Emergency department staff's attitudes toward narcotics and drug-seeking patients who fabricate symptoms: A multicenter survey

Abstract

Recently, there has been an increase in the amount of prescription narcotics used in Taiwan. Despite the possibility that patients suspected of abusing opioids are visiting emergency departments (EDs) to collect drugs, only few studies have assessed the attitudes of ED staff toward these fabricating drug seekers and narcotics prescription. Both issues are crucial in identifying fabricating drug seekers and for pain management. The aims of this study were to investigate the attitudes of ED staff toward fabricating drug seekers and narcotics prescription, and to understand the characteristics of patients suspected to be fabricating drug seekers. From January 1, 2008 to December 31, 2008, 174 staff members of four EDs completed questionnaires to review their perceptions for patients with fabricated drug-seeking behaviors and their attitudes toward prescribing narcotics. The staff members were also requested to report the characteristics of those patients suspected of fabricating a need for narcotics. According to the ED staff's clinical practice, the three most commonly fabricated drug-seeking behaviors were insistence on specific medications, frequent ED visits, and over-reporting of symptoms. Most medical personnel would choose non-narcotic analgesics as their first-line remedy. A total of 14 patients were reported as fabricating drug seekers. The fabricated drug-seeking behavior patterns described by the ED staff were similar to the descriptions mentioned in the literature and their attitudes toward prescribing narcotics were conservative. However, more interventions to overcome staff's opiophobia are needed to improve pain management. Reported fabricating drug seekers usually complain of abdominal pain, while parenteral meperidine was the most sought-after drug.