Prescription Abuse: Cause, Consequence and Control
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1 Prescription Abuse: Cause, Consequence and Control Glen R. Hanson, Ph.D., D.D.S. Professor in Pharmacology, University of Utah Director of the Utah Addiction Center, University of Utah Senior Advisor, National Institute on Drug Abuse, NIH
2 What Do We Mean When We Say Prescription Drug Abuse? Use: Prescribed and clinically appropriate Misuse: Either not prescribed or clinically inappropriate
3 Drug Abuse- use of a drug in a manner not medically or socially approved (recreationally??). Prescription abuse Pharm Party
4 Dependence: Persistent use resulting in adaptations typically accompanied by accommodation or tolerance (causing compensatory escalation) and withdrawal (e.g., aches, diarrhea, depression and cravings) Drug addiction: Compulsive drug use that consists of repetition to satisfy intense urges, despite severely negative consequences
5 Categories of Rx drug users Legitimate (do not break laws and drugs properly managed and used) Legitimate (laws not broken, but either not being managed properly or used improperly) Illegal (laws broken to obtain and/or use) Combinations
6 What is the attitude about the drug? Necessary for a medical condition (e.g., pain, stress, anxiety) If the drug can be obtained legally, everything will be OK Obsessed: tremendous energy is spent on assuring drug access
7 How many people are abusing (misusing?) prescription drugs? Survey Says: Approximately 9 million Americans use prescription drugs at least once for nonmedical reasons a year. Approximately 4 million Americans report using prescription drugs nonmedically monthly.
8 In 2010 nonmedical use & consequences >12 yrs lifetime= 20% HS Seniors annual use Vicodin= 10% OxyContin= 5% Adderall= 5% ~ 15,000 overdose deaths in U.S.A., 2011
9 What is the pharmacological status of the patient/user? Deriving medical benefit from the medication Physically dependent, but not addicted Physically dependent and addicted
10 What is the role of the Rx provider & dispenser? (DRUG DEALERS?) AWOL ( take a number attitude; does not know patient nor history) Enabler (excessively accommodating) Candy man
11 Where do abused Rx drugs come from (demographics)? Doctor s Rx = 19% Dealer = 8% Friend or relative = 66% Buy the drugs = 21% Took/stole the drugs = 12% Given the drugs = 33% Internet purchases = minor
12 What should we do about it??
13 Utah Legislature/Governor 2010 Resolution: Objectives: more effective education and assessment of risk before prescribing and more effective monitoring and disposal after prescription issued
14 Why Does Someone Abuse a Prescription Drug?
15 Addiction Cycle for Prescription Drugs relieve medical condition (e.g., pain, anxiety, stress, weight gain) reinforcing effects (stimulates reward pathways) induces physical dependence often there is a tolerance and withdrawal issue (usually occurs due to lengthy drug use) patients often have substance abuse risk before treatment (mental risk/prexisting problem patient uses various strategies to maintain drug supply (often illegal)
16 Prevention Obtain accurate history (any drug abuse problems in family or personally?) HOW? Doctors/pharmacists need to do their jobs-educate and warn!
17 DEFINING SBIRT PROGRAM SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) IS A COMPREHENSIVE AND INTEGRATED APPROACH TO THE DELIVERY OF EARLY INTERVENTION AND TREAMTMENT SERVICES THROUGH UNIVERSAL SCREENING TO PERSONS WITH SUBSTANCE USE DISORDERS AND THOSE AT RISK Babor et al., 2007
18 DEFINING SBIRT SBIRT is designed to fill the gap between primary prevention efforts and more intensive treatment for persons with serious substance use disorders SBIRT PHYSICIANS and programs can reach a significant proportion of the population using alcohol and other drugs before high-end interventions are needed
19 SBIRT PYRAMID REFERRAL TO TREATMENT BRIEF TREATMENT BRIEF INTERVENTION SAMHSA SBIRT PROGRAM, 2009
20 AGE-RELATED NEED FOR SBIRT IN UTAH Division of Substance Abuse and Mental Health, 2010
21 SBIRT CORE COMPONENTS Screen Brief Intervention Brief Treatment Referral to Treatment Identification of substance related and emotion problems Uses motivational interviewing to raise awareness of risks and motivate client toward treatment engagement Evidence based cognitive behavioral treatment with clients who elect further treatment or need follow-up care (including co-occurring disorders) Referral of those with more serious or emergent treatment needs
22 SBIRT CORE COMPONENTS SCREENING accurate identification of at risk, high risk, and addicted individuals ISSUES TO CONSIDER important to consider 1) perceived threat, 2) cognitive capacity, 3) self image, 4) denial patient and medical staff, and 5) level of trust
23 SBIRT SCREENING TOOLS AUDIT (ALCOHOL USE DISORDERS IDENTIFICATION TEST) 10 questions, focuses on hazardous drinking as well as alcohol use disorders, adult population, 5 min/3 min DAST (Drug Abuse Screening Test) 10 or 28 questions, focuses on drugs, adult and adolescent populations, 5 min/2 min TWEAK (Tolerance, Worry, Eye-Opener, Amnesia, Cut-Down) 5 questions, originally developed to screen for alcohol use in pregnant women; adult population, 3 min/2min
24 How can the health care provider contribute?
25 Patient Education Only use the Rx to treat the condition for which it was prescribed Recognize the symptoms of dependence and addiction (& difference) Rx addiction is a relapsing disorder and often requires professional help
26 How to safely store Promptly dispose of the leftovers!!! Legal prohibitions on sharing or selling/protect family members and others from unintentional or intentional misuse
27 Tools to assist assessments: Division of Occupational and Professional Licensing (DOPL) Monitoring- regulator of Rx drug prescribers Licensing and certification management-establish qualifications and require training (CE requirements)
28 Monitoring through databasesapproach real-time information High-risk patients: Medication management agreements Tight control on Rx numbers and routine accountability Drug screens-- with consequences
29 Be able to recognize if treatment is required and get patient help (be able to explain why important and how it is done)
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