Attorneys working up cases in the opioid abuse arena will need to verify the opioid prescription and the psychological and physical effects on the individual in order to spot abuse.  Check emergency room records first:  these patients will frequently seek help in an emergency room setting.


First, take a look at the patient’s history.

Individuals at higher risk for developing problems and addiction with opioid use may have:

  • Personal/family history of alcohol, illegal drugs, prescription drug abuse
  • Ages 16-45
  • Preadolescent sex abuse
  • Psychiatric diseases such as depression and schizophrenia

Visit drugabuse.gov for specific screening tools used to determine an individual’s risk for opioid addiction.

Second, review the subjective complaints.


Individuals who have been adversely impacted by opioid use can present with a variety of complaints, including:

Spotting Opioid Abuse

  • Dry mouth
  • Lethargy
  • Anxiety/depression/suicidal ideation
  • Flushed skin
  • Nausea/vomiting
  • Sweating
  • Decreased sex drive
  • Increased sensitivity to pain
  • Cravings
  • Constipation

Third, review the health care provider’s physical examination.

This review should include examinations by both physicians and nurses. Objective symptoms commonly found in opioid use and abuse may include:

  • Constricted pupils (or, conversely, dilated pupils when the person is in withdrawal)
  • Shallow breathing pattern or even respiratory depression
  • Slurred speech
  • Nodding off
  • Loss of consciousness
  • Needle marks
  • Alteration in temperature regulation
  • Increased sphincter tone (muscular ring around the anus, can lead to urinary retention)

A note of caution – once a tolerance to opioids develops, even a careful observer may fail to notice symptoms.  Small sized, or constricted, pupils may be the only physical manifestation of opioid use/abuse.

Fourth, review diagnostic testing.

  • Urine drug screen (detectable 2-5 days after use)
  • Saliva/blood (detectable 6-12 hours after use)
  • Sweat (detectable up to 24 hours after use)
  • Hair (up to 90 days after use)
  • An x-ray of the lungs may show pulmonary fibrosis in individuals who have injected

In summary, a quick review of an individual’s medical records can help to establish the validity of the claim.

Need help?  Nurse Paralegal USA owner Kathleen Christmas earned a Paradigm Specialist in Pain Management certificate in 2016.  There is no charge for a phone consultation.

Find in-depth information on both abuse and withdrawal symptoms at: