Module 5: Monitoring and Evaluation

Lesson 2

Learning outcome

Identify aberrant drug-related behaviours associated with CDS use.

Introduction

Misuse of prescription CDS may take diverse forms. Clinicians need to monitor patients on CDS for behaviours that are indicative of medication misuse.

Medication misuse

Medication misuse is a significant concern and must be a consideration in all patients who are prescribed a CDS. Appropriate and comprehensive assessment of risk must be done prior to initial prescribing.  Please refer back to modules 3 and 4 for assessment tools and techniques.

Misuse of a CDS can take many forms including:

• Taking the medication in a manner that differs from what was prescribed (including not taking the medication)
• Taking a CDS which was not prescribed
• Providing a prescribed CDS to another person

There is an important difference between medication misuse and abuse that relates directly to the individual’s motivation. Taking a medication to get a euphoric response, for example, is quite a different scenario than taking extra medication to obtain a more effective therapeutic response (e.g., taking a second dose of analgesic when the first dose fails to control the pain).

Risks related to misuse

Whatever the intent, misuse of CDS is fraught with unquantifiable risk because the use is not being clinically monitored. All patients receiving CDS must agree to follow a treatment agreement that sets out expectations for medication use and related appropriate behaviours. All clinicians must be alert for the signs of medication misuse of all types, regardless of patient intent.