Are patients with a history of illicit drug use perceived to be ‘drug-seeking’ when they request pro re nata medication and does this impact on its administration?

Abstract

Background: Providing optimal treatment is pivotal to improved health and justice outcomes for patients with dual diagnosis. Unfortunately, the available evidence suggests that these patients may be unduly prejudiced during hospitalisation due to perceptions that their requests for pro re nata (PRN) medication is ‘drug-seeking’, reflecting persistent dependence or tendencies toward abuse of licit and illicit substances.

Aims: To examine psychiatric nurses' responses to patients requests for PRN medication, to examine whether these requests are interpreted as ‘drug-seeking’, and to characterise patients described as such.

Method: Case files and medication charts of patients diagnosed with schizophrenia admitted to a secure psychiatric service were reviewed to determine (a) their history of drug use, (b) the frequency with which they requested PRN medication, (c) how often staff administered PRN medication following request, and (d) how often patients were labelled ‘drug seeking’.

Results: Patients with a history of amphetamine and opiate use were more frequently labelled ‘drug-seeking’. However, the label ‘drug-seeking’ was applied infrequently and did not substantially affect administration of PRN medication.

Conclusion: Education to highlight the impact of negative causal attributions on helping behaviour and guidelines to improve practice and consistency in the administration of PRN medication is recommended.

Keywords:

• dual diagnosis
• drug seeking
• drug use
• medication
• schizophrenia