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Aberrant Drug-Related Behaviors
Distinguished on the Basis of Clinical Experience into
Those that are Relatively More or Less Likely Related to Addiction.

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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.

Portnoy, RK: Contemporary Diagnosis and Management of Pain in Oncologic Patients, Second Edition. Newtown, PA. Handbooks in Healthcare Co., 1998, p 35.

Definitions related to the use of opioids for the treatment of pain. American Pain Society. http://www.ampainsoc.org/advocacy/opioids2 This is a consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine

Establishing a diagnosis for problematic drug-related behavior. http://www.stoppain.org/pcd/content/addiction/establishing.asp#abuse

 

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