Prescription drugs are rapidly becoming primary drugs of abuse in the United States and throughout the world. There are many commonly held misconceptions of the abuse potential for powerful substances such as Oxycontin ®, because such substances can be obtained legally, and have legitimate use in the medical profession.
Although many prescription drugs can be abused or misused, there are three classes of prescription drugs that are most commonly abused:
- Opioids, which are most often prescribed to treat pain Read More
- CNS depressants, which are used to treat anxiety and sleep disorders Read More
- Stimulants, which are prescribed to treat the narcolepsy, attention-deficit hyperactivity disorder (ADHD), and obesity Read More
Preventing and detecting prescription drug abuse
Although most patients use medications as directed, abuse of and addiction to prescription drugs are public health problems for many Americans. However, addiction rarely occurs among those who use pain relievers, CNS depressants, or stimulants as prescribed; the risk for addiction exists when these medications are used in ways other than as prescribed. Health care providers such as primary care physicians, nurse practitioners, and pharmacists as well as patients can all play a role in preventing and detecting prescription drug abuse.
Health Care Providers
About 70 percent of Americans – approximately 191 million people – visit a health care provider, such as a primary care physician, at least once every 2 years. Thus, health care providers are in a unique position not only to prescribe needed medications appropriately, but also to identify prescription drug abuse when it exists and help the patient recognize the problem, set goals for recovery, and seek appropriate treatment when necessary. Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why. Screening also can be performed if a patient presents with specific symptoms associated with problem use of a substance.
Over time, providers should note any rapid increases in the amount of a medication needed – which may indicate the development of tolerance – or frequent requests for refills before the quantity prescribed should have been used. They should also be alert to the fact that those addicted to prescription medications may engage in “doctor shopping,” moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse.
Preventing or stopping prescription drug abuse is an important part of patient care. However, health care providers should not avoid prescribing or administering strong CNS depressants and painkillers, if they are needed. (See box on pain and opiophobia.)
Pharmacists can play a key role in preventing prescription drug misuse and abuse by providing clear information and advice about how to take a medication appropriately, about the effects the medication may have, and about any possible drug interactions. Pharmacists can help prevent prescription fraud or diversion by looking for false or altered prescription forms. Many pharmacies have developed “hotlines” to alert other pharmacies in the region when a fraud is detected.
There are several ways that patients can prevent prescription drug abuse. When visiting the doctor, provide a complete medical history and a description of the reason for the visit to ensure that the doctor understands the complaint and can prescribe appropriate medication. If a doctor prescribes a pain medication, stimulant, or CNS depressant, follow the directions for use carefully and learn about the effects that the drug could have, especially during the first few days during which the body is adapting to the medication. Also be aware of potential interactions with other drugs by reading all information provided by the pharmacist. Do not increase or decrease doses or abruptly stop taking a prescription without consulting a health care provider first. For example, if you are taking a pain reliever for chronic pain and the medication no longer seems to be effectively controlling the pain, speak with your physician; do not increase the dose on your own. Finally, never use another person’s prescription.
Treating prescription drug addiction
Years of research have shown us that addiction to any drug, illicit or prescribed, is a brain disease that can, like other chronic diseases, be effectively treated. But no single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. To be successful, treatment may need to incorporate several components, such as counseling in conjunction with a prescribed medication, and multiple courses of treatment may be needed for the patient to make a full recovery.
The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments teach people how to function without drugs, how to handle cravings, how to avoid drugs and situations that could lead to drug use, how to prevent relapse, and how to handle relapse should it occur. When delivered effectively, behavioral treatments – such as individual counseling, group or family counseling, contingency management, and cognitive-behavioral therapies – also can help patients improve their personal relationships and ability to function at work and in the community.
Some addictions, such as opioid addiction, can also be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior. Medications also can be used to relieve the symptoms of withdrawal, to treat an overdose, or to help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction , research shows that a combination of both, when available, is most effective.
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