Prescription Drug Abuse

Prescription Drug Abuse An Introduction. Overview. Prescription Drug Misuse (DefinitionsOpioid Dependence vs. Chronic Pain Managed with Opioids? Aberrant Medication-Taking Behavior. Addiction Abuse/Dependence. Which Prescription Medications Are Most Likely to Be Abused? Which Prescription Medications are Most Likely to Be Diverted? Consequences of Prescription Opioid Abuse. Another Factor Leading to Prescription Drug Misuse. Why Do Some Physicians Over- Prescribe? Why do some Physicians Under-Prescribe? “Opiophobia”. Framework for Safe Prescribing. What Is the Physician’s Role? When Are Opioids Indicated? Opioid Efficacy in Chronic Pain. The Risk-Benefit Framework Judge the Treatment, not the Patient. Screening Instruments for Addiction Risk. Opioid Risk Tool. Management of Opioid Therapy. Monitoring Pill (and Used Patch) Counts. Monitoring Urine Drug Tests. Prescription Monitoring Programs. Not Enough Benefit? Too Much Risk? Summary. Thanks for your attention.

Prescription Drug Abuse Outline Overview of Prescription Drug Abuse (PDA) Framework for Safe Prescribing Identifying PDA.

Includes Non-medical use Substance abuse/PDA Dependence Addiction Diversion Does NOT include physical dependence.

Additional notes provided for slide 4 (see below).

Opioid Dependence vs. Chronic Pain Managed with Opioids?

The diagnosis of Opioid Dependence requires 3 or more criteria occurring over 12 months Tolerance – YES Withdrawal/physical dependence – YES Taken in larger amounts or over longer periods – MAYBE Unsuccessful efforts to cut down or control – MAYBE Great deal of time spent to obtain substance – MAYBE Important activities given up or reduced – MAYBE Continued use despite harm – MAYBE.

A spectrum of patient behaviors that may reflect misuse Health care use patterns (e.g., inconsistent appointment patterns) Signs/symptoms of drug misuse (e.g., intoxication) Emotional problems/psychiatric issues Lying and illicit drug use Problematic medication behavior (e.g., noncompliance) Implications Concern comes from the “pattern” or the “severity” Differential diagnosis.

Prescription Drug Misuse Aberrant Medication-Taking Behaviors (AMTBs) A spectrum of patient behaviors that may reflect misuse Total Chronic Pain Population.

Which Prescription Medications Are Most Likely to Be Abused?

Commonly Abused Medications Opioids CNS depressants Benzodiazepines Barbiturates Stimulants Others.