Misconceptions
Prescription drug abuse
Prescription drug abuse is a term commonly used to describe excessive and harmful use of prescription medicines by patients.
Opioids, like many other prescription medicines, do have the potential to be misused. It is a mistake to condemn such medications or to avoid them entirely in appropriate circumstances simply because a small minority choose to abuse them.
It is also essential to understand the differences between a patient’s requirement for appropriate medication to manage their pain, and that of the unhealthy and abnormal dependence of an addict abusing their medicine.
The simplest and most reliable way to distinguish appropriate use of opioids from their abuse is to consider whether they are being used for a legitimate medical purpose in accordance with the directions of a competent and ethical treating physician. Patients who take such medications for the right reasons and in the right doses cannot be described as abusing medications.
When prescription medications are obtained illegally (e.g. by theft, from friends, family, or bought from drug sellers), when they are taken for non-medical purposes, or when they are taken in a fashion or quantity not recommended by a treating physician, this should be seen as problem drug use. Patients should be referred to the appropriate agency to assist with this problem, for example specialists in addiction medicine.
Is any patient group particularly susceptible to prescription drug abuse?
It is not possible to assess an individual’s propensity to problem drug use by means of screening questionnaires. Before prescribing opioid medications, physicians should assess the patient, communicate with other treating healthcare teams and thoroughly examine a patient’s medical records to ensure opioid therapy is an appropriate choice.
Prescription medication abuse can also occur in patients with no previous history of problem drug use. For example, when prescribed an opioid for a medical purpose, a patient may discover that not only is pain management achieved, but that the opioid also induces a desirable mood, level of energy, or other positive effects. These effects can be reproduced by additional doses of medicine even after the original legitimate medical reason for its use no longer exists. In these instances, patients may then continue to request medications from their physician or from other physicians even though they no longer require them to control pain.
Before starting opioid therapy, patients and healthcare professionals should be clear about what behaviours are legitimate and acceptable. Patients need to know what is expected of them.
Warning signs of abuse and addiction
The efficacy and side effects of prescription medications vary considerably from patient to patient, as do the warning signs of prescription drug abuse. The warning signs include:
- Earlier prescription seeking.
- Claims of lost medication.
- Multiple physician visits.
- Documented evidence of intoxication.
- Frequent missed appointments.
- Documented use of other scheduled drugs.
From the physician's standpoint, the symptoms of patients abusing opioids typically fail to improve. Their symptoms may appear to become worse, necessitating higher and higher dosages of medication. Nothing else seems to work or provide relief.
Whenever prescription medications are taken in excess of directions, or when they are taken for reasons other than those for which they were initially intended and prescribed, and when the patient begins to be preoccupied with obtaining and consuming the medication, the likelihood of prescription drug abuse is high. Obtaining medications by devious or unusual means is another indicator that the patient is in serious difficulty. Dishonesty, secrecy, lying, stockpiling and manipulating (for example, exaggerating or inventing symptoms) to obtain medications are indicators of problem drug use. However, it must be remembered that patients who have poor pain control sometimes exhibit similar behaviours in an attempt to gain pain control.
Physical signs of prescription drug abuse
The warning signs of opioid abuse vary from patient to patient, there are a number of indicators that should prompt further investigation:
Skin popping (caused by injecting drugs under the skin) 
Track marks (rows of scars from repeated injections) - arm
Track marks - neck
Healing ulcer - leg
Constricted pupils
Perforated nasal septum 
Other warning signs include:
- Loss of appetite
- Sniffles
- Watery eyes
- Cough
- Nausea
- Possession of syringes, bent spoons or needles