Aberrant and the 4Cs

Question 1

Aberrant med bx: suggestive but NOT diagnostic of problematic drug use:

Answer 1

• Hoarding drugs
• Requesting specific amounts of a drug,
• Requesting a specific brand name drug
• Receiving prescriptions from other physicians
• Unsanctioned dose escalations

Question 2

Aberrant med behaviors: Behaviors that may cause more concern:

Answer 2

• Borrowing or stealing drugs
• Chewing a patch or slow-release tablets
• Multiple unsanctioned dose escalations
• Using illicit drugs
• Selling drugs
• Having a negative urine screen for a prescribed drug

Question 3

The 4C’s

Answer 3

A pattern of the 4 C’s may suggest addiction in opioid-treated pain patients

1. Adverse Consequences/harm due to use
2. Impaired Control over use
3. Compulsive use
4. Preoccupation with the use due to Craving

Question 4

Screening tools:

Answer 4

• Overall, there is limited evidence to predict opiate aberrant drug-related behaviors
• Screening tools for addiction in patients with chronic pain
with evidenced validity
• Pain Medication Questionnaire (Adams 2004)
• Screener and Opioid Assessment for Patients with Pain-Revised SOAPP-R (Butler 2010)