Prescription Drug Addiction and Treatment
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Who is Most Vulnerable?
Adolescents
According to the 2003 National Survey on Drug Use and Health, 9.2% of youth aged 12 -17 had used a prescription psychotherapeutic drug for nonmedical reasons in the past year and 4.0% were current users. Prescription opioids are a particularly serious problem in this age group. NIDA's 2004 Monitoring the Future survey of 8th, 10th, and 12thgraders found that 5.0% of 12th-graders reported abusing OxyContin in the past year, and 9.3% reported abusing Vicodin, making Vicodin one of the most commonly abused prescription drugs in this population. Another troubling trend is the recent phenomena known as "pharming," where young people mix prescription medications and ingest some or all of them at once, unaware of potentially severe drug interactions.
Elderly Adults
Although persons 65 years of age and above comprise only 13% of the population, they are prescribed approximately one-third of all medications in the United States. In addition, older patients are likely to be prescribed more long-term prescriptions, as well as multiple prescriptions, which could potentially result in unintentional misuse. A large percentage of older adults also use OTC medicines and dietary supplements, along with prescription medications, which could lead to dangerous results. The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. Because of high rates of comorbid illnesses among the elderly, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse or misuse can have more adverse health consequences among this age group.
Gender Differences
Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and antianxiety drugsÑin some cases, 55% more likely. Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12- to 17-year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines). However, among women and men who use a sedative, anti-anxiety drug, or hypnotic, women are almost two times more likely to become addicted.
What Can We Do?
Healthcare providers, primary care physicians, pharmacists, and patients themselves, can all play a role in identifying and preventing prescription drug abuse.
Physicians.
Because most people visit their primary care physician at least once every 2 years, primary care physicians are in a unique position not only to prescribe medications, but to identify prescription drug abuse and help the patient find treatment. Screening for prescription drug abuse should be incorporated into every routine medical visit. Doctors can begin by asking questions about substance abuse history, current prescription and OTC use, and reasons for use. Further, doctors should also be aware of other potential signs of abuse, such as rapid increases in the amount of medication the patient reportedly needs, or refill requests before the refill date.
Assessing Prescription Drug Abuse:
Four Simple Questions for You and Your Physician
- Have you ever felt the need to cut down on your use of prescription drugs?
- Have you ever felt annoyed by remarks your friends or loved ones made about your use of prescription drugs?
- Have you ever felt guilty or remorseful about your use of prescription drugs?
- Have you ever used prescription drugs as a way to "get going" or to "calm down?"
Pharmacists
It is a pharmacist's responsibility to provide clear information on how to take medications appropriately, describe possible effects, and warn of possible drug interactions. The pharmacist also can be part of the first line of defense in recognizing prescription drug abuse. By monitoring prescriptions for falsification or alterations and being aware of potential "doctor shopping" (where patients get multiple prescriptions from different doctors), pharmacists play a valuable role in prevention.
Patients
There are also steps a patient can take to ensure the appropriate use of prescription medications. Patients should always follow the directions, be aware of potential interactions, never stop or change a dose on their own, and never take another person's prescription. Patients should also inform their healthcare professionals about current prescription and OTC medicines they are taking, along with any dietary or herbal supplements they might be taking.
What Are The Treatments for Prescription Drug Abuse?
Years of research have shown that addiction to any drug, illicit or prescribed, like other chronic diseases, can be treated effectively. However, no single type of treatment is appropriate for all individuals with addictions. To be successful, treatment must take into account the type of drug used as well as the needs of the user. Treatment may incorporate several behavioral and pharmacological components, as well as detoxification. Because drug abuse is a chronic and relapsing disease, multiple courses of treatment may be needed for patients to make a full recovery.
There are two main categories of drug addiction treatment – behavioral and pharmacological.
Behavioral Treatment
Behavioral drug abuse treatments such as individual counseling, group or family counseling, contingency management, and cognitive-behavioral therapy-teach patients how to stop using drugs, how to handle cravings, how to prevent a relapse, and how to handle a relapse if one should occur. When delivered effectively, behavioral treatments also can help patients improve their personal relationships and ability to function at work and within the community.
Pharmacological Treatment
Some addictions, such as opioid addiction, can be treated with medications. Methadone and Buprenorphine currently are used to treat heroin addiction, but they also may prove useful in treating addiction to pain relievers. Further research is needed to determine whether these medications will provide an effective treatment for prescription drug abuse.
Research shows that a combination of both behavioral and pharmacological treatments is the most effective strategy, especially for treating opioid addiction.
What Are Some of The Problems With Prescribing Pain Medications?
There is a fine balance between under-prescribing and over-prescribing pain relievers, particularly opioids.
The data available to us so far suggests that the risk of becoming addicted to prescription pain medication is minimal in those who are treated on a short-term basis. The risk for patients with chronic pain is less well understood. Some studies have shown that those most vulnerable to becoming addicted to prescription pain medications have a history of psychological disorders, prior substance abuse problems, or a family history of these disorders.
Pain management for patients who have substance abuse disorders is particularly challenging for the medical profession. However, these patients still can be successfully treated with opioid pain medications; they may need to be admitted to a treatment or recovery program and monitored closely if prescribed controlled substances for pain.
Developing effective treatments for addiction and pain medications that are less likely to be abused is a priority for NIDA. For example, the medication buprenorphine/naloxone (marketed as Suboxone), developed by NIDA in collaboration with the pharmaceutical industry for the treatment of opioid addiction, may provide an alternative treatment for pain that has less potential for abuse than other pain medications. However, further research is needed before this practice can be recommended.
* This does not apply only to opioids. Changes in routes of administration also contribute to the abuse of other prescription medications, and this practice can lead to serious medical consequences.
