Prescription Drug Abuse

Original Editors - Lauren Cotton & Erin Smith from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Erin Smith, Lauren Cotton, Lucinda hampton, Admin, Elaine Lonnemann, Kim Jackson, WikiSysop, 127.0.0.1, Wendy Walker and Lauren Lopez  

Introduction

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. Drug abuse may become ongoing and compulsive, despite the negative consequences.
An increasing problem, prescription drug abuse can affect all age groups, including teens. The prescription drugs most often abused include 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.

Epidemiolgy

Abuse of prescription drugs has reached an epidemic level

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.

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

Prescription drugs are the most commonly abused substances by teens after marijuana, synthetic marijuana (spice), and alcohol.

Obtaining

Some prescription drug addicts start with legitimate prescribed for them. eg A patient needing 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.

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.

Characteristics/Clinical Presentation

Signs that go along with prescription drug addiction. These are:

• 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.

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:

Opioids	Anti-anxiety medications and sedatives	Stimulants
Constipation Nausea Feeling high (euphoria) Slowed breathing rate Drowsiness Confusion Poor coordination Increased dose required for pain relief Worsening or increased sensitivity to pain with higher doses (hyperalgesia)	Drowsiness Confusion Unsteady walking Slurred speech Poor concentration Dizziness Problems with memory Slowed breathing	Increased alertness Feeling high Irregular heartbeat High blood pressure High body temperature Reduced appetite Insomnia Agitation Anxiety Paranoia

Dangers

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.

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.

Physical Therapy Management

Physical Therapy preferred practice patterns in connection to drug abuse:

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)

5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling (780 - General Symptoms, 781 - Symptoms involving nervous and musculoskeletal systems)

6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders (305 - Nondependent Abuse of Drugs)

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)

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.

Case Reports/ Case Studies

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."  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. 

Follow-up Questions:

1. Have you had any fractures or dislocations to your bones or joints?
2. Have you been injured in a road traffic accident?
3. Have you injured your head?
4. Have you been in a fight or assault?

1. Substance Misuse Treatment for High Risk Chronic Pain Patients on Opioid Therapy: A Randomized Trial

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910796/

2. Trends in opioid use and dosing among socio-economically disadvantaged patients

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205807/

3. Neglected Simultaneous Bilateral Femoral Neck Fractures Secondary to Narcotic Drug Abuse Treated by Bilateral One-Staged Hemiarthroplasty: A Case Report

http://www.josr-online.com/content/5/1/41

4. Addiction to Opioids in Chronic Pain Patients: A Literature Review

http://www.laboratoriosilesia.com/upfiles/sibi/P0607563.pdf

Resources

http://www.drugabuse.gov/

http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html

http://www.theantidrug.com/

http://www.na.org/

References

see adding references tutorial.