Recognize the Abuser

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Modus Operandi Often Used 	What You Should Do 	U.S. Department of Justice
Drug Enforcement Administration
by the Drug-Abusing Patient 	When Confronted by a
Include: 	Suspected Drug Abuser
• Must be seen right away;
• Wants an appointment toward end of of
fice hours;
• Calls or comes in after regular business
hours;
• Traveling through town, visiting friends
or relatives (not a permanent resident);
• Feigning physical problems, such as
abdominal or back pain, kidney stone, or mi
graine headache in an effort to obtain narcotic
drugs;
• Feigning psychological problems, such as
anxiety, insomnia, fatigue or depression in an
effort to obtain stimulants or depressants;
• States that specific non-narcotic analge
sics do not work or that he/she is allergic to
them;
• Contends to be a patient of a practitioner
who is currently unavailable or will not give
the name of a primary or reference physician;
• States that a prescription has been lost or
stolen and needs replacing;
• Deceives the practitioner, such as by
requesting refills more often than originally
prescribed;
Pressures the practitioner by eliciting
sympathy or guilt or by direct threats;
DO:
• Perform a thorough examination appro
priate to the condition.
• Document examination results and ques
tions you asked the patient.
• Request picture I.D. or other I.D. and
Social Security number. Photocopy these docu
ments and include in the patient’s record.
• Call a previous practitioner, pharmacist
or hospital to confirm the patient’s story,
• Confirm a telephone number, if provided
by the patient.
• Confirm the current address at each visit.
• Write prescriptions for limited quantities.
DON’T:
• “Take their word for it” when you are
suspicious.
• Dispense drugs just to get rid of drug-
seeking patients.
• Prescribe, dispense or administer con
trolled substances outside the scope of your
professional practice or in the absence of a
formal practitioner-patient relationship.
Recognizing
the
Drug Abuser
Office of Diversion Control
Sections of this document were adapted from A Guide to 	Liaison and Policy Section
Utilizes a child or an elderly person when 	Prescribing, Administering and Dispensing Controlled
Substances in Missouri, January 1999. Printed with	
seeking methylphenidate or pain medication. permission. All rights reserved. Additional information on DEA’s Diversion Control Program
is available at: www.DEAdiversion.usdoj.gov

The purpose of this guide is
to inform and educate you, the
healthcare practitioner, to
ensure that controlled sub
stances continue to be avail
able for legitimate medical
and scientific purposes while
preventing their diversion
into the illicit market. It is
not the intent of this publica
tions to reduce or deny the use
of controlled substances where
medically indicated. Nothing
in this guide should be
construed as authorizing
or permitting any person to
conduct any act that is not
authorized or permitted
under federal or state laws.
Your Responsibilities
The abuse of prescription drugs–especially
controlled substances–is a serious social and
health problem in the United States today. As a
healthcare professional, you share responsibil
ity for solving the prescription drug abuse and
diversion problem.
• You have a legal and ethical responsibil
ity to uphold the law and to help protect society
from drug abuse.
• You have a professional responsibility to
prescribe controlled substances appropriately,
guarding against abuse while ensuring that
your patients have medication available when
they need it.
• You have a personal responsibility to
protect your practice from becoming an easy
target for drug diversion. You must become
aware of the potential situations where drug
diversion can occur and safeguards that can be
enacted to prevent this diversion.
This guide will help you meet these
responsibilities.
Recognizing the Drug Abuser
Telling the difference between a legitimate pa
tient and a drug abuser isn’t easy. The drug-seeking
individual may be unfamiliar to you. They could
be a person who claims to be from out-of-town and
has lost or forgotten a prescription or medication.
Or the drug seeker may actually be familiar to you
such as another practitioner, co-worker, friend or
relative. Drug abusers or “doctor shoppers” often
possess similar traits and modus operandi. Recog
nizing these characteristics and modus operandi is
the first step to identifying the drug-seeking patient
who may be attempting to manipulate you in order
to obtain desired medications.
Common Characteristics of the Drug
Abuser:
• Unusual behavior in the waiting room;
• Assertive personality, often demanding
immediate action;
• Unusual appearance–extremes of either
slovenliness or being over-dressed.
• May show unusual knowledge of con-
trolled substances and/or gives medical
history with textbook symptoms OR gives
evasive or vague answers to questions regard-
ing medical history;
• Reluctant or unwilling to provide refer-
ence information. Usually has no regular doctor
and often no health insurance;
• Will often request a specific controlled
drug and is reluctant to try a different drug;
• Generally has no interest in diagnosis;
fails to keep appointments for further diag-
nostic tests or refuses to see another practi-
tioner for consultation;
• May exaggerate medical problems and/or
simulate symptoms;
• May exhibit mood disturbances, suicidal
thoughts, lack of impulse control, thought
disorders, and/or sexual dysfunction;
• Cutaneous signs of drug abuse–skin
tracks and related scars on the neck, axilla,
forearm, wrist, foot and ankle. Such marks
are usually multiple, hyper-pigmented and
linear. New lesions may be inflamed. Shows
signs of “pop scars” from subcutaneous
injections.