ADDICTION BY PRESCRIPTION FOR ALL AGES DEPRESSION: SIGNS AND SYMPTOMS. October "I don t feel like myself anymore."

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1 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 or your doctor, or go to the nearest hospital emergency room. You may also call the National Hopeline Network at (800) 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.

2 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 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.

3 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

4 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

5 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

6 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) SAMHSA, Summary of Findings from the National Household Survey on Drug Abuse. DHHS Pub. No. (SMA) SAMHSA, By Drew Edwards, EdD, MS 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

7 unexplained money problems stealing blackouts and memory lapses inability to stop using By Drew Edwards, MS Achieve Solutions To read more about this topic, click on Addiction by Prescription For All Ages under the Featured Topic bar on the lower right-hand side of the home page of Achieve Solutions. Achieve Solutions, offered by ValueOptions, is a behavioral health and wellness Web site filled with thousands of educational articles and tools for employees and their family members.