Chabal et al reported criteria for the diagnosis of prescription opiate abuse in a patient with chronic pain. These can help to identify a patient who may require further evaluation and an intervention. The authors are from the University of Washington and Veterans Affairs Medical Center in Seattle.

Clinical findings:

(1) overwhelming focus on opiate issues during  office visits, that persists beyond the third office visit and that prevents addressing other important issues

(2) one or both of the following in the absence of acute change in the medical condition

(2a) asking for early refills 3 or more times (a pattern of behavior)

(2b) taking higher or more frequent doses

(3) one or more of the following related to being a nuisance about the opiate prescription

(3a) disturbing the staff

(3b) multiple calls to the office with problems

(3c) multiple visits to the office with problems

(4) multiple problems requiring another prescription (lost, stolen, spilled, etc)

(5) seeks out additional sources of opiates (multiple providers, Emergency Department, illicit)


A patient with 3 or more findings was considered to be a prescription opiate abuser.

To read more or access our algorithms and calculators, please log in or register.