Addicted Patients

So It's really kind of weird. Since I have been in monitoring I have become a lot more aware of patients in my practice with potential substance abuse problems. Not sure if I'm just being nosey or if I have started being more aware of the level of how much substance abuse may be problematic; as has been highlighted in the media and by my own monitoring. I have noticed so many more patients starting to request things like benzodiazepines and muscle relaxers now that opiate RX's are so stringently controlled. I had one new patient who came in with slurred speech, ataxia, and some psych differential DX's wanting an RX for lorazepam 5mg TID! She stated she had been on it for "years". I refused pending a drug screen and did a UA on her. Her benzo profile was negative, but her ETOH was off the chart. And I had another patient not on RX opiates or methadone who was off the charts for both of those meds, and wanting the MD to give him an RX for Norco for chronic back pain. Both patients had what might be considered credible excuses for their drug screen results. Unfortunately, even being in monitoring and having an advanced degree, I am having to really search hard for how long ETOH, benzos, opiates, and methadone are going to show up on a UA because I honestly don't know and the literature and lab statistics for actual length of time for positive results are so conflicting and ambiguous. So I guess what scares me the most is that after now seeing so many patients with potential problems, how the monitoring programs can actually decide who poses a real patient safety problem, and who is just a poor schmuck caught up in the process! I guess they can't and that's why everyone ends up in monitoring.