Drug abuse is a difficult thing for healthcare providers to deal with, when they discover it. They have to make sure that their prescribed drugs don’t interact badly with the drugs that the patient uses recreationally. They also have to make sure that the patient isn’t just trying to get drugs from them. They have to overcome their own distrust of the patient and still come to an accurate diagnosis and treat the patient compassionately. Finally, they often are obligated to make an effort to treat the drug abuse as well as the sickness that caused the patient to seek treatment.
Drug Interactions
One of the challenges that healthcare providers face when dealing with patients who abuse drugs is making sure that the drugs prescribed won’t interact badly with the drugs the patient uses (Beers, Storrie, & Lee, 1990). This is especially difficult because the patient is often reluctant to tell the truth about his drug abuse. Sometimes the patient may not even know everything he is using. This is because street drugs are sometimes diluted with other drugs. Because of these factors, doctors have to take a very careful approach towards prescribing medication with many drug interactions to patients who have been identified as using drugs.

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Drug-seeking Patients
Some addicts view the hospital as one of their best resources for obtaining their preferred drugs (Longo, Parran, Johnson, & Kinsey, 2000). In particular, those who are addicted to painkillers or benzodiazepines may commonly engage in drug-seeking behavior. This poses a challenge for doctors because they can no longer be sure that the ethical medical behavior is to treat the symptoms the patient claims to have. If the patient is lying to them, prescribing the sought-after drugs would just encourage further drug-seeking and feed the addiction. But doctors will generally err on the side of prescribing medicine, even at a dosage less than that sought, because the risk of turning away someone who is genuinely ill is very great.

Trusting Drug Abusers
One of the challenges that is posed relating to the issue brought up above is mutual mistrust. Doctors find it very difficult to trust patients who are probably or possibly lying to them (Merrill, Rhodes, Deyo, Marlatt, & Bradley, 2002, pp. 327–328). Patients recognize that their doctors do not trust them, and consequently doubt that they are receiving adequate care. On the whole, care quality is harmed, as doctors will second-guess what the patient is telling them even if they believe the patient is probably suffering from a real illness. Patients may be less likely to seek care once a doctor discovers that they abuse drugs, because they feel stigmatized.

Treating Drug Abuse
The final difference in care as a result of discovering drug abuse is that the drug abuse that is discovered needs to be treated just like any other ailment would (McLellan, 2002). There are large fields of medicine that specialize in treating addicts and curing addiction, but because addiction is largely a mental disorder, it is difficult for general practitioners to treat it effectively. The general practitioner is therefore in a difficult position: while the patient is under his care, he has the ability to encourage the patient to seek treatment for his addiction. But while the patient is under his care, most treatments for drug abuse are not possible (e.g. in the hospital environment, a patient undergoing severe withdrawal could be dangerous and could interfere with the treatment for their other conditions). So the doctor has to walk a middle ground between focusing on the addiction and focusing on the underlying ailment — sometimes to the detriment of both.

Conclusion
Drug abuse treatment is an enormous field, and it is impossible to overstate the amount of consideration that goes into decisions like how to treat a patient who abuses drugs. It would similarly be impossible to summarize all of the changes that occur in such a short document. However, I hope that this paper provides a good overview of some of the changes that occur to patient care: in addition to curing the underlying ailment, the practitioner now has an entirely new set of concerns.

    References
  • Beers, M. H., Storrie, M., & Lee, G. (1990). Potential adverse drug interactions in the emergency room. An issue in the quality of care. Annals of Internal Medicine, 112(1), 61–64.
  • Longo, L. P., Parran, T., Jr, Johnson, B., & Kinsey, W. (2000). Addiction: part II. Identification and management of the drug-seeking patient. American Family Physician, 61(8), 2401–2408.
  • McLellan, A. T. (2002). Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction , 97(3), 249–252.
  • Merrill, J. O., Rhodes, L. A., Deyo, R. A., Marlatt, G. A., & Bradley, K. A. (2002). Mutual Mistrust in the Medical Care of Drug Users. Journal of General Internal Medicine, 17(5), 327–333.