The Comprehensive Aberrant Drug Related Behaviors List
Aberrant Drug Related Behavior lists are used by doctors in pain management to observe "addictive tendencies" in patients and ultimately - to judge whether a patient is a "real" patient or an addict. If a doctor observes one or several of the listed behaviors in a patient, there is the possibily that they will decide you are not a pain patient, and instead are an addict who is seeking drugs for illicit use.
Although in common use in pain management practices around the country, and accepted by academic medicine as a viable tool in pain management, physicians are not required to inform you about these "behavioral tools." The use of these behavioral tools are veiled behind the physician privilege, and patients rarely, if ever, understand that this system is being used to judge their normal day-to-day activity, including the way they appear, what they say, how they fill their medications, and what their family thinks about them. Thus, many patients make the mistake of exhibiting these behaviors without an understanding of the implication to their access to pain care. We at PRN feel it is vital that these lists are made common knowledge to pain patients. Without knowing these systems, pain patients are set up to fail. Understanding the systems in play in the doctor's office will help explain the fear, feelings of failure, and strange and unpredictable physician behavior that pain patients describe to us every day.
This comprehensive list has been culled from several different sources. Some behaviors are "more aberrant" and some are "less aberrant." All patients should be aware that if you exhibit ANY of these behaviors, you could be denied pain care. A patient who shows any of these behaviors can be "red flagged." When you are "red flagged" your doctor or pharmacist will not tell you about your "flagged" status and it is almost impossible to have the designation removed from your record. Patients are left in the dark as to why no doctor will treat them, why the pharmacy doesn't seem to carry their meds, and why they are shut out of ER's...
How to Get Red Flagged:
- Complain to your doctor when your medications don't seem to ease your pain
- Have a preoccupation with getting your medication
- Report effects like increased energy, raised mood, or euphoria since you started taking pain medication
- Primarily find oxycontin, percocet, dilaudid, or lortab to be the most effective drug that helps your pain symptoms
- Express anxiety or depression about your pain when it doesn't go away
- Look "unkempt"
- Have piercings and/or tattoos
- Talk to your doctor specifically about your medication during more than three visits
- Don't tolerate many medications well
- Don't get any relief from anything other than opioid medication
- Fill prescriptions of a similar kind by another doctor
- Have had problems in work, family, or other important family roles where people have said you have failed in your responsibilities
- Have problems with close relationships in your life
- Have a psychiatric history (Done therapy in the past)
- Have legal problems
- Have family who have a history of drug or alcohol abuse
- Have family members who suspect that your drugs may make you an addict
- Have family members who believe you are addicted
- Use more than 180mgs of opioids per day
- Prefer one type of medication administration than another (Prefer slow-acting pills instead of daily injections at the ER, or expressing an aversion to having a morphine pump installed in your body, for example)
- Become angry when your physician refuses to treat your pain
- Use other drugs at the same time as your pain meds (Including alcohol)
- Get medication from someone, not a doctor, for your pain
- Taken someone else's pain medication
- Switch doctors until you find one who will treat your pain
- Call or visit your doctor often
- Have used more than one pharmacy to get your medication filled
- Ever miss appointments with your doctor
- Ever loose your medication or your prescriptions
- Only see a doctor a few times before you switched to a doctor who would treat your pain and reported that to your doctor
- Have a previous doctor who believed you are or were addicted to your medications
- Request specific medication for your pain
- Request your medication by name
- Request more medication
- Report no effects of other medications
- Have bad reactions to your medications
- Go to the ER a lot to get your pain treated
- Believe you might become addicted to medication
- Have contact with "street culture" or other "subcultures"
- Raise your dose once or twice before you see your doctor again because of increased pain
- Use your medication to treat another symptom that you have not previously mentioned to your doctor
- Save your medications even if you do not need them anymore
- Refuse some treatments or tests suggested by your doctor
Denying patients pain treatment based on the observation of these behaviors is systematic abuse. The denial of pain care leads to worsening of the patient's disease, causes irreparable damage to the patient's brain and nervous system, destroys the patient's interactions with their families and work environments and ultimately leads to patients' untimely deaths. Also, these behaviors are not medical tools - yet they have the medical establishments' full approval, when they amount to nothing more than pseudo-science.
Imagine if a diabetic patient had to prove that he had never lost a prescription, that his sugar cravings were not "aberrant", and he were forced, through non-treatment, into comas. Americans would be up in arms. If diabetics were kept at the minimal level of insulin to just barely keep them alive and then given antidepressants and required to go to psychotherapy to help them stop exhibiting insulin craving behaviors -- you would have a fair approximation of what patients in pain currently endure.
These aberrant drug related behaviors are being used by physicians to deny suffering people access to ethical and non-abusive medical treatment. Beyond that, by having to pass muster with a doctor who can judge their worth based on these behaviors, patients in pain have absolutely no control over their health, or their quality of life. They often have to switch doctors multiple times to find someone who will treat them, and if they are fortunate to be able to travel across the country to find a doctor, they have committed aberrant behavior. The lack of medical care can also force patients into buying drugs on the street, on the Internet or in Mexico, which keeps the vicious cycle continuing and puts patients in the realm of illegal activity, which can lead to their imprisonment or death due to fake or tainted medications. Any move a pain patient makes leads to being turned down, turned away, or forced to jump through an unending series of hoops. It is a rare patient who does not exhibit at least one of these behaviors, so it is a miracle that anyone is getting treated today. Physicians have to resist these prejudicial ideas in order to treat patients appropriately. The doctors who treat the patients as though they were human beings are the very ones prosecuted by the DEA and law enforcement.
The aberrant drug-related behaviors only add to the traumatic experience of pain patients. Currently, patients are thrown into an Orwellian universe that compounds their pain and misery and forecloses their options for continued survival. From our experience, this heaping of insult and exclusion from care often leads to patient suicide. As suicides from undertreated pain are not recorded and if a patient commits suicide by overdose, such a death is counted as a drug abuse death. As a result, the current system guarantees numbers for the DEA to point to in order to justify their existence. Until patients are not judged by how they look, what they say, or the amount of knowledge they posses regarding their own care and medicines, pain care will continue to be nothing more than systematic abuse pretending to be medical practice.