What are the possible signs of prescription drug abuse?

This is your third time seeing this patient, and he reports the NSAID that he has been prescribed is not addressing his pain. He reports his pain is a 10 out of 10, HR 108, talking extremely fast, he is diaphoretic, unshaved, his clothes are a bit wrinkled and he is requesting that you prescribe him Percocet because he doesn’t think Tramadol, that you are considering prescribing, will work.

• What are the possible signs of prescription drug abuse?
• What should the NP do when a patient has continued to return?