Opioid misuse in Canada and critical appraisal of aberrant behavior screening tools

Table 4 Aberrant drug-behaviors[5,9,38]

Indicator	Examples
Altering route of delivery1	Injecting, biting, crushing, separating oral formulations
Accessing opioids from other sources1	Obtaining the drug from friends/relatives
	Selling/purchasing from the “street”
	Double-doctoring
	Altering or creating fraudulent prescriptions
	Drug hoarding/trading
	Multiple emergency room visits
Unsanctioned use	Unauthorized dose escalations
	Binge use
Drug seeking behavior	Repeat prescription losses1
	Aggressive requesting of higher doses
	Harassing staff for faxed prescriptions or “emergency” fit-in appointments
	Manipulation of the prescribing physician
	Claiming nothing else “works”/requesting specific opioid1
Repeated withdrawal symptoms	Dysphoria, myalgias1, GI symptoms, cravings, nausea/vomiting etc.
Co-morbid conditions	Addicted to illicit drug, alcohol, cannabis and/or sedatives/hypnotics
	Underlying mood/anxiety disorders unresponsive to treatment
Social irregularity	Deteriorating/poor social function
	Concern expressed by family members
Views on opioid medication	Sometimes acknowledges being addicted
	Strong resistance to tapering or switching opioids
	Admits to mood-levelling effects
	Acknowledges distressing withdrawal symptoms

¹Associated with higher risk of addiction than others. GI: Gastrointestinal.