More Suggestive of Addiction:
Selling prescription drugs
Prescription forgery
Stealing drugs from others
Injecting oral formulations
Obtaining prescription drugs from non-medical sources
Concurrent abuse of alcohol or illicit drugs
Repeated dose escalations or similar noncompliance despite multiple warnings
Repeated visits to other clinicians or emergency rooms without informing prescriber
Drug-related deterioration in function at work, in the family, or socially
Repeated
resistance to changes in therapy despite evidence of adverse drug effects
Less Suggestive of Addiction:
Aggressive complaining about the need for more drugs
Drug hoarding during periods of reduced symptoms
Requesting specific drugs
Openly acquiring similar drugs from other medical sources
Occasional unsanctioned dose escalation or other noncompliance
Unapproved use of the drug to treat another symptom
Reporting psychic effects not intended by the clinician
Resistance to a change in therapy associated with intolerable adverse effects
Intense
expressions of anxiety about recurring symptoms.
Adapted from Portenoy, RK: Opioid therapy for nonmalignant pain. In: Fields HL, Liebeskind JC, eds: Pharmacological Approaches to the Treatment of Chronic Pain: New Concepts and Critical Issues. Progress in Pain Research and Management, Vol. 1. Seattle, IASP Press, 1994, p 267. Taken from Portnoy, RK: Contemporary Diagnosis and Management of Pain in Oncologic Patients, Second Edition. Newtown, PA. Handbooks in Healthcare Co., 1998, p 35.