It’s still in its early phases of testing, but one Toronto Emergency Room has put ER doctors on the path to reducing prescriptions given to “med seeking” patients.

 

A fair number of patients who go to see a doctor fake pain or illness in order to obtain a prescription for certain drugs.  These can often include opiates such as oxycontin, benzodiazepines such as Valium or Xanax, and other drugs.  It can be extremely challenging for a doctor to know when someone is faking or telling the truth if there are no specific tests to help them make their determination.

 

My sister is a nurse on a hospital inpatient unit.  She tells me some patients are constantly asking for medication for this or that.  They are often asked to rate their pain on a scale of 1-5 and they claim to be a 5 so they can have stronger medicine.  They sometimes become combative, rude and irate when they are told they need to wait longer.  She says it can be a real challenge to know when a painkiller isn’t working because the patient already has an addiction to painkillers, and therefore has a tolerance to the drug, and when it isn’t working because the patient is truly in extreme pain.

 

One way that patients “med seek” in the ER is to fake alcohol withdrawals.  According to http://www.ideastream.org/news/npr/344232232, Valium is often given for alcohol withdrawals.  I worked on a detoxification unit at a hospital for a few years before going into private practice, and I remember this was often the case.  Someone who has an addiction to benzodiazepines will often go to great lengths to use again.  Occasionally these people go to the emergency room and fake a tremor in their hands.  They claim to be sobering up from alcohol dependence.

 

Sobering up from alcohol dependence can be very dangerous depending on the level of use.  If the use was consistent and high in volume, a person will experience uncomfortable withdrawal symptoms.  Some of these are irritability, anxiety, nausea, headache, sweating, fast heart rate, confusion and tremors.  In extreme cases a person can get delirium tremens (DTs), which can include hallucinations and seizures.  Sometimes DTs cause death.

 

When a patient shows up in the emergency room claiming to suffer from alcohol withdrawals, the doctor has to determine whether these are real or fake.  They then have to decide what to prescribe.  It can be a very challenging decision.

 

It turns out though, that truly faking hand tremors is almost impossible if the doctor knows exactly what to look for.  There is now an app being tested that helps doctors create a score.  A high score means it’s most likely from alcohol.  A low score means it’s most likely malingering (faking illness for some gain).  Most malingerers faking alcohol withdrawal tremors are looking for a benzodiazepine.

 

Coming from someone who sits in therapy with people struggling with addiction on a regular basis, this app is a great thing!  One of the best ways to get through an addiction is for access to the drug of choice to be restricted as much as possible.  This is especially true during the early days of sobriety when the ability to resist temptation is still low.  It is why those of us who work in this field always advise family members to stop giving any kind of money to someone with a drug problem; if you can’t pay for it, it’s harder to get it, which means it’s harder to use it.

 

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT