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| <div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | | <div class="editorbox"> |
| '''Original Editors '''- Lauren Cotton & Erin Smith [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | | '''Original Editors '''- Lauren Cotton & Erin Smith [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] |
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| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} |
| </div> | | </div> |
| <references /> | | == Introduction == |
| | [[File:Prescription drug abuse.jpeg|thumb|Prescription drug abuse]] |
| | Prescription drug abuse occurs when someone uses a prescribed medication for purposes other than what it was intended for, use more than the dose prescribed by the physician, or continue prolonged use after the amount prescribed by the physician was taken<ref name="Mayo">Mayo Clinic. Prescription Drug Abuse. http://www.mayoclinic.com/print/prescription-drug-abuse/DS01079/METHOD=print&DSECTION=all (accessed 15 March 2012).</ref>. Drug abuse may become ongoing and compulsive, despite the negative consequences.<br>An increasing problem, prescription drug abuse can affect all age groups, including teens. The prescription drugs most often abused include [[Opioid Use Disorder|opioid painkillers]], anti-anxiety medications, sedatives and stimulants. Early identification of prescription drug abuse and early intervention may prevent the problem from turning into an addiction.<ref name=":0">Mayoclinic Prescription drug abuse Available:https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813 (accessed 10.4.2022)</ref> |
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| == Definition/Description == | | == Epidemiolgy == |
| | [[File:US timeline. Number of overdose deaths from all drugs.jpg|right|frameless|631x631px]] |
| | Abuse of prescription drugs has reached an epidemic level |
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| Prescription drug abuse occurs when someone uses a prescribed medication for purposes other than what it was intended for, use more than the dose prescribed by the physician, or continue prolonged use after the amount prescribed by the physician was taken<ref name="Mayo">Mayo Clinic. Prescription Drug Abuse. http://www.mayoclinic.com/print/prescription-drug-abuse/DS01079/METHOD=print&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;DSECTION=all (accessed 15 March 2012).</ref>. Abuse of prescription medications can produce serious adverse health effects, including addiction<ref name="NIDA">National Institute on Drug Abuse. InfoFacts: Prescription and Over-the-Counter Medications. http://www.drugabuse.gov/publications/infofacts/prescription-over-counter-medications (accessed 19 March 2012).</ref>.
| | * More than 16.7 million people age 12 and older in the United States abused prescription drugs in 2012, with approximately 2.1 million people meeting criteria for a diagnosis of a substance use disorder related to prescription drugs.<ref>McHugh RK, Nielsen S, Weiss RD. Prescription drug abuse: from epidemiology to public policy. Journal of substance abuse treatment. 2015 Jan 1;48(1):1-7.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250400/ (accessed 10.4.2022)</ref> |
| | * In Australia, in 2019, an estimated 900,000 people (4.2%) aged 14 and over used a pharmaceutical drug for non-medical purposes in the previous 12 months<ref>AIHW Available: Illicit drug use https://www.aihw.gov.au/reports/australias-health/illicit-drug-use (accessed 10.4.2022)</ref> |
| | * Prescription drugs are the most commonly abused substances by teens after marijuana, synthetic marijuana (spice), and alcohol<ref name=":1">Get smart about drugs Prescription Drug Abuse Available: https://www.getsmartaboutdrugs.gov/content/prescription-drug-abuse (accessed 10.4.2022)</ref>. |
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| <br>Prescribed drugs that are commonly abused in the healthcare system are narcotic painkillers. Narcotics are natural opioid drugs that can help to reduce pain, and can also promote drowsiness. Physicians commonly use narcotics to reduce a patient’s post-operative pain or to reduce anxiety and induce anesthesia prior to an operation<ref name="Free Dictionary">The Free Dictionary. Narcotics. http://medical-dictionary.thefreedictionary.com/Narcotics (accessed 19 March 2012).</ref>. These drugs are also commonly prescribed to “enable individuals with chronic pain to lead productive lives<ref name="NIDA" />.”
| | == Obtaining == |
| | Some prescription drug addicts start with legitimate prescribed for them. eg A patient needing [[Pain Medications|pain medication]] after surgery. When patients take their medications in ways that go beyond their doctors’ instructions, tolerance and eventual addiction can be the result. |
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| <br>“Opioids are analgesic, or pain-relieving, medications. Studies have shown that properly managed medical use (taken exactly as prescribed) of opioid analgesics is safe, can manage pain effectively, and rarely causes addiction<ref name="NIDA" />.” However, many people who are prescribed and taking opioids for a period of time may develop a physical dependence on the drug which could lead to abuse of the painkiller and will require medical supervision<ref name="NIDA" />. Some examples of opioids that you may see commonly abused in the healthcare system are<ref name="NIDA" />: <br>• Hydrocodone (e.g., Vicodin)<br>• Oxycodone (e.g., OxyContin)<br>• Codeine <br>• Propoxyphene (Darvon)<br>• Meperidine (Demerol)<br>• Lortab<ref name="NDIC">National Drug Intelligence Center. Prescription Drugs Fast Facts. http://www.justice.gov/ndic/pubs5/5140/index.htm (accessed 19 March 2012).</ref><br>• Dilaudid<ref name="NDIC" /><br>• Lorcet<ref name="NDIC" /><br>• Tylox<ref name="NDIC" /><br>• Percocet<ref name="NDIC" /><br>• Percodan<ref name="NDIC" /><br>
| | Others become addicted to prescription drugs without ever legally obtaining a prescription. They either buy the drugs on the street, purchase them online, or steal them. Unfortunately, the black market for prescription medications is now growing at an alarming rate. People use them because they are cheap and easy to get.<ref name=":2">UK Addiction treatment centre Prescription Drug Addiction and Abuse Available: https://www.ukat.co.uk/prescription-drug-addiction/ (accessed 10.4.2022)</ref> |
| | [[File:Prescription Drug Supply Chain.jpeg|center|thumb|748x748px|Prescription Drug Supply Chain]] |
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| Here are some statistics related to prescription drug abuse<ref name="Pharm Times">Zanni G. Pharmacy Times. Rx Drug Abuse: An Escalating Problem with Multiple Causes. http://www.pharmacytimes.com/publications/issue/2007/2007-09/2007-09-6799 (accessed 28 March 2012).</ref>:
| | == Characteristics/Clinical Presentation == |
| | Signs that go along with prescription drug addiction. These are: |
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| [[Image:Pharm.jpg]]
| | * A tendency to visit doctors frequently |
| | * A tendency to shop online for prescription drugs |
| | * Regular complaints about medical conditions that would justify drug use |
| | * A gradual drop-off in school or work performance |
| | * And increasing disinterest in personal appearance |
| | * A tendency toward defensiveness when talking about prescription medications<ref name=":2" />. |
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| == Prevalence ==
| | Signs and symptoms of prescription drug abuse depend on the specific drug. Because of their mind-altering properties, the most commonly abused prescription drugs are: |
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| The prevalence of prescription drug abuse is at a dangerously high level. According to the Centers for Disease Control, “In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year”<ref name="CDC">Centers for Disease Control and Prevention. Prescription Painkiller Overdoses in the US. http://www.cdc.gov/VitalSigns/PainkillerOverdoses/#LatestFindings (accessed 15 March 2012).</ref>. The results of the National Survey on Drug Use and Health (2010) showed that “an estimated 2.4 million Americans used prescription drugs non-medically for the first time within the past year”<ref name="SAMHSA">U.S. Department of Health and Human Services:fckLRSubstance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Results from the 2010fckLRNational Survey on Drug Use and Health:fckLRSummary of National Findings. http://www.oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm (accessed 16 March 2012).</ref>. These numbers show that this problem is one that deserves the attention of the healthcare community.
| | !Opioids |
| | | !Anti-anxiety medications and sedatives |
| <br>The Drug Abuse Warning Network, which monitors emergency department visits across the country, stated that “an estimated 1,079,683 ED visits in 2009 involved the nonmedical use of prescription drugs, over-the-counter medicines, or other types of pharmaceuticals“<ref name="DAWN">U.S. Department of Health and Human Services:
| | !Stimulants |
| Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network, 2009: National Estimates of Drug-Related Emergency Department Visits. http://www.samhsa.gov/data/2k11/DAWN/2k9DAWNED/HTML/DAWN2k9ED.htm#High6 (accessed 16 March 2012).</ref>. Prescription pain relievers were the drugs used most commonly, with oxycodone, hydrocodone, and methadone rating the highest amongs the drugs used<ref name="DAWN" />.
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| <br>The population affected the most by prescription drug abuse includes those ages 18-25, with a percentage of prescription drug use non-medically at 5.9%<ref name="NIDA">National Institute on Drug Abuse. Research Reports: Prescription Drugs: Abuse and Addiction. http://www.drugabuse.gov/publications/research-reports/prescription-drugs/trends-in-prescription-drug-abuse/older-adults (accessed 15 March 2012).</ref>. However, another age group at a higher risk for prescription drug abuse is the older adult group (65+). More than 1/3 of the total dollars spent on outpatient prescription medications in the US come from this population. Due to the prevalence of co-morbidities and chronic disease, the older population is more likely to be prescribed long term medications as well as multiple medications, which leads to a greater chance for improper use<ref name="NIDA" />.<br>
| | * Constipation |
| | | * Nausea |
| == Characteristics/Clinical Presentation ==
| | * Feeling high (euphoria) |
| | | * Slowed breathing rate |
| Some symptoms that you may hear of if someone is abusing a painkiller are subjective complaints of depression and constipation.
| | * Drowsiness |
| | | * Confusion |
| <br>Some objective measures that may be seen are:
| | * Poor coordination |
| | | * Increased dose required for pain relief |
| • low blood pressure<ref name="Mayo" />
| | * Worsening or increased sensitivity to pain with higher doses (hyperalgesia) |
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| • decreased respiration rate<ref name="Mayo" />
| | * Drowsiness |
| | | * Confusion |
| • may also observe some confusion<ref name="Mayo" />
| | * Unsteady walking |
| | | * Slurred speech |
| • drowsiness<ref name="NIDA 2">National Institute on Drug Abuse. Prescription Medications. http://www.drugabuse.gov/drugs-abuse/prescription-medications (accessed 19 March 2012).</ref>
| | * Poor concentration |
| | | * Dizziness |
| • depressed breathing<ref name="NIDA 2" />
| | * Problems with memory |
| | | * Slowed breathing |
| • In some cases if taken with other medications or alcohol, then you may see decreased heart rate, respiration rate, and an increase in body temperature<ref name="NIDA 2" />.
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| | | * Increased alertness |
| • It is also possible to see excessive mood swings, the appearance of being high or sedated, and also an appearance of overly and unusually energetic<ref name="Mayo" />.
| | * Feeling high |
| | | * Irregular heartbeat |
| <br>Another characteristic that can be seen in someone who is abusing painkillers is noticing medication use that may be interfering with activities. This will be helpful in identifying narcotic abuse in the physical therapy clinic. Also, you may also see your patient continuing to use a medication despite other adverse effects that they may note that they are having<ref name="NYU">NYU Langone Medical Center. Prescription Drug Addiction. http://psych.med.nyu.edu/conditions-we-treat/conditions/prescription-drug-addiction (accessed 19 March 2012).</ref>.
| | * High blood pressure |
| | | * High body temperature |
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| | * Reduced appetite |
| | | * Insomnia |
| Some of the behavioral and physiologic respones that may be found will largely be dependent upon the actual chemical itself, the route of administration, and the client's circulatory system<ref name="Substance Abuse">Goodman C, Snyder T, Differential Diagnosis for Physical Therapists Screening for Referral. In: Falk, K Editor. Substance Abuse. Saunders: Elsevier,2007. p59-61</ref>.
| | * Agitation |
| | | * Anxiety |
| Some adverse reactions that may be seen are<ref name="Substance Abuse" />:
| | * Paranoia |
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| *delayed wound healing | | <ref name=":0" /> |
| *delayed repair of soft tissue injuries | | == Dangers == |
| *soft tissue infections (e.g. abscess, cellulitis) | | The dangers that go along with prescription drug addiction are very similar to other addictions. Addictive prescription medications have adverse effects on the physical body that directly correlate with the kind of drug being used. |
| *Low grade fever | |
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| == Associated Co-morbidities ==
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| The connection between drug abuse and mental disorders is one that has been highlighted in recent literature. As the National Institute on Drug Abuse’s Research Report Series shares, people with mood/anxiety disorders are approximately two times as likely to have a drug disorder, and people with a drug abuse history are about twice as likely to have a mood/anxiety disorder, although it is difficult to prove that one causes the other, or visa versa<ref name="NIDA 2">National Institute on Drug Abuse. Topics in Brief: Comorbid Drug Abuse and Mental Illness. http://www.drugabuse.gov/publications/topics-in-brief/comorbid-drug-abuse-mental-illness (accessed 16 March 2012).</ref>. According to the National Drug Intelligence Center, around 4.0 million adults in 2002 met criteria for a mental illness and substance dependence or abuse<ref name="NDIC">National Drug Intelligence Center. Drug Abuse and Mental Illness Fast Facts. http://www.justice.gov/ndic/pubs7/7343/index.htm#What (accessed 15 March 2012).</ref>.
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| <br>Another co-morbidity seen with drug abuse is chronic pain. In many instances the reason that a painkiller is prescribed is for relief from serious pain symptoms. The pain can stem from a surgical procedure, a traumatic event, or can be due to chronic severe pain. The most concerning situation is a combination of both co-morbidities, a patient with chronic pain and consistant drug abuse that also has a mental disorder. An article in the Pain journal states that “to our knowledge, no guidelines currently exist for managing opioid misusers with chronic pain and a psychiatric or substance abuse history<ref name="Pain">Jamison RN, Ross EL, Michna E, et al. Substance Misuse Treatment for High Risk Chronic Pain Patients on Opioid Therapy: A Randomized Trial. Pain. 2010 September; 150(3): 390–400. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910796/ (accessed 16 March 2012).</ref>.” Due to the high risk of abuse and overdose that comes with opioids, these drugs should be prescribed and monitored carefully.<br><br>
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| == Medications ==
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| There are several different medications that can help to decrease the side effects of withdrawal symptoms in someone who may be dependent on an opioid painkiller secondary to abuse of that drug. However, at first the individual may have to undergo detoxification under medical supervision in order to reduce any withdrawal symptoms they may be having<ref name="NIDA" />. Options to effectively treat addiction to prescription opioids are found from research done on treating heroin addiction<ref name="NIDA" />. The medications that may be used to treat opioid addiction secondary to abuse are as follows:
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| <br>• Methadone – synthetic opioid that gets rid of withdrawal symptoms and reduces cravings<ref name="NIDA" /><br>• Buprenorphine – synthetic opioid that can be prescribed in a physician’s office<ref name="NIDA" /><br>• Naltrexone – long-acting opioid receptor blocker that can be used to help prevent relapse. It can only be used for someone who has been through detox<ref name="NIDA" />. <br>• Naloxone – short-acting opioid receptor blocker that counteracts effects of opioids. This drug can also be employed to treat overdose<ref name="NIDA" />. <br>• Suboxone – In a 2011 study performed by the National Health Institute, they found that Suboxone (Buprenorphine plus Naloxone) was useful to treat those addicted to opioid painkillers in a primary care setting. However, they do mention that further research is still required to figure out how to sustain recovery among those who are addicted to opioid medications<ref name="NIH">National Institutes of Health. Painkiller Abuse Treated by Sustained Buprenorphine/Naloxone. http://www.nih.gov/news/health/nov2011/nida-08a.htm (accessed 19 March 2012).</ref>.
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| “Although pain is common among opioid-dependent patients, pharmacologic approaches are limited. Tsui et al found that treatment with escitalopram, a selective serotonin reuptake inhibitor, was associated with clinically meaningful reductions in pain severity and pain interference during the initial 3 months of treatment<ref name="Medscape">Medscape Reference. Opioid Abuse Treatment and Management. http://emedicine.medscape.com/article/287790-treatment (accessed 19 March 2012).</ref>.” <br><br>
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| == Diagnostic Tests/Lab Tests/Lab Values ==
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| Several tools are available for clinician use to screen patients for drug abuse. These include:
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| The Drug Abuse Screening Test (DAST): This test is a self-reported 28 question test to screen for drug abuse. The questions are in yes/no format and the tests reports that a score of more than 12 strongly suggests a substance abuse problem.<ref name="DAST">Substance Abuse Screening Instrument. The Drug Abuse Screening Test (DAST). http://www.drtepp.com/pdf/substance_abuse.pdf (accessed 28 March 2012).</ref>
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| NIDA Quick Screen V1.0: This test is a quick patient reported questionnaire of alcohol, drug, and tobacco use that can be followed up with the NIDA-Modified ASSIST test if a patient identifies using prescription or illegal drugs for non-medical reasons.<ref name="NIDA">NIDA Quick Screen V1.0 and NIDA-Modified ASSIST V2.0. http://www.drugabuse.gov/sites/default/files/pdf/nmassist.pdf (accessed 28 March 2012).</ref>
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| The most common way to test for prescription drug abuse is through a toxicology screen, based off of a urine sample, that will reveal substances found within the persons urine at the time of testing:
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| Urine Toxicology Screens: screen designed to test for illegal drugs and some prescription drugs in the urine. Most drugs will cause a positive test for 1-2 days after ingesting, but some can continue for longer. A GC-MS Test can be used following a positive urine toxicology screen to ensure that the test was not a false positive<ref name="Medline plus">Medline Plus. Urine drug screen. http://www.nlm.nih.gov/medlineplus/ency/article/003364.htm (accessed 15 March 2012).</ref>.
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| GC-MS Test: A gas-chromatography mass spectrometry test can be used to help confirm or deny a flase positive on a urine toxicology screen. False positive readings can occur from factors such as some foods, prescription medications, and other drugs ina person's system at the time of the test.<ref name="Medline plus" />
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| == Causes == | |
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| There is not a specific factor that can predict if someone will become addicted to drugs, however there are several areas that can place someone at a higher risk for developing drug addiction secondary to drug abuse<ref name="WebMD">WebMD. Mental Health. http://www.webmd.com/mental-health/drug-abuse-addiction?page=2 (accessed 19 March 2012).</ref>. They are as follows:
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| <br>• Biology – The genes that people are born with along with their gender, ethnicity, and the presence of other mental disorders can potentially influence the risk for drug abuse<ref name="WebMD" />. <br>• Environment – Family, friends, socioeconomic status, quality of life, peer pressure, history of physical and/or sexual abuse, stress, and anxiety can place someone at a higher risk for drug abuse<ref name="WebMD" />. <br>• Development – Critical developmental stages can be affected by genetic and environmental factors that can lead to an increased risk for drug abuse<ref name="WebMD" />.
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| <br>A large cause of painkiller prescription drug abuse is to reduce pain associated with acute or chronic conditions, and some people who may have been taking prescription narcotic painkillers for a long period of time could develop a dependency on the drug which in turn could cause drug abuse<ref name="NIH Medline">NIH Medline Plus. Opioids and Chronic Pain. http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg9.html (accessed 19 March 2012).</ref>.
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| <br>Other causes of drug abuse that could be related to prescription painkiller abuse are listed below<ref name="About.com">About.com Addictions. How Painkiller Addiction or Overuse Happens. http://addictions.about.com/od/substancedependence/tp/painkillers.htm (accessed 28 March 2012).</ref>:<br>• Numb physical pain<br>• Non-drug pain management services may be inaccessible <br>• Distance from emotional pain<br>• Pleasurable <br>• Induce relaxation <br>• Tolerance built up to current prescription <br>• Intensity of pain secondary to physical neglect <br>• Unpleasant withdrawal to developed dependency <br>• Legally available to obtain which can make it easier to abuse <br>
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| == Systemic Involvement ==
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| All drugs are capable of producing unwanted side effects. In the case of prescription painkillers the list is longer than some, warranting the need for medical clearance and monitoring while on these drugs.
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| Common side effects:<br>Reduced Sense of Pain<br>Sedation<br>Depression<br>Dizziness<br>Nausea/vomiting<br>Constipation<br>Physical dependence<br>Tolerance<br>Respiratory depression<ref name="Pain Physician" />
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| Less Common Side Effects:<br>Delayed gastric emptying<br>Hyperalgesia- increased pain sensitivity<br>Immunologic and hormonal dysfunction<br>Muscle rigidity<br>Myoclonus<ref name="Pain Physician">Benyamin R,Trescot AM, Datta S. fckLROpioid Complications and Side Effects. Pain Physician 2008; 11:S105-S120. http://www.painphysicianjournal.com/2008/march/2008;11;S105-S120.pdf (accessed 15 March 2012).</ref>
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| Abuse of these drugs creates even more potential systemic problems. One of the biggest risks of an overdose of a narcotic is severe respiratory depression and potential death. Abuse of one of these drugs can cause physical dependence or addiction. Either of these can then lead to withdrawal symptoms in the future if the drug is no longer taken or available. Withdrawal symptoms include:
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| Restlessness<br>Muscle and bone pain<br>Insomnia<br>Diarrhea<br>Vomiting<br>Cold flashes with goose bumps<br>Involuntary leg movements<ref name="NIDA 3">National Institute on Drug Abuse. Research Reports: Prescription Drugs: Abuse and Addiction. http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-possible-consequences-opioid-use-abuse (accessed 16 March 2012).</ref><br><br>
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| == Medical Management ==
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| According to the National Institute on Drug Abuse, past research has shown that addiction to any drug can be treated effectively. The first step to any drug treatment plan is detoxification, to cleanse the person of the drug or drugs in the system. The next step in the process involves a combination of treatments that typically fit into one of two categories: behavioral and pharmacological treatment<ref name="NIDA Med Treatment">National Institute on Drug Abuse. Treating Prescription Drug Addiction. http://www.drugabuse.gov/publications/research-reports/prescription-drugs/treating-prescription-drug-addiction (accessed 1 April 2012).</ref>.
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| <br>Behavioral treatments can include a combination of individual counseling, group or family counseling, contingency management, and cognitive behavioral therapies. This form of treatment focuses on preparing oneself to face challenges including cravings and withdrawal, learn strategies to cope without the drug and avoid situations that could tempt the person to partake, and finally plans to handle potential relapse<ref name="NIDA Med Treatment" />.
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| <br> Pharmacological treatment is not used for treatment of all types of drug abuse, but has been proven through research to be effective in treating the abuse of opioid drugs, a category that includes prescription painkillers. The medications available for treatment are able to help reduce withdrawal symptoms and help overcome cravings<ref name="NIDA Med Treatment" />. These medications are listed and described in the Medication section of this page.
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| <br>Both treatment styles have been shown in research to be effective in treating prescription drug abuse. However, the most effective solution may be found in the combination of the two. As the NIDA report states, “Although a behavioral or pharmacological approach alone may be sufficient for treating some patients, research shows that a combined approach may be best.<ref name="NIDA Med Treatment" />”<br><br>
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| | A hidden danger inherent to prescription drugs is the misplaced belief that they are completely safe because doctors prescribe them. What must be understood is that these drugs are classified as prescription only specifically because they are addictive and/or dangerous. The very fact that they are only obtainable through prescription should tell you something. Do not believe the myth that they are less harmful or less powerful.<ref name=":1" /> |
| == Physical Therapy Management == | | == Physical Therapy Management == |
| | Physical therapists are not qualified to treat prescription drug abuse, but that does not mean that this is a problem PTs should ignore. An important part PTs can play is in recognising the signs and symptoms, screening a patient when a problem is suspected, and making sure to ask each patient about all drugs, prescription and over the counter, that they are currently taking. |
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| Physical Therapy preferred practice patterns in connection to drug abuse<ref name="Guide">American Physical Therapy Association. Guide to Physical Therapist Practice. http://guidetoptpractice.apta.org/ (accessed 29 March 2012).</ref>:
| | If you suspect a client has an addiction to prescription drugs advice them to seek help, beginning with them talking with their doctor. They may feel embarrassed to talk about it, but remind them that medical professionals are trained to help, not judge. It's easier to tackle the problem early before it becomes an addiction and leads to more-serious problems<ref name=":0" />. |
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| 4C: ''Impaired Muscle Performance (780.7 - General Symptoms, 781.2 - Abnormality of Gait, 781.3 - Lack of coordination ataxia not otherwise specified muscular incoordination, 781.9 - Other symptoms involving nervous and musculoskeletal systems)''
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| 5A: ''Primary Prevention/Risk Reduction for Loss of Balance and Falling (780 - General Symptoms, 781 - Symptoms involving nervous and musculoskeletal systems)''
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| 6A: ''Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders (305 - Nondependent Abuse of Drugs)''
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| 6B: ''Impaired Aerobic Capcity/Endurance Associated with Deconditioning (508 - Respiratory conditions due to other and unspecified external agents, 786 - Symptoms involving respiratory system and other chest symptoms)''
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| <br> Physical therapists are not qualified to treat prescription drug abuse, either with behavioral or pharmacological treatments, but that does not mean that this is a problem PTs should ignore. An important part PTs can play is in recognizing the signs and symptoms, screening a patient when a problem is suspected, and making sure to ask each patient about all drugs, prescription and over the counter, that they are currently taking. If a PT suspects the potential for drug abuse they should report all findings to the referring MD or primary care physician as well as discuss with the patient the dangers of taking prescribed medication outside of the recommendation of an MD.
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| == Alternative/Holistic Management ==
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| *Acupuncture<ref name="ndsn">Spray J, Jones S. The Use of Acupuncture in Drug Addiction Treatment. http://www.ndsn.org/sept95/guest.html (accessed 1 April 2012).</ref>
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| *Non 12 step support groups<ref name="Drug Rehab ">Drug Rehab. Non 12 Step Drug Rehab. http://www.drugrehab.org/drug-rehab/non-12-step-drug-rehab/ (accessed 1 April 2012).</ref>
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| *Meditation<ref name="Drug Rehab " />
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| *Yoga<ref name="Drug Rehab " />
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| *Hypnosis<ref name="Drug Rehab " />
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| *Breathwork therapy<ref name="Drug Rehab " /><br>
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| == Differential Diagnosis ==
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| Before a Physician can accurately determine if patient is abusing narcotics they must determine if there is another cause for their symptoms. Below are listed some differential diagnoses that someone may with signs and symptoms of opioid abuse may suffer from.
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| Opioid Abuse DDx<ref name="Opioid">Medscape Reference. Opioid Abuse Differntial Diagnosis. http://emedicine.medscape.com/article/287790-differential (accessed 1 April 2012).</ref>:
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| *Gastroenteritis, Bacterial
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| *Gastroenteritis, Viral
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| *Influenza
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| *Pancreatitis, Acute
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| *Pancreatitis, Chronic
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| *Peptic Ulcer Disease
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| *Toxicity, Barbiturate
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| *Toxicity, Benzodiazepine
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| *Hypoglycemia<ref name="Remedy">Remedy's Health Communities. Narcotic Abuse. http://www.healthcommunities.com/narcotic-abuse/diagnosis.shtml (accessed 1 April 2012).</ref>
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| *Electrolyte Imbalance<ref name="Remedy" />
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| *Head or Brain Injury<ref name="Remedy" />
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| *Stroke<ref name="Remedy" />
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| Some of the above mentioned conditions can cause symptoms of "delirium and cause slurred speech, inability to concentrate, and impaired memory, which are also signs of intoxication<ref name="Remedy" />."
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| In order for a Physical Therapist to try to determine if someone is abusing a substance such as narcotic painkillers some follow-up questions will need to be asked. The questions to be asked can assist in diagnosing someone because they "are based on the established correlation between trauma and alcohol or other substance abuse<ref name="Substance Abuse " />." If a patient answers yes tos 2 or more of the below follow-up questions then the Physical Therapist should discuss this with the patient's physician<ref name="Substance Abuse " />.
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| Follow-up Questions:
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| #Have you had any fractures or dislocations to your bones or joints?
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| #Have you been injured in a road traffic accident?
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| #Have you injured your head?
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| #Have you been in a fight or assault?
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| == Case Reports/ Case Studies ==
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| <br>
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| 1. Substance Misuse Treatment for High Risk Chronic Pain Patients on Opioid Therapy: A Randomized Trial
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| [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910796/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910796/]
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| 2. Trends in opioid use and dosing among socio-economically disadvantaged patients
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| [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205807/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205807/]
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| 3. Neglected Simultaneous Bilateral Femoral Neck Fractures Secondary to Narcotic Drug Abuse Treated by Bilateral One-Staged Hemiarthroplasty: A Case Report
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| [http://www.josr-online.com/content/5/1/41 http://www.josr-online.com/content/5/1/41]
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| 4. Addiction to Opioids in Chronic Pain Patients: A Literature Review
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| [http://www.laboratoriosilesia.com/upfiles/sibi/P0607563.pdf http://www.laboratoriosilesia.com/upfiles/sibi/P0607563.pdf]
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| == Resources <br> ==
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| http://www.drugabuse.gov/
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| http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html
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| http://www.theantidrug.com/
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| [http://www.na.org/ http://www.na.org/]
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])<br> ==
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| <rss><div class="researchbox"><rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1bczA4VFKSFm0Q8HtTvpUxLI0_lOY59gjyiXg-2o9BhVrcFYxH|charset=UTF-8|short|max=10</rss></div></rss><br>
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| == References == | | == References == |
|
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|
| see [[Adding References|adding references tutorial]]. | | see [[Adding References|adding references tutorial]]. |
|
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| <references /> | | <references /> |
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| [[Category:Bellarmine_Student_Project]] | | [[Category:Bellarmine_Student_Project]] |
| | [[Category:Medical]] |
| | [[Category:Psychological Concepts]] |
| | [[Category:Older People/Geriatrics]] |
| | [[Category:Pain]] |
| | [[Category:Pharmacology for Older People]] |
| | [[Category:Pharmacology]] |
