- Multiple dose escalations despite warnings
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- Borrowing or stealing medications
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- Refusal to comply with toxicology testing
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- Concurrent use of alcohol or illicit drugs
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- Filling prescriptions from multiple clinicians or pharmacies without informing the primary prescriber
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- Selling of prescription medications, prescription forgery, intravenous injection of oral medications
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- Deterioration in social functioning not otherwise explained by social or illness factors
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- Resistance to change or discontinuation of opioids despite adverse effects
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