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Thus, these practitioners are in a unique position not only to prescribe needed medications appropriately, but also to identify prescription drug abuse when it exists and help patients recognize the problem, set goals for recovery, and seek appropriate treatment when necessary. Unfortunately, many providers do not receive the necessary training in medical school to make them effective at carrying out these functions. The first defense against prescription drug abuse is proper assessment including assessing the risk of abuse in an individual, proper diagnosis, and proper record keeping. Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-thecounter medicines patients are taking and why. Screening also can be performed if patients present with specific symptoms associated with problem use of a medication. Over time, practitioners should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been used. This may indicate under-treatment, diversion, addiction or, rarely, the development of tolerance to a medication. As stated earlier, they should also be alert to the fact that those addicted to or those selling prescription medications may engage in "doctor shopping"--moving from health professional to professional--in an effort to get multiple prescriptions for the drugs they abuse or sell. In monitoring all of these factors, however, doctors should never lose sight of the need to provide proper medical care to all of their patients.
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