Consider approaching a patient if certain behaviors are present, such as:
- Repeated request for refills of opioid medication earlier than necessary
- Unusual requests for replacement prescriptions
Note that certain types of patients may be at greater risk for opioid dependence, like those with:
- A family history of substance abuse
- Comorbid psychiatric conditions, eg, depression1
- Other comorbid conditions, eg, HIV and hepatitis C
- Resolved pain, but the expressed need for opioids
Ask the Right Questions: the Drug Abuse Screening Test (DAST-10)
You may even have the patient fill out a questionnaire in order to get the conversation started. Keep in mind:
- A nonjudgmental tone and presentation will enable the patient to speak more openly
- During the conversation, it is often beneficial to reassure the patient that opioid dependence is a medical condition—not a moral failure (no one wants to become dependent)
The next step is to confirm the diagnosis.
