How to identify drug seekers

Some experts feel there are no specific, consistent signs that can help ED staff determine if a patient is truly in pain or feigning pain to fuel a drug addiction, while others think that some behaviors can be attributed to drug seeking.

Susanne J. Pavlovich-Danis, MSN, RN, ARNP-C, CDE, CCRN, currently a nurse practitioner at a private medical practice in Plantation, Fla., who also writes continuing medical education content for ED clinicians, said behaviors sometimes exhibited by drug seekers include:

Changing practices to combat opioid addition

Guzi said it is essential to relieve pain for patients. “Looking at narcotic alternatives and medicating more judiciously is a trend that is occurring nationally,” she said. “We don’t know why some people become addicted and some don’t. Genomics is believed to play a role. Moving to non-narcotic medications whenever possible, providing comfort measures such as ice, warm blankets and repositioning, and using alternative therapies when appropriate such as music and pet therapy can help make patients more comfortable and less reliant on narcotics.” One key driver of the opioid epidemic is the treatment of chronic pain with long-acting opioids, said Solheim. “Rarely are these medications being prescribed from the ED. While emergency providers are not the primary cause of the opioid epidemic, they do play a role in combating it through the care they take in prescribing opioid analgesics.” Overall, very little has changed in the treatment of pain in EDs said Solheim; however, many guidelines and policies have been established to facilitate safe prescribing patterns. Some of the key themes of many of the new prescribing guidelines and policies according to Solheim include:

Solheim said emergency room providers also are advised to consult with resources provided by national organizations like the American College of Emergency Physicians’ emergency prescribing guidelines, in addition to their respective state’s prescribing rules. 

Don't overlook patients who are truly in pain

Given the current climate and concerns about opioid addiction, Guzi said it is important not to label patients when they present with pain. “Whether a patient is experiencing pain from a chronic illness, acute pain from an injury, or the pain of withdrawal, patients are seeking relief from their pain. The pendulum appears to have swung a bit more the other way. We need to look at patients without bias. Our behavior should be the same for each patient.” Even if a patient has a history of addiction, if they get in an auto accident and suffer a broken bone or burns, they still will need pain relief, said Guzi. “Changing the terminology to ‘relief-seeking’ versus ‘drug-seeking’ can help reduce bias. And patients do need relief whether they have an addiction or not.” Some clinicians become reluctant to prescribe narcotics as “Some fear being scammed by drug seekers and are less likely to prescribe the strongest available pain relief options unless overwhelming objective evidence supporting severe pain exists,” said Pavlovich-Danis. “For example, some may not give opioids for back pain or migraines but will readily prescribe them for a fractured femur or third-degree burn.”

Using statewide data bases