Imagine being addicted to a prescription drug — pain medication, muscle relaxants, or perhaps sleeping pills. To what lengths would you go to get your drug of choice? Feign low back pain? Present to an urgent care center holding your left flank, wincing, and claiming that your urine is pink? Would you go so far as to have elective surgery to secure a supply of pain pills and sleeping aids? It may be hard to fathom, but if you were genuinely addicted you'd do all of this — and more.

According to a recently released President's National Drug Control Strategy report (www.whitehousedrugpolicy.gov), 6.2 million Americans in 2002 reported having used prescription drugs for nonmedical reasons during the month prior to the study. In terms of illegal use of drugs, this ranks second only to marijuana use. As a practicing physician, the odds are that you are faced with the occasional (or more-than-occasional) drug-seeking patient. How you respond to them is important.

Unfortunately, drug-addicted patients are not always easy to spot. College students, executives, suburban moms, academicians — even physicians themselves — can all succumb to addiction. In addition to those who self-medicate to ease emotional pain, there are plenty of addicts who started taking narcotics for a legitimate reason — perhaps following an injury or major surgery. These patients can be more motivated to kick their habit, and physicians would do well to talk to them about getting into treatment for addiction.

You may also encounter individuals trying to secure narcotics for a family member or friend, or to sell on the street for a profit. This is known as diversion.

Recognizing drug-seekers