Patients and prescription drugs: Physician challenges

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Physicians face two growing challenges when it comes to their patients and drugs: Identifying drug-seeking behavior by patients who have an addiction problem and knowing when patients are taking too many medications and knowing when to discontinue some of those prescriptions.

Given the country’s opioid epidemic, doctors may be seeing more drug-dependent patients coming to their office seeking pain medications. They should watch for the classic red-flags to identify drug-seeking behavior, according to Joshua Elder, M.D, a postdoctoral fellow at Yale University's Robert Wood Johnson Clinical Scholars Program, who practices emergency medicine.

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Those include factors such as patients requesting medication by name, reporting medications as lost or stolen, or reporting pain at a 10 on a pain scale, he told ATTN:.

But it’s not easy for a doctor to tell when an addicted patient is seeking drugs. Elder co-authored a study in 2012 that found emergency room doctors were only able to successfully identify drug-seeking patients a third of the time. “It’s basically a physician’s gut feeling, almost, that a person is trying to get medication for non-therapeutic reasons,” Casey Grover, M.D, an emergency medicine specialist, who co-authored the study, told ATTN:. Both doctors agree that prescription drug monitoring programs, statewide electronic databases that allow physicians to check a patient’s prescription history, can help.

Another common problem physicians encounter is when patients are taking too many medications--one study that showed nearly 40 percent of patients in their 60s take more than five medications. More healthcare professionals are “deprescribing” medications after screening patients to see if they can remove ineffective medicines or ones that can result in risky drug combinations, according to The Wall Street Journal.

Both U.S. and Canadian doctors are using a website, deprescribing.org, which is maintained by the Canadian Deprescribing Network--a group that includes health professionals, policy makers and patient advocates--for guidelines on discontinuing patient medications, the newspaper said.

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