visits for same complaint increased chances of drug seeking motives by 2.5 times
A “suspicious history” increased the chances of being a drug-seeker by 1.9 times
Symptoms out of proportion to examination increased the chances of being a drug-seeker by 1.8 times
Going to a specific hospital site made it more than three times more likely that a patient was looking for opiates

The study also showed could pick out drug-seeking patients 2 out of 3 times just by their intuition. Looking up a patient on the state databases caused physicians to give opioids to 6.5% of patients that would not have gotten them and caused them to rip up opioid prescriptions for 3% of patients what would have otherwise received them.

23% of emergency department patients are drug seekers?

This Annals study also showed that 23% of more than 500 patients presenting to the emergency department for complaints of toothache, headache or back pain met the definition of a drug seeker. This is probably an overestimate of the total number of drug-seeking patients seeking emergency medical care since those complaints are only a small percentage of all the complaints that are logged in emergency departments, but the study does show how pervasive that drug-seeking behavior appears to be in patients with those presenting complaints.

When opiates are withheld from patients suffering from legitimate pain, more anger needs to be directed toward the many patients who scam the system, not toward the doctors who are reluctant to be hit with criminal charges when a drug seeking patient overdoses.

6 comments

  1. This is why I hate telling any doc what to prescribe me for pain. I hate oxycodone (nauseating) but when I tell them I want hydrocodone or just codeine they look at me sideways like I am a seeker…. even when I say “Look just give me 10 hydrocodone/APAP and I’ll be fine, it’s enough for weekend til my doc is open” and I’ve gotten an argument and then told that I’ll get nothing and to take Ibuprofen.
    Sad that they were willing to give me oxycodone until i asked for something different.

  2. Someone with chronic pain (back, etc) should be under the care of pain management. I’ve been to the er 2x since a car accident and bring my file, my own pain meds
    And drs info. I was in the er after a fall one month after back surgery. The er doc was appreciative that I had all my info so she could help and know I wasn’t looking for pain meds. Unfortunately that’s what I need to do to ensure I receive proper care when needed and not presumed I’m a drug seeker.

  3. I have to deal almost daily with drug seekers at the rural office I work in. I have learned very quickly to scan the med list that the nurses put in the computer before I even walk into the room. When I first started as a NP, I would go through the entire visit and invariably the conversation would turn toward pain medications and then onto the next 15 minutes explanation of why I cannot write them. Now, I start off the conversation with “I can’t write for those meds so we need to come up with alternatives.” Most of the time, they will just get mad and leave which saves me time. I hate when I feel like I am spending most of my time weeding out the seekers and try really hard not to make snap judgments. It can make a provider burn out quickly. Thanks for adding me to your blog roll!

  4. Uh, no.
    23% of toothache, headache, and back pain ED patients are drug seekers, which isn’t 23% of all ED patients, unless someone’s got a reputation around the town junkies as Dr. Feelgood that’s seriously skewing their sign-in complaints.

    Having had three abscessed teeth in my lifetime, I was absolutely seeking drugs at 4PM on a Saturday of a three-day weekend, to stop me from clawing my face open with a hammer to stop the pain. And knowing that one Vicodin worked for most of a day, while T#3 made my head feel like a Macy’s Parade float, was considered giving a good history, despite being 15 times more likely to be a “drug seeker” according to those criteria.

    For that matter, seeking “drugs” (antibiotics are still drugs, right?) for a raging UTI, or U/S-visible kidney stone, would also meet most of the rather vague and largely unhelpful criteria.

    So I think they need to do a little tuning up of the criteria, and the descriptor. Seeking drugs, even for pain relief, when pain is the only treatable symptom, isn’t the problem.

    Seeking them weekly for no discernable symptoms or conditions is the problem.

    State RX databases help enormously in weeding out the former patients from the latter douchebags, as several of the docs I work with would cheerfully attest, from purely anecdotal evidence. Much like taking Demerol out of the ED-available pharmacopeia did.

    But at least someone’s looking at it.

  5. “Drug Seekers” – what the heck else are you supposed to be called? If I hurt bad enough to be in the Emergency Department at 0300, you better believe I’m “drug seeking” and I damn sure expect you to either admit me or send me home with a referral for the problem and some meds more potent than Tylenol!

    We really need to get legislators and lawyers out of the doctor-patient relationship.

  6. michael michaud

    I have debated on a study for the following correlation to narcotic seeking pts:

    To Many Ring Sign- pts with more rings than fingers.

    Sun-glass Sign- come on you all know this one.

    And then the third which is unrelated to narcotic abuse yet still amusing:

    Negative correlation between number of pts in an exam room and actual acuity.

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