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An Introduction to Substance Use Disorders for Dental Professionals

Course Number: 545

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. 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 12).

Figure 12. Questions to Identify the Drug-seeking Patient.70

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

  • How often does this patient present?
  • Does the patient need to be seen right away?
  • Does the patient want an appointment toward the end of office hours?
  • Does the patient call or come in after regular business hours?
  • Has the patient told you that he has moved, but doesn't want you to talk to his previous doctor?
  • Is the patient traveling through town, visiting friends or relatives (not a permanent resident)?
  • Is the patient feigning oral problems in an effort to get drugs?
  • 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 state that a specific non-narcotic analgesic does not work or that he is allergic to them?
  • Does the patient claim to be a patient of a practitioner who is currently unavailable?
  • Does the patient pressure the practitioner by eliciting sympathy or guilt or by direct threats?
  • Does the patient utilize a child or elderly person when seeking pain medication?
  • 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.?