On the Meaning of "Drug Seeking"

Margo McCaffery, MS, RN, FAAN; Megan A. Grimm, MPH, CHES; Chris Pasero, MS, RN, FAAN; Betty Ferrell, PhD, FAAN; Gwen C. Uman, PhD

Disclosures

Pain Manag Nurs. 2005;6(4):122-136. 

In This Article

Review of Literature

The term "drug seeking" has been used for at least 25 years, possibly much longer, not only in the United States but also in Canada, New Zealand, and Australia (Goldman, 1989; Powell, 1989; Sarfato & Gray, 1985). Although the term is most often used in the United States in reference to obtaining opioids, it has also been used in relation to other medications such as benzodiazepines and amphetamines (Sarfato & Gray, 1985).

The obvious meaning of the term "drug seeking" in relationship to opioids is patient behavior designed to obtain analgesics for pain relief. This alone is not unacceptable or unusual. That raises the question, When does this behavior become inappropriate, causing the patient to be labeled a drug seeker?

The term "drug seeking" is rarely defined, leaving the reader to infer the meaning by the context in which it is used. A recent article on definitions related to the medical use of opioids did not even include the term "drug seeking" (Savage, Joranson, Covington, Schnoll, Heit, & Gibson, 2003).

Goldman (1999) defined drug seeking as "individuals who knowingly break the law by seeking and obtaining controlled drugs in order to sell them on the street" (p. 99). He identified three categories of drug seekers: (1) those who have chemical dependency, (2) those who seek drugs to sell on the street, and (3) those who are hired by drug dealers to obtain prescriptions they can sell.

Another example of an attempt to define drug seeking is, "Drug-seeking may be seen with either active addiction or pseudoaddiction, or as part of deviant behavior such a drug diversion. A way to distinguish between these conditions is by giving the patient appropriate pain medication..." (Weaver & Schnoll, 2002, p. 6). Pseudoaddiction is defined as behaviors that appear to indicate addiction but actually reflect undertreated pain (Weissman & Haddox, 1989). The authors also stated that some types of drug-seeking behavior may be more predictive of opioid abuse than of pseudoaddiction.

One recent article discusses patients with pain who are also addicted to opioids, referred to as user/ abusers, and suggests that both pain control and abuse disorders are responsible for drug-seeking behavior (Mitra & Sinatra, 2004). These same authors identify what they call a subset of drug seekers who have undertreated pain, or pseudoaddiction. The authors state that in these patients drug-seeking behaviors may resemble addiction but actually reflect the patients' efforts to seek adequate pain relief.

The term "drug seeking" is also defined by Compton (1999) as "a set of behaviors in which an individual makes a directed and concerted effort to obtain a medication... behaviors may include 'clock watching,' frequent requests for early refills, or hoarding analgesics" (p. 429). The point is made that these behaviors are not necessarily evidence of addiction and may be pseudoaddiction.

In the Core Curriculum for Pain Management Nurses, Cox (2003), quotes from Compton (1999), above, stating the same definition and related behaviors. Cox, as did Compton, emphasizes that these do not necessarily mean addiction and possibly are behaviors that indicate pseudoaddiction. Thus, according to Compton and some of the above authors, drug-seeking behavior could be for legitimate or illegitimate purposes.

Clearly, there is no agreement on the definition of drug seeking. In general, it seems that drug seeking is considered any one of a number of seemingly inappropriate attempts to obtain opioids. Without a clear definition of drug seeking, it is difficult to say what behaviors constitute drug seeking.

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