Table 1.
Abuse Drug Questionnaire (ADQ) used for the surveillance system implementation.
| Question Number | Question Text | Answer |
|---|---|---|
| 1 | Pharmacy ID | |
| 2 | Pharmacist | |
| 3 | Patient age | <25/25–25/36–45/46–65/> 65 |
| 4 | Patient sex | Male/Female |
| 5 | Patient origin | Native/Not native |
| 6 | Substance involved | Benzodiazepines/Buprenorphine/Clomethiazole/Codeine/Dextromethorphan/Fentanyl and related compounds/Methadone/Methylphenidate/Misoprostol/Modafinil/Tramadol/Others |
| 7 | Drug request | Does not require a prescription/Requested with prescription/Requested without prescription/Probably forged prescription |
| 8 | Intimidation | Yes/No |
| 9 | Frequent request | Yes/No |
| 10 | Pharmacist management | Supplied/Not supplied |
| 11 | Why do you supply the medicine? | |
| 12 | Observations |