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Drug misuse leading to drug seeking behaviour and drug diversion: 2 case reports A case report described an adolescent boy and an adolescent girl [exact ages not stated], of whom, the boy misused oxycodone and unspecified opioid analgesics, while the girl misused morphine, which had all been prescribed for chronic pain. The misuse further resulted in opioid seeking behaviour and drug diversion [not all routes and dosages stated]. Patient A: A boy had multiple morbidities, including chronic pain, for which he had been receiving long-term opioid analgesics [specific drugs not stated]. His history was also notable for multiple central line infections resulting in bacteraemia and hospitalisation. He was currently admitted due to positive blood cultures with three different kinds of bacteria. He also reported chest, abdominal and back pain. Multiple consultations were undertaken to determine the cause of his recurring pain. About 2 weeks following admission, the nursing staff raised concerns about his continuous opioid analgesic infusions. It was believed that he was manipulating his opioid analgesics through the infusion pumps. The nurses had been identifying concerns, including clamped IV tubing, manipulation of medication pumps, the pump alarming that the bag was empty when this was not expected, missing IV supplies (including syringes and saline flushes), finding extra supplies, including empty syringes in his room, an oral syringe full of medication (oxycodone), which had not been ordered for him, a nurse entering his room to find him pushing a button on the medication pump, and him requesting the nurses push or infuse IV medications more rapidly. Of note, he had multiple prior admissions for central line infections, some of which grew bacteria which were not expected based on his medical status. The hospital team felt that he might be manipulating his medication pumps; hence, the same was discussed with him. However, he denied using pain medications inappropriately or manipulating the pumps infusing pain medications. After further investigations, it was concluded that he himself was diverting the medications. Following consultation with the chronic pain service, he was weaned off IV opioid analgesics. He was subsequently discharged. During the following admission, he admitted to manipulating his pain pumps. He later completed an outpatient chronic pain program, where he was transitioned to longer acting oral opioids and nonopioid therapies. He was eventually weaned off opioids completely. Patient B: A girl had multiple morbidities, including chronic pain, for which she had been receiving patient controlled analgesia (PCA) with IV infusions of morphine for several months. Her treatment included combinations of nurse-administered bolus infusions and continuous infusions, and she demanded doses where she physically pushed the button to administer a prescribed quantity of medication at set frequencies. A review of her documents revealed that she had pushed her PCA pump button 284 times over 12 hours, and she had