Download Solutions: October 2011: Addiction by Prescription — For All Ages

October 2011
ADDICTION BY PRESCRIPTION — FOR ALL AGES
DEPRESSION: SIGNS AND SYMPTOMS
"I don’t feel like myself anymore."
“Everything and everybody seems to bother me and I can’t feel happy.”
“I feel like there’s this incredible weight on me and I’m dragging.”
“It takes everything I have to get through the day. All I want to do is be alone or sleep.”
“Everything I do takes so much effort.”
“I get irritated and angry at the simplest and littlest things.”
“I feel achy and run down.”
People suffering from depression commonly express these feelings. You may not necessarily feel sad or depressed, but
you might complain you have a general sense of not being well that makes everyday activities and interactions
burdensome.
Common signs and symptoms of depression include:
depressed mood, including feelings of guilt
“heavy weight” upon the person
constant tension, “always wound up”
frustration
irritability
frequent tearfulness and/or crying
lack of interest in any pleasurable activity—unable to feel pleasure or joy
poor self-esteem, “I don’t feel good about myself”
hopelessness
poor appetite
insomnia, with difficulty falling asleep and/or frequent middle-of-the-night awakening
dwelling on past events
constant fatigue or weariness
no improvement despite a positive change in the environment or events
difficulty with memory and concentration
withdrawal from friends and family
multiple physical complaints such as stomachache or headache that don’t get better with conventional treatment
thoughts of suicide
If you are feeling suicidal, get help immediately. Call 9-1-1 or your doctor, or go to the nearest hospital
emergency room. You may also call the National Hopeline Network at (800) 784-2433.
Having 5 or more of these symptoms most days for 2 weeks could mean that you have major depression. Please visit a
health professional for more evaluation.
If you have fewer than 5 of these symptoms and still feel great sadness, you may have either major depression or a
milder form of depression. An evaluation by a mental health professional may be helpful.
By Josepha Cheong, MD; Michael Herkov, PhD; Wayne Goodman, MD
© 1999-2011 University of Florida Brain Institute
THE ROLE OF PATIENTS IN PREVENTION
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 central nervous system 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.
Never use another person’s prescription.
Source: National Institute on Drug Abuse
A GUIDE TO SAFE USE OF PAIN MEDICINE
If you’ve ever been treated for severe pain from surgery, an injury or an illness, you know just how vital pain relief
medications can be. Pain relief treatments come in many forms and potencies, and are available by prescription or overthe-counter (OTC), and treat all sorts of physical pain—including that brought on by chronic conditions, sudden trauma,
and cancer.
Some pain relief medicines (also known as “analgesics” and “painkillers”), including opioid analgesics, act on the body's
peripheral and central nervous systems to block or decrease sensitivity to pain. Others act by inhibiting the formation of
certain chemicals in the body.
Among the factors health care professionals consider in recommending or prescribing them are the cause and severity of
the pain.
TyPES
OF PAin RELiEVERS
OTC medications
These relieve the minor aches and pains associated with conditions such as headaches, fever, colds, flu, arthritis,
toothaches, and menstrual cramps.
There are basically 2 types of OTC pain relievers: acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).
Acetaminophen is an active ingredient found in more than 600 OTC and prescription medicines, including pain relievers,
cough suppressants and cold medications.
NSAIDs are common medications used to relieve fever and minor aches and pains. They include aspirin, naproxen and
ibuprofen, as well as many medicines taken for colds, sinus pressure and allergies. They act by inhibiting an enzyme that
helps make a specific chemical.
Prescription medications
Typical prescription pain relief medicines include opioids and non-opioid medications.
Derived from opium, opioid drugs are very powerful products. They act by attaching to a specific "receptor" in the brain,
spinal cord and gastrointestinal tract. Opioids can change the way a person experiences pain.
Types of prescription opioid medications include:
morphine, which is often used before and after surgical procedures to alleviate severe pain
oxycodone, which is also often prescribed for moderate to severe pain
codeine, which comes in combination with acetaminophen or other non-opioid pain relief medications and is often
prescribed for mild to moderate pain
hydrocodone, which comes in combination with acetaminophen or other non-opioid pain relief medications and is
prescribed for moderate to moderately severe pain
Types of non-opioid prescription medications include ibuprofen and diclofenac, which treat mild to moderate pain.
USE
AS DiREctED
Pain medications are safe and effective when used as directed. However, misuse of these products can be extremely
harmful and even deadly.
Consumers who take pain relief medications must follow their health care professional's instructions carefully. If a
measuring tool is provided with your medicine, use it as directed.
Do not change the dose of your pain relief medication without talking to your doctor first.
Also, pain medications should never be shared with anyone else. Only your health care professional can decide if a
prescription pain medication is safe for someone.
Here are other key points to remember.
With acetaminophen:
Taking a higher dose than recommended will not provide more relief and can be dangerous.
Too much can lead to liver damage and death. Risk for liver damage may be increased in people who drink 3 or
more alcoholic beverages a day while using acetaminophen-containing medicines.
Be cautious when giving acetaminophen to children. Infant drop medications can be significantly stronger than
regular children's medications. Read and follow the directions on the label every time you use a medicine. Be sure
that your infant is getting the infants' pain formula and your older child is getting the children's pain formula.
With NSAIDs:
Too much can cause stomach bleeding. This risk increases in people who are over 60 years of age, are taking
prescription blood thinners, are taking steroids, have a history of stomach bleeding or ulcers, and/or have other
bleeding problems.
Use of NSAIDs can also cause kidney damage. This risk may increase in people who are over 60 years of age, are
taking a diuretic (a drug that increases the excretion of urine), have high blood pressure, heart disease, or preexisting kidney disease.
With opioids:
Use of opioids can lead to drowsiness. Do not drive or use any machinery that may injure you, especially when you
first start the medication.
The dose of an opioid pain medication that is safe for you could be high enough to cause an overdose and death in
someone else, especially children.
KnOw
thE ActiVE inGREDiEntS
A specific area of concern with OTC pain medicines is when products sold for different uses have the same active
ingredient. A cold and cough remedy may have the same active ingredient as a headache remedy or a prescription pain
reliever.
To minimize the risks of an accidental overdose, consumers should avoid taking multiple medications with the same
active ingredient at the same time.
All OTC medicines must have all of their active ingredients listed on the package. For prescription drugs, the active
ingredients are listed on the container label.
Talk with your pharmacist or another health care professional if you have questions about using OTC medicines, and
especially before using them in combination with dietary supplements or other OTC or prescription medicines.
MiSuSE
AnD ABuSE
Misuse and abuse of pain medications can be extremely dangerous. This is especially so in regard to opioids. These
medications should be stored in a place where they cannot be stolen.
According to the National Institutes of Health, studies have shown that properly managed medical use of opioid analgesic
compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.
But the abuse of opioids is a significant public safety concern. Abusers ingest these drugs orally, and also crush the pills
in order to snort or inject them.
Commonly abused opioid pain medicines include prescription drugs such as codeine, and the brand-name products
OxyContin (oxycodone), Vicodin (hydrocodone with acetaminophen), and Demerol (meperidine).
Addiction is just one serious danger of opioid abuse. A number of overdose deaths have resulted from snorting and
injecting opioids, particularly the drug OxyContin, which was designed to be a slow-release formulation.
USE
OPiOiDS SAFELy:
3
kEy StEPS
1. Keep your doctor informed. Inform your health care professional about any history of substance abuse. All
patients treated with opioids for pain require careful monitoring by their health care professional for signs of abuse
and addiction, and to determine when these analgesics are no longer needed.
2. Follow directions carefully. Opioids are associated with significant side effects, including drowsiness,
constipation and depressed breathing depending on the amount taken. Taking too much could cause severe
respiratory depression or death. Do not crush or break pills. This can alter the rate at which the medication is
absorbed and lead to overdose and death.
3. Reduce the risk of drug interactions. Don't mix opioids with alcohol, antihistamines, barbiturates or
benzodiazepines. All of these substances slow breathing, and their combined effects could lead to life-threatening
respiratory depression.
Source: U.S. Food and Drug Administration
PRESCRIPTION DRUG ABUSE AND THE ELDERLY
As we age, our health gradually declines. The quite normal aches and pains of youth and middle age become more painful
and debilitating. Moreover, our capacity to fight off infection and disease diminishes, and when we are injured or become
ill, the healing process is slower. As a result, an increasing number of older persons are using prescription medication to
provide relief for the discomfort of aches and pains associated with illness and aging.
The overuse and abuse of prescription medication is the most common form of drug abuse among the elderly. Although
persons 65 years of age and older comprise only 13 percent of the U.S. population, they consume approximately onethird of all medications prescribed. The National Institute on Drug Abuse reports that elderly persons use prescription
medications three times as frequently as the general population and have the poorest rates of compliance with directions
for taking medications. It is now estimated that 17 percent of persons aged 60 or older are affected by prescription drug
abuse.
COmmOnLy
PREScRiBED AnD ABuSED DRuGS AmOnG thE ELDERLy
Narcotic analgesics. Narcotic analgesics are prescribed because of their pain-relieving properties. Medications
that fall within this class include morphine, demerol, codeine and their closely related synthetic cousins. Morphine,
one of the most powerful pain relievers available, is used to treat severe pain on a short-term basis. Codeine, on
the other hand, is prescribed for milder pain. Other examples of commonly prescribed narcotic analgesics derived
from codeine include Oxycontin ®, Darvocet ® and Vicodin ®.
Sedative-hypnotic drugs. Sedatives are drugs that reduce feelings of stress and nervousness and induce mental
calmness. The term sedative is virtually synonymous with the term anxiolytic, which is a drug that reduces anxiety.
Hypnotics are drugs that are used to promote sleep. The categories are not mutually exclusive. In fact, when
sedatives are given in relatively high doses, they induce sleep just as the hypnotics do. Conversely, when hypnotics
are given in low doses, they can induce daytime sedation, impair cognitive functioning and coordination, which
increases the risk of falls and other accidents. Commonly prescribed drugs in this class include tranquillizers such
as Valium ®, Xanax ® and Soma ® as well as sleeping preparations such as Ambien ®.
COnSEQuEncES
OF ABuSinG PREScRiPtiOn mEDicAtiOnS
Older persons are more likely to become mentally and physically impaired by psychoactive and mood-altering
medications because of their decreased liver function. With increasing age, the liver loses its ability to metabolize
medications. Consequently, elderly people require smaller doses of medicine to achieve the desired therapeutic effect.
When dosing is not adjusted for age and liver function, overdose, sedation, mental impairment and dependency can
occur. This is particularly problematic and dangerous with pain medication, sedatives and tranquillizers.
Signs of misuse or abuse include:
cognitive impairment, confusion, poor memory
increased falls, accidents and injuries
daytime drowsiness and poor and unrefreshing sleep
secrecy or dishonesty about medication use frequently running out of medication before the next scheduled refill
feigning illness or injury to attain medication
doctor shopping, e.g. seeing more than one doctor for the same problem
Identifying prescription drug abuse among the elderly is difficult because the normal warning signs of substance abuse
can be masked by concurrent illnesses and chronic conditions such as chronic pain, sleep problems, anxiety, depression
or confusion. Therefore, experts recommend that persons older than age 60 be screened for alcohol and prescription drug
abuse as part of the routine physical examination.
If you are concerned that an elderly parent or friend may be abusing her prescription medication, seek professional help.
Sources:
CSAT. Substance Abuse Among Older Adults (TIP #26): Physicians Guide. DHHS Pub. No. (SMA) 00-3394. SAMHSA,
2000.
Summary of Findings from the National Household Survey on Drug Abuse. DHHS Pub. No. (SMA) 00-3466. SAMHSA,
2000.
By Drew Edwards, EdD, MS
© 2002-2011 Achieve Solutions ®
YOUNG ADULTS: PRESCRIPTION DRUG ABUSE IS DRUG ABUSE
Better life through better chemistry—the American way. Look in the medicine cabinet of any American home, including
your own, and you will see a multitude of drug preparations and prescriptions, ranging from over-the-counter cold and
pain remedies to powerful prescription medication to treat a variety of conditions.
It’s no surprise that prescription drug abuse has risen sharply in the last decade. Nonmedical use of prescription drugs
such as opioids, central nervous system depressants and stimulants can lead to abuse and addiction, characterized by
compulsive drug seeking and use.
Young adults should understand that these are legal drugs with potentially lethal consequences when used without
medical supervision.
COmmOn
DRuGS OF ABuSE
The abuse of methylphenidate (Ritalin ®), commonly used to treat attention-deficit/hyperactivity disorder (ADHD), is now
common. By crushing the tablets and snorting the drug, individuals attain a “cocaine-like” high. In fact, Ritalin has been
shown to affect the brain in much the same way as cocaine. And nonmedical use of pain relievers such as oxycodone with
aspirin (Percodan®) and hydrocodone (Vicodin®) and, oxycontin, is on the rise.
Why
iS thE ABuSE OF thESE DRuGS On thE RiSE ?
One reason is increased availability. It is now possible to obtain powerful prescription medication over the Internet from
foreign countries as well as from illegal domestic sources, not to mention a parent’s or friend’s medicine cabinet. Also,
many of these drugs are highly addicting so experimental use can quickly develop into dependency.
SiGnS
OF PREScRiPtiOn DRuG ABuSE
changes in appearance, including weight loss or weight gain
loss of interest in school, work or once enjoyable activities
lethargy and sleep problems, including insomnia or sleeping too much
frequent illness or physical complaints. Many trips to the doctor for vague and poorly defined symptoms.
change in bowel habits
change of friends and activities
irritability and restlessness or abrupt changes in mood or attitude
unexplained absences
missing medications from a family member
unexplained money problems
stealing
blackouts and memory lapses
inability to stop using
By Drew Edwards, MS
© 2002-2011 Achieve Solutions ®
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