MJA: Graziotti et al., Box 3

3: Aberrant drug-related behaviour that is predictive of developing addiction*

Major aberrant behaviour -- more predictive
Selling prescription drugs Prescription forgery Stealing or borrowing drugs from others Injecting oral formulations Obtaining prescription drugs from non-medical sources Concurrent abuse of alcohol or illicit drugs Multiple non-sanctioned dose escalations Multiple edpisodes of prescription loss Repeatedly seeking prescriptions from other physicians or emergency departments without informing the prescriber or after warnings to desist Evidence of deterioration in function, at work, in the family, or socially, that appear to be drug-related Repeated resistance to therapy changes despite clear evidence of adverse physical or psychological effects from the drug	*Management options for major aberrant behaviour* Wean and cease opioid Notify relevant alcohol and drug authority and consider joint management Consider very frequent (e.g., weekly or daily) supply
Minor aberrant behaviour -- less predictive
Aggressive complaining about the need for more drug Drug hoarding during periods of reduced symptoms Requesting specific drugs Openly acquiring similar drugs from other medical sources Unsanctioned dose escalation Unapproved use of the drug to treat other sumptoms	*Management options for minor aberrant behaviour* Reassess medication, expectations, underlying nociceptive source Consider changing to another drug Reinforce previous discussions concerning restrictions of supply from other sources Consider reducing time interval between supply of medication Consider urine testing

*Based on Portenoy²⁰