Medical vs. Use of Drugs. Warning Signs of Chemical Dependence. Intent Effect. Legality Pattern 5/5/2010. Daily use above ceiling doses
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1 Identifying and Preventing Drug Abuse By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Medical vs. Non-Medical Use of Drugs Intent Effect Control Legality Pattern Warning Signs of Chemical Dependence Daily use above ceiling doses Use of alcohol or other drugs non- medically Addict behavior Poor therapeutic response Prescription drug abuse is a large and growing problem. Between 1992 and 2002, prescriptions for controlled substances increased 2x faster than for non-controlled substances and 12x faster than the general population. Abuse of prescription drugs is the fastest- growing class of drugs being abused by adolescents; Opioids are being abused the most. 1
2 Large Mid-Western University Study 40% - no lifetime use 39.7% - medical use only 15.8% - both medical and non-medical use 4.4% - non-medical use only Early onset of NMUPD was a significant predictor of prescription p drug abuse and dependence. The increase for past month non-medical use of prescription drugs from was 162% compared to 33% for marijuana and 61% for cocaine. Americans are 4.6% of the world s population Americans consume 80% of the world s Opioid supply American s consume 99% of the global Hydrocodone supply 2006 National Survey on Drug Use and Health 7 million (2.8% of all persons >12) had used prescription drugs in the last month non- medically 16.4 million (6.6%) had used non-medically in the last year 49.8 million (20.3%) had used non-medically during their lifetime Average therapeutic sales of Opioids per person have increased from 74 mg per person in 1997 to 329 mg in 2006 (347%) Methadone increased by 1129% per person OxyCodone increased by 899% 2
3 Source of Prescription Pain Relievers used Non-Medically 55.7% friends or relatives 19.1% from one M.D. 3.9% from drug dealers 0.1% from the Internet Investigations have illustrated drug abuse in 18-41% in patients receiving Opioids for chronic pain. DAWN From the increase in ED visits for narcotics was 274% (160K) From the increase in ED visits for Benzodiazepines was 141% (172k) Methadone has been implicated in more unintentional poising deaths than any other Opioid. From , Methadone deaths increased by 390% (It went from 4% of all poisoning deaths to 13%) Protection for the Physician Between 1995 and 2005, rates of treatment admissions involving Opioid analgesics more than tripled. Know the patient See the patient frequently Have contact with family members Urine tests 3
4 Diversion of prescription Opioids might be reduced through physician education focusing on: Recognizing that a patient is misusing or diverting. Considering a patient s risk for Opioid misuse before initiating Opioid therapy. Physicians are whipsawed between the imperative to treat pain with Opioids and the fear of producing addiction in some patients. Understanding the variation in the abuse potential of different Opioid medications currently on the market. Patient Education: Safeguarding Disposal Understanding Consequences of Manipulating Physicians Selling Their Medications Self-reported craving is a potential marker for identification of those at risk for Opioid medication misuse. Medical use of Benzodiazepines 71% over 50 years of age 67% Female Non-Medical User 61% Male 74% less than 35 years old 4
5 Benzodiazepine Checklist for Long-term Use: Diagnosis Drug and Alcohol Use Toxic Behavior Family Monitor Treatment for Chemically Dependent Patients: Don t use Benzodiazepines in outpatient treatment Refer patients to AA/NA Refer family members to AL-ANON Find Non-Benzo alternative Non-Addictive Alternativesti Anxiety Antidepressants Buspirone Hydroxyzine Biofeedback/Relaxation Techniques Panic Disorder SSRI s TCA s Insomnia Hydroxyziney y Antidepressants Relaxation Tapes 5
6 Pain Non-steroidal Anti-inflammatories Heat, cold Pain management Conclusion 6
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