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CM 20- Rx Drug Abuse Prescription drug abuse means taking a prescription drug that is not prescribed for you, or taking it for reasons or in dosages other than as prescribed. Abuse of prescription drugs can produce serious health effects, including addiction The NIDA-funded 2010 Monitoring the Future Study showed that 2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th graders had abused Vicodin and 2.1% of 8th graders, 4.6% of 10th graders, and 5.1% of 12th graders had abused OxyContin for nonmedical purposes at least once in the year prior to being surveyed. In 2009, 16 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed. Commonly abused Commonly abused classes of prescription drugs include opioids (for pain), central nervous system (CNS) depressants (for anxiety and sleep disorders), and stimulants (for ADHD and narcolepsy). Opioids Long-term use of opioids or central nervous system depressants can lead to physical dependence and addiction. Opioids can produce drowsiness, constipation and, depending on amount taken, can depress breathing. Hydrocodone (Vicodin®) Oxycodone (OxyContin®) Oxymorphone (Opana®) Propoxyphene (Darvon®) Hydromorphone (Dilaudid®) Meperidine (Demerol®) Diphenoxylate (Lomotil®) CNS Depressants Central nervous system depressants slow down brain function; if combined with other medications that cause drowsiness or with alcohol, heart rate and respiration can slow down dangerously. Diazepam (Valium®) Pentobarbital sodium (Nembutal®) Alprazolam (Xanax®) CNS Stimulants Stimulants can cause anxiety, paranoia, dangerously high body temperatures, irregular heartbeat, or seizures when taken repeatedly in high doses. Methylphenidate (Ritalin® and Concerta®) Dextroamphetamine (Dexedrine®) Amphetamines (Adderall®) CM 20- Rx Drug Abuse Risk Assessment for Substance Abuse Personal history of alcohol or drug abuse Family history of alcohol or drug abuse History of preadolescent sexual abuse Age between 16-45 Drug Seeking Patient Medications most commonly abused o Narcotic analgesics, sedative-hypnotics, stimulants Addiction is a common malady in medicine o 20-50% of hospitalized patients = addiction o 15-30% in primary care = addiction o 50% of psychiatric patients = addiction Addiction characteristics o Underprescribing can result in overuse o Escalating use o Drug-seeking behavior Manipulation Losing prescriptions Doctor shopping Characteristics of Overprescribing Physicians Dated = deficient in knowledge Duped = o Believes to much in the goodness of others o Has a difficult time saying “no” o Wants to please others o Bases self-worth on the opinions of others Dishonest in exchange for financial gain Disabled o Chemically dependent themselves o Co-dependent = fear anger or abandonment Risk Factors for Fibromyalgia Perfectionism Anxiety Loss of control Sedentary lifestyle Chronic Back Pain $50 billion spent for treatment annually 22 studies of pain greater than 3 months Physical therapy is essential and is essentially ignored Osteopathy the Best Treatment Treat Your Own Back by Robin McKenzie = 800-367-7393 (optp.com) Rehabilitation programs + psychological components = best outcomes--but insurance companies are reluctant to pay for psychotherapy for chronic pain Biofeedback/relaxation techniques Cognitive behavior therapy Psychodynamic understanding essential CM 20- Rx Drug Abuse Risk Management Maintain current knowledge base Maintain good records o Progress note with the diagnosis and reason for prescribing and treatment time course o Keep a flow chart to monitor refills Prescribing practices o Prescribe the exact amount o Write out the number o Keep prescription pads under close control o Warn about driving a car with sedating meds Guidelines for Opioid Use Use as last resort Written goals for measurable goals for reduction of pain and improvement in function = relaxation, biofeedback, exercise Patient signs agreement listing risk Regular monitoring face-to-face Opioids discontinued for breaking rules or not meeting treatment goals Lortab/Vicodin most commonly used opioids Use in chronic, noncancer pain??????? NSAIDs and TCAs boost analgesic effects of narcotics Because of anti-GABA effects, benzodiazepines exacerbate pain and interfere with opioid effects Some studies = opioids may increase pain SC State Guidelines for Prescribing Opiates With the exception of transdermal patches, supply limitation is 31 days and must be dispensed within 90 days of the date of issue. After 90 days, a Schedule II controlled substance prescription is void Self-prescribing or prescribing for family members is only permitted in an emergency Preprinted prescriptions for controlled substances in any schedule are prohibited The state limits the quantity of each prescription schedules III-V controlled medications to a 90 day supply If authorized for refill, no prescription shall be refilled sooner than 48 hours prior to the time that the prescription should be consumed if the prescribed daily dosage is divided into the total prescribed amount Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations. SCRIPTS (SC Reporting and ID Prescription Tracking System) The purpose of the S.C. Reporting & Identification Prescription Tracking System (SCRIPTS) is to collect data on all Schedule II, III, and IV controlled substances dispensed in and/or into the state of South Carolina The program is intended to improve the state’s ability to identify and stop diversion of prescription drugs in an efficient and cost effective manner that will not impede the appropriate medical use of legal controlled substances SCRIPTS is an online service. A prescriber or a pharmacist must apply for access to the database by supplying the program with appropriate credentials prior to receiving any patient information. A prescriber or pharmacist may not allow anyone else to use his or her user name and password to obtain a patient Rx history report. The Web site is available 24/7; however, there may be up to a six week lag-time from the actual dispensing date until the date the data is available online. In most cases, a patient report is available for viewing within minutes CM 20- Rx Drug Abuse Medical Ethics Primum Non Nocere First, Do No Harm Given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good".