J Clin Outcomes Manage
Prescribing medications that have potential for abuse
Abstract Objective: To review the underlying causes of patient behavior related to abuse of controlled substance medications, including opioid analgesics prescribed for chronic pain, and outline the approach to management of patients prescribed medications with abuse potential. Methods: Review of the literature and case presentation with discussion. Results: Controlled substance medications, including opioids, sedatives, and stimulants, have the potential to be abused. Signs of medication abuse take the form of aberrant medication-taking behaviors (AMTBs), which include unauthorized dose escalation, doctor shopping, or intake of dangerous combinations of medications. The differential diagnosis for AMTB includes not only addiction but also pseudoaddiction, drug diversion, and chemical coping. Each of these can be differentiated by observing the pattern of patient behavior. Universal precautions, such as use of a medication agreement, random urine drug testing, and ongoing reassessment of function, should be applied to all patients who are prescribed long-term controlled substances to avoid misuse. A thorough evaluation may reveal risk factors that indicate a need for enhanced monitoring of a patient in addition to universal precautions. Failure to meet agreed-upon functional goals requires a change in the treatment plan. Conclusion: Familiarity with the types of AMTBs and universal precautions allows for safe and effective prescribing of controlled substance medications.
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