Table 2.

Types of Aberrant Drug Related Behaviors (ADRBs) s Identified in Content Analysis and Illustrative Quotes

Type of ADRB	Illustrative quote(s)
Patients requesting opioids, including requests for specific opioids or dosages	“She is requesting narcotics in a very roundabout and confusing way (she is ‘allergic’ to various alternatives such as Tylenol, Ultram, etc)”
	“He repeatedly mentions that he has ‘a high tolerance to medications’ and that ‘the only thing that works is Lortab.”
Obtaining non- prescribed opioids	“Mr. X left sick call after seeing Dr. Y and did not have prescriptions filled for Ultram or Flexeril. He states that he will look for someone to buy some Lortabs from.”
	“Has been taking his sister’s Lortabs, but now she needs them for pain.”
Emergency room visits related to opioids	“Since her visit she has been to [local community] ER ‘since you didn’t give me any pain medicines’ and was given an injection of Dilaudid [opioid].”
Patient emotion related to opioids	“He demanded [social worker] get him co-pays for methadone (and swore at her in [clinic] lobby).”
	“I spoke with [patient], and he was very upset and agitated. He said that he couldn’t wait until [later date] for pain medication; if he had to wait that long, he would just go ahead and ‘shoot his brains out’.”
Lost/stolen opioids	“Recently returned from [nearby city] where he left his pain medication and tenofovir [HIV medication] and asks for refills of both.”
	“She reports argument with her son who ‘stole medications from her purse.’”
Running out of opioids early	“He states that he is out of his oxycodone because he has been having so much breakthrough pain that he frequently has to take more than one pill a day.”
Inconsistent urine drug screens (negative for opioid, positive for illicit substance, or both)	“Unfortunately urine drug screen done [date] was positive for cocaine. It was negative for opiates and benzodiazpines, even though she is supposed to be both on Lortab and Klonopin. Ms. X does have a past history of cocaine abuse. Despite the positive test, she denies using cocaine and says it must have been positive because a roommate smoked crack around her.”
Multiple opioid prescribers	“[Health department] inquiry reveals patient received script for short acting meds Hydrocodone from other MD (Dr. X) on [date] and [date] despite signing opioid contract with this clinic.”
Illicit substance use	“In care with a pain clinic that prescribes Suboxone [opioid agonist-antagonist used to treat addiction] and Lortab 7.5mg #90 per month. Using prescription drugs (Oxycodone). Admits he is hiding drug use from his mother.”
Patient threats related to opioids	“Told 2 nurses he would buy street drugs since I didn’t give him narcotics.”
	“I was informed by social worker that Ms. X has been seen selling her Lortab in front of the place where she currently lives. Our interaction was short but long enough for me to tell Ms. X that we will no longer prescribe Lortab. She became angry, said she would still get if off the street and left.”
Patient selling opioids (“diversion”)	“The patient is aware that documentation in chart from previous providers described diverting behaviors. Because of this documentation we decided to treat Mr. X condition with long acting medications (fentanyl patches with gradual dose increase, now on 50mcg/hr).”