Clinical Prescription Drug Abuse and the Drug-Seeking Patient Urgent message: The urgent care clinic is a prime target for prescrip- tion drug abusers seeking possibly inappropriate prescriptions. Cli- nicians must be vigilant to screen, intervene, and refer such patients. Marcelina Behnam, MD and Mark Rogers, MD Introduction ver the past several years, prescription drug abuse has become a problem of epi- demic proportions for ur- gent care centers and emer- gency departments around the country. There has been an in- crease both in visits related to the acquisition of these medica- tions, and in emergency depart- ment visits related to the mis- use of prescription drugs. 1,2 In response to this epi- demic, new government leg- islation has been enacted and intervention and treatment centers developed. This review article discusses © Getty.com/Juan Silva the current problems of pre- scription drug abuse and substance use disorders (SUDs), as well as measures being implemented to address them. O Rise of Prescription Drug Abuse Within the past decade, there has been a substantial rise in prescription drug use and abuse. Drugs of abuse are classified both by abuse potential and pharmacologic action, the latter of which is broken down into three main categories: stimulants, opioids, and CNS depressants. Each of these categories has seen a rise in use and abuse in the past several years, with opi- w w w. j u c m . c o m ates being the most commonly abused. 1 According to a 2004 na- tional survey on drug use and health published by the Sub- stance Abuse and Mental Health Services Administra- tion (SAMHSA), 19.1 million Americans were current illicit drug users. Among those 19.1 million, the largest segment (2.4 million) was populated with those engaging in non- medical (i.e., recreational) use of prescription pain relievers. In 2005, according to the National Survey on Drug Use and Health (NSDUH), 6.4 mil- lion Americans over the age of 12 reported using a pre- scription drug for a non-medical purpose within the past month. Of those: Ⅲ 4.7 million used narcotic pain relievers Ⅲ 1.8 million used tranquilizers Ⅲ 1.1 million used stimulants (including metham- phetamine) Ⅲ 272,000 used sedatives. 2 Opiate abuse accounts for more than 50% of prescrip- tion drug abuse. Between 2004 and 2005, the Drug Abuse Warning Network (DAWN) reported that emer- gency department visits involving non-medical use for JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a y 2 0 0 8 11