Prescription Drug Abuse: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
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>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;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>. | 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;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>. | ||
<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" />.” | <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" />.” | ||
<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> | <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> | ||
== Prevalence == | == Prevalence == | ||
Revision as of 16:21, 28 March 2012
Original Editors - Lauren Cotton & Erin Smith from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
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[1]. Abuse of prescription medications can produce serious adverse health effects, including addiction[2].
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[3]. These drugs are also commonly prescribed to “enable individuals with chronic pain to lead productive lives[2].”
“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[2].” 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[2]. Some examples of opioids that you may see commonly abused in the healthcare system are[2]:
• Hydrocodone (e.g., Vicodin)
• Oxycodone (e.g., OxyContin)
• Codeine
• Propoxyphene (Darvon)
• Meperidine (Demerol)
• Lortab[4]
• Dilaudid[4]
• Lorcet[4]
• Tylox[4]
• Percocet[4]
• Percodan[4]
Prevalence[edit | edit source]
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”[5]. 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”[6]. These numbers show that this problem is one that deserves the attention of the healthcare community.
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“[7]. Prescription pain relievers were the drugs used most commonly, with oxycodone, hydrocodone, and methadone rating the highest amongs the drugs used[7].
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%[2]. 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[2].
Characteristics/Clinical Presentation[edit | edit source]
Some symptoms that you may see if someone is abusing a painkiller are subjective complaints of depression and constipation.
Some objective measures that may be seen are:
• low blood pressure (1)
• decreased respiration rate (1)
• may also observe some confusion (1)
• drowsiness (3)
• depressed breathing (3)
• 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 (3).
• 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 (1).
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 (2).
Associated Co-morbidities[edit | edit source]
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[8]. 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[4].
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 alos 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[9].” Due to the high risk of abuse and overdose that comes with opioids, these drugs should be prescribed and monitored carefully.
Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Urine Toxicology Screens: screen designed to test for illegal drug 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[10].
Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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.
Common side effects:
Reduced Sense of Pain
Sedation
Depression
Dizziness
Nausea/vomiting
Constipation
Physical dependence
Tolerance
Respiratory depression[11]
Less Common Side Effects:
Delayed gastric emptying
Hyperalgesia- increased pain sensitivity
Immunologic and hormonal dysfunction
Muscle rigidity
Myoclonus[11]
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:
Restlessness
Muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goose bumps
Involuntary leg movements[12]
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
see adding references tutorial.
- ↑ 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;DSECTION=all (accessed 15 March 2012).
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 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). Cite error: Invalid
<ref>tag; name "NIDA" defined multiple times with different content - ↑ The Free Dictionary. Narcotics. http://medical-dictionary.thefreedictionary.com/Narcotics (accessed 19 March 2012).
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 National Drug Intelligence Center. Prescription Drugs Fast Facts. http://www.justice.gov/ndic/pubs5/5140/index.htm (accessed 19 March 2012). Cite error: Invalid
<ref>tag; name "NDIC" defined multiple times with different content - ↑ Centers for Disease Control and Prevention. Prescription Painkiller Overdoses in the US. http://www.cdc.gov/VitalSigns/PainkillerOverdoses/#LatestFindings (accessed 15 March 2012).
- ↑ 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).
- ↑ 7.0 7.1 U.S. Department of Health and Human Services: 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).
- ↑ 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).
- ↑ 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).
- ↑ Medline Plus. Toxicology screen. http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm (accessed 15 March 2012).
- ↑ 11.0 11.1 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).
- ↑ 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).
