Prevent Prescription Drug Abuse Research Articles

Roles of Pharmacy Technicians in Preventing Prescription Drug Abuse.

Objective: To provide and identify potential roles and strategies for pharmacy technicians to identify and prevent drug abuse within the pharmacy. Data Sources: Related materials were searched via PubMed and Google Scholar from 2000 to present using search terms: "pharmacy," "technicians," "prescription," "drug," and "abuse." Articles describing statistics, warning signs, and prevention strategies for pharmacies were identified through databases and organizations' sites. Portions of the Ohio Administrative Code on OARRS (Ohio Automated Rx Reporting System), and Pennsylvania prescription drug monitoring program information were also identified. Study Selection and Data Extraction: Relevant sections of the Ohio Administrative Code and OARRS were identified through the Ohio Board of Pharmacy website. Information regarding the Pennsylvania Prescription Drug Monitoring was identified via Pennsylvania's Department of Health website. Sections of the Combat Methamphetamine Act of 2005 were identified through the Drug Enforcement Administration Diversion website. Resources on drug abuse and prevention statistics were obtained from Drug Abuse.gov and American Society of Health System Pharmacists. Information regarding warning signs were identified from the National Association of Boards of Pharmacy. Data Synthesis: The data provided for identification of potential roles for technicians within efforts to prevent prescription drug abuse, including evaluation of warning signs, involvement in the use of prescription monitoring programs, and in efforts to prevent methamphetamine abuse and diversion. Conclusions: After identifying potential roles for pharmacy technician involvement in the prevention of prescription drug abuse, it is evident that there is a need for further education and training on the subject specific to pharmacy technicians.

Correlates of Prescription Opioid Legitimacy Judgments Among Community Pharmacists

ABSTRACTBackground: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.

The Pharmacist as Gatekeeper of Prescription Drug Abuse: Return to "Community Scientists"

The non-medical use or abuse of prescription drugs, including benzodiazepines, is a growing health problem in Japan. An association between prescription drug overdose and suicide risk has also been reported. The Japanese Ministry of Health, Labour and Welfare has expected pharmacists to act as "gatekeepers", facilitating early identification of individuals at high risk of prescription drug abuse including overdose, supplying medication counseling to patients, and helping to introduce these patients to appropriate medical care. Prescription drugs such as benzodiazepines are widely used in psychiatry. However, these drugs are prescribed not only by psychiatrists but also by other healthcare professionals including primary care physicians. Moreover, in recent years, the dispensing of prescriptions has moved rapidly from inside to outside hospitals, with prescription drugs being dispensed mainly at community pharmacies. Although all healthcare professionals including hospital pharmacists can play a role in preventing prescription drug abuse, the role of the community pharmacist is vital in addressing this problem. Formerly, community pharmacists were recognized as "community scientists", low-threshold accessible healthcare advisors. Now, community pharmacists should return to the role of community scientists to prevent prescription drug abuse. This article begins by reviewing the current situation of prescription drug abuse and dependence in Japan. The role of pharmacists as gatekeepers in preventing prescription drug abuse is then examined. Finally, this article discusses the effect of intervention in the form of gatekeeper training for community pharmacists.

The American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fifth Edition

Back to table of contents Previous article Next article Book ForumFull AccessThe American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fifth EditionChristian Thurstone, M.D.Christian ThurstoneSearch for more papers by this author, M.D.Published Online:1 Oct 2015https://doi.org/10.1176/appi.ajp.2015.15060812AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by Marc Galanter, M.D., Herbert D. Kleber, M.D., and Kathleen T. Brady, M.D., Ph.D. Washington, D.C., American Psychiatric Association Publishing, 2015, 980 pp., $199.00 (hardcover).Given the pace of research in the field, an update to the last edition published in 2008 is much anticipated. Overall, this edition is an important contribution. It is comprehensive and updated. The editors, who are on the cutting edge of the field, have lined up a list of contributors who are also impressive. Anyone who reads this text will be well-prepared for a certification examination and will have a good fund of knowledge for patient care.The textbook is divided into various sections starting with the bio-psycho-social basis for addiction. It then progresses to a discussion of specific drugs of abuse and treatment options. The text concludes with special topics including adolescents, pregnant women, and prevention. Each chapter is authored or coauthored by an expert in that particular area. Another helpful feature of the book is a list of recommended readings at the end of each chapter for those who want more details.The textbook also includes important updates. For example, it uses new DSM-5 terminology. It also incorporates some of the latest neurobiology and clinical science of addiction. Specifically, the chapters on marijuana include the latest neurobiology of the endocannabinoid system as well as an excellent review of the latest behavioral and pharmacological treatments. Additionally, the chapter on the neurobiology of addiction lays an excellent foundation, and the chapter on preventing prescription drug abuse is especially well updated and practical.The main limitation of the text is a lack of precision and detail in certain areas. For example, the chapter on motivational enhancement cites the latest edition of the book on motivational interviewing but does not explain specifically how motivational interviewing has been substantially changed or updated.Another example of the lack of precision and detail is found in the chapters on marijuana. The chapter on marijuana treatment (Chapter 24) states that cannabidiol (CBD) is a CB1 and CB2 receptor antagonist but later states that CBD potentiates the effects of Δ9-tetrahydrocannabinol (THC) via a CB1 receptor-dependent mechanism. At the same time, other research not included in the chapter shows that CBD has a very low affinity for the CB1 receptor and that it may sometimes inhibit or potentiate the effect of THC, depending on the specific outcome being measured (1). In this case, clarification and precision are needed to avoid confusion. Furthermore, the chapters on marijuana would also benefit from specific details on practical and relevant topics such as edibles, butane hash oil, dabbing, and the different strains of marijuana, including Cannabis indica and Cannabis sativa.In summary, the revised Textbook of Substance Abuse Treatment is a welcome and much-needed update. Its readers will have a good fund of knowledge from experts in the field. However, many chapters require additional detail to help the reader clearly understand the subject. In view of this limitation, those who are interested in the topic may want to compare this text with the recently updated ASAM Principles of Addiction Medicine to see which text meets their needs better.Dr. Thurstone is affiliated with the Department of Psychiatry, University of Colorado Health Sciences Center, Denver.The author reports no financial relationships with commercial interests.Reference1 McPartland JM, Duncan M, Di Marzo V, et al.: Are cannabidiol and Δ(9) -tetrahydrocannabivarin negative modulators of the endocannabinoid system? A systematic review. Br J Pharmacol 2015; 172:737–753Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 172Issue 10 October 01, 2015Pages 1028-1029 Metrics PDF download History Accepted 1 July 2015 Published online 1 October 2015 Published in print 1 October 2015

A Primer on Prescription Drug Abuse and the Role of the Pharmacy Director.

Prescription drug abuse, or using a prescription drug in a way not intended by the provider, has become such an issue in the United States that in 2013 the US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) classified it as a new epidemic. The goal of this article is to provide pharmacy directors with a primer on prescription drug abuse and its prevention. This article will cover the causes and societal impact of prescription drug abuse, review recent and proposed strategies to prevent prescription drug abuse, and discuss efforts within the health system to reduce the risks of narcotic diversion that can lead to prescription drug abuse. There are several health and societal factors that have contributed to the rise in prescription drug abuse. As there is no singular contributory factor to this epidemic, there is no easy solution for proper containment and monitoring of prescription drug use. Pharmacy directors play a vital role in the safe use of prescription medications by providing for fail-safe systems for accounting and controlling prescription drugs. In addition, pharmacists can play a role in educating patients and health care workers on the dangers of prescription drug abuse. Health systems should form teams to identify drug diversion and provide an intervention that demands accountability while helping the impaired professional. Health system pharmacy directors must play an integral role in these efforts and continue to seek opportunities to reduce any risks for prescription drug abuse.

Clinical behavior of Japanese community pharmacists for preventing prescription drug overdose.

Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. This study examined the community pharmacist's clinical behavior regarding patients who overdose on prescribed drugs, and explored the possibility of overdose prevention by community pharmacists. We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about clinical behavior such as medication counseling and referral to the prescriber if prescription drug overdose was identified. Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. Half of respondents evaluated their practice such as medication counseling and referral to the prescriber as 'good'. On multivariate analysis, a 'poor' self-evaluation of referral to the prescriber was significantly associated with the following perceptions: 'insufficient confidence in communication with prescribers' (odds ratio [OR], 2.7; 95% confidence interval [95%CI]: 1.4-5.3), and 'to avoid trouble with prescribers' (OR, 1.7; 95%CI: 1.0-2.7). Japanese community pharmacists could prevent prescription drug abuse in their practice, but the pharmacists who have insufficient confidence in communication with prescribers and who are afraid of trouble with a prescriber, reported poor self-evaluation for referral to the prescribers. All prescribers should understand the importance of referral by community pharmacists, to assist community pharmacists in playing a critical role in prevention of prescription drug abuse.

P-48 * THE JAPANESE COMMUNITY PHARMACIST AS A "GATEKEEPER" FOR PREVENTING PRESCRIPTION DRUG OVERDOSE

Introduction. Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. The Japanese government has expected community pharmacists to act as gatekeepers for prescription drug abusers. This study aimed to examine the pharmaceutical practices adopted by community pharmacists to prevent prescription drug abuse. Method. We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about pharmaceutical practices such as referral to the prescriber if prescription drug overdose is expected. Result. Questionnaires were completed by 1416 pharmacists (response rate of 76%). Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. On multivariable analysis, a poor self-evaluation of referral to the prescriber was significantly associated with the following perceptions by pharmacists: “Insufficient confidence in communication with prescribers” (OR = 2.7, 95% CI = 1.4–5.3), and “To avoid trouble with prescribers” (OR = 1.7, 95% CI = 1.0-2.7). Conclusion. All prescribers should understand the importance of referrals by community pharmacists, in order to assist the community pharmacists to play the critical role of gatekeeper for preventing prescription drug overdose.

Risk factors for acute decompensation of chronic kidney disease in hospitalized patients in the nephrology department: a case-control study

To investigate risk factors for acute kidney injury (AKI) in hospitalized patients with chronic kidney disease (CKD) a case-control study was conducted in the Nephrology Department of Hedi Chaker University Hospital in Sfax, Tunisia, for a 1-year period. All patients with baseline renal insufficiency hospitalized for AKI were considered as cases. They were compared with control patients with CKD. A conditional logistic regression model was used to identify independent risk factors for AKI in patients with CKD. A total of 58 cases were compared with 114 control subjects. In multivariable models, baseline diabetes, cardiopathy disease, and exposure to non-steroidal anti-inflammatory drugs were independent risk factors for AKI in patients with CKD. However, exposure to calcium channel blockers (CCBs) was associated with decreased risk for AKI on CKD (OR = 0.4; CI 95%: 0.2 - 0.8, p = 0.007). Patients with CKD may benefit from more aggressive cardiovascular screening to prevent episodes of acute kidney injury. More efforts should be made to prevent prescription drug abuse and to demonstrate the role of CCBs in renal protection in these patients.

Prescription Drug Attitudes Questionnaire: Development and Validation

The purpose of this study was to develop and validate a scale measuring attitudes towards prescription drug use for nonmedical reasons. Participants (N = 310) were recruited from a small northeastern college and completed the Prescription Drugs Attitudes Questionnaire (PDAQ), the College Alcohol Problems Scale (CAPS-R) and answered questions about current substance use. Principal components analysis of the PDAQ yielded a two-factor structure accounting for 58.2% of the total variance in attitudes toward prescription drugs where the factors represented items concerning Recreational and Achievement-Oriented attitudes. The PDAQ had good internal consistency (.94) and convergent validity with a measure of alcohol problems (r = .37), alcohol use (r = .44), and illicit drug use (r = .36). The PDAQ is a reliable and valid scale that can be used by researchers and clinicians to understand and prevent prescription drug abuse among youth.

Characterization of Adolescent Prescription Drug Abuse and Misuse Using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS®) System

To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS(®)) System. Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures. A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD ± 1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38% were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants. Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents.

Assessment of controlled substances, dependence on them, and their management by pharmacists

Introduction Substance abuse is more than just a health problem; it is a formidable moral, social, and economic challenge of pandemic proportions. Palestine is not an exception to this problem, and the trend of use is increasing. Healthcare providers, primary care physicians, pharmacists, patients themselves, and their families, can all play a role in identifying and preventing prescription drug abuse. Methodology The study population included 205 public pharmacies distributed across the Gaza Strip governorates. Data was collected by means of an interview questionnaire administered to pharmacists working in the pharmacies. Study objectives The aim of the study was to identify and verify several variables and attributes affecting drug abuse, including the knowledge, attitudes, and practices of pharmacists, and to study and analyze the drug abuse situation in the Gaza Strip. Results The majority of pharmacists (90.2%) acknowledged drug addiction as an existing phenomenon in the Gaza Strip society, and 32.2% of pharmacists believed that the physician, the pharmacist, and the inspection department all shared the responsibility for its existence. Most pharmacists believed that the increased anxiety and tension in the community was the most common reason for this increase in demand for drugs. Approximately 50.2% of pharmacists did not believe that their colleagues dispensed any of the controlled drugs without a doctor’s prescription. Approximately 89.8% of pharmacists were convinced of the need for a medical prescription to dispense any of the drugs listed, and of these 89.8%, 84.8% did not dispense any of the controlled drugs to a person they suspected of being dependent on drugs, even if that person had a medical prescription. Hence, the study showed no significant relationship. Conclusion The study showed that drug abuse is an existing phenomenon in the Gaza Strip and there is a lack of attention to reduce its spread and impact on society. There are similarities between female and male pharmacists in the Gaza Strip with regard to knowledge about drug abuse; however, there are differences in practice and attitude among them. Recommendation Physicians, pharmacists, and the inspection department should assume their respective responsibilities toward prevention of drug abuse as a shared responsibility in order to ensure a safe future for the entire community.

Management of Controlled Substances and Dependences by Pharmacists

Introduction: Substance abuse is more than a health problem; it is a formidable moral, social and economic challenge with pandemic dimensions. Palestine is not exception and it suffers of this problem, and the trend of use is increasing. Healthcare providers, primary care physicians, and pharmacists, as well as patients themselves and their families, all can play a role in identifying and preventing prescription drug abuse. Methodology: The study population included 205 of the public pharmacies in the Gaza Strip governorates. Data collection has been performed via interview questionnaire with the pharmacists working in the pharmacies. Study objectives: were oriented to identify and verify several variables and attributes affecting the existence of drug abuse including: study and analysis of the drug abuse situation in the Gaza Strip, knowledge, attitude and practice of pharmacist. Results: The majority of pharmacists (90.2%) agree about existence of drug addiction as phenomenon in Gaza strip society and 32.2% of pharmacists believe that the physician, the pharmacist and the inspection department all of them share the responsibility towards drug abuse existence. Most of pharmacists believe that the increased anxiety and tension in the community is the most reason for this demand increase. About (50.2%) of pharmacists don’t believe that their colleagues dispense any of the controlled drugs without a doctor’s prescription. About (89.8%) of pharmacists are convinced of the need to a medical prescription to dispense any of the drugs listed in all cases, and of these 89.8% there are (84.8%) of pharmacists who don’t dispense any of these drugs to a person they doubt even if this person has a medical prescription, so the study show no significant relationship. Conclusion: the study showed that drug abuse is an existing phenomenon in the Gaza Strip lacking the suitable care and attention to reduce its spread and impact on society. There are similarities between female and male pharmacists in the Gaza Strip in knowledge but differences in practice and attitude. Recommendation: The physicians, pharmacists and inspection department, should assume their responsibilities towards drug abuse as being a shared responsibility to control the future of the entire community.

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

Carisoprodol Legal Status and Patterns of Abuse

To review the current legal status and patterns of abuse of carisoprodol. A literature search was conducted through MEDLINE (1950-August 2010), PubMed (1966-August 2010), EMBASE (1966-August 2010), and International Pharmaceutical Abstracts (1970-August 2010) using the search terms carisoprodol and abuse. In addition, reference citations from publications identified were reviewed. State laws and regulations were accessed through NABPLAW Online (2010) using the search term carisoprodol. Federal proposed rules were accessed through the Federal Register (1995 Volume 59-2010 Volume 75) using the search term carisoprodol. State laws and federal proposed rules regarding carisoprodol were examined. Case reports and studies involving carisoprodol abuse were evaluated. Carisoprodol is not federally scheduled under the Controlled Substances Act (CSA). However, carisoprodol is scheduled in 36% (n = 18) of states of the US. The Drug Enforcement Administration issued a Notice of Proposed Rulemaking in the Federal Register on November 17, 2009, to place carisoprodol into schedule IV of the CSA, with a deadline to submit written comments by December 17, 2009. Case reports, retrospective studies, and national reports, including reports from the American Association of Poison Control Centers and results from the Monitoring the Future national survey on drug use, have identified carisoprodol's abuse potential. Carisoprodol should be placed in schedule IV of the CSA based on its abuse potential and current state laws and regulations. Federally scheduling carisoprodol would lead to uniformity among the states and hopefully assist in preventing prescription drug abuse. Larger, well-designed studies evaluating carisoprodol abuse should be performed.

Screening Urged to Prevent Prescription Drug Abuse

Back to table of contents Previous article Next article Professional NewsFull AccessScreening Urged to Prevent Prescription Drug AbuseJun YanJun YanSearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0004Risk-taking tendencies, major depression, and other substance use problems are some of the major risk factors linked to teens' misuse of prescription drugs, a study in the July Journal of the American Academy of Child and Adolescent Psychiatry shows.According to data collected in the 2005 National Survey on Drug Use and Health (NSDUH), one in 12 adolescents aged 12 to 17 (8.2 percent) reported having misused at least one prescription medication in the previous year. This prevalence trailed only the use of alcohol, tobacco, and marijuana.Misuse was defined as “any intentional use of a medication with intoxicating properties outside of a physician's prescription for a bona fide medical condition, excluding accidental misuse.”Opioids such as hydrocodone and oxycodone are by far the class of medications most frequently misused by adolescents, followed by stimulants (for example, amphetamines and methylphenidate), tranquilizers (including benzodiazepines and muscle relaxants), and sedatives (for example, barbiturates).In this study, Ty Schepis, Ph.D., and Suchitra Krishnan-Sarin, Ph.D., from the Department of Psychiatry at Yale University School of Medicine found that prescription drug misuse among adolescents was significantly linked to poor academic performance, a major depressive episode in the past year, risk-taking tendencies, a history of mental health treatment in the past year, and the concurrent use of other substances, including cigarettes, alcohol, marijuana, cocaine, or inhalants.Thirty-six percent of these adolescents who misused medications had symptoms that met one or more DSM-IV criteria for substance use disorder. “It was somewhat unexpected to see that over a third of the adolescents misusing prescription drugs have begun to develop symptoms of dependence,” Schepis commented to Psychiatric News.The high rate of adolescents with co-existing substance use problems is consistent with findings from other studies, the authors pointed out. They urged clinicians to screen young patients routinely for possible prescription misuse and educate parents about the high risk of such misuse.“There is anecdotal evidence to suggest that prescription drugs are perceived to be safer or less problematic than illicit substances,” Schepis said. In addition, because prescription drugs are legal, teenagers may have easier access to painkillers, stimulants, and tranquilizers than to illegal substances, especially if parents are not monitoring their medicine cabinets.“We can combat the supply of illicit drugs, but it's a lot harder to control the supply of prescription medications because they have legitimate medical indications,” he said.Clinicians should be more proactive in educating parents and adolescents about the dangers of misusing prescription medications, Schepis suggested, especially considering the high prevalence of substance use disorder symptoms among these teenagers.Another notable finding was that adolescent girls had a slightly higher prevalence of misusing opioids, stimulants, and tranquilizers than did their male peers. This trend is consistent with some adult surveys that found a higher rate of misusing prescription medications by women than by men.The NSDUH is an annual in-home survey sponsored by the Substance Abuse and Mental Health Services Administration that tracks trends in substance use throughout the United States. The sample used in this study comprised 18,678 adolescents, and the results were extrapolated to population estimates. This study was supported in part by a grant from the National Institutes of Health.“Clinicians must educate adolescents about the difference between proper and improper use,” said Schepis. “Adolescents may not fully understand the potential harm in misusing prescription drugs like overdose and developing addiction.”An abstract of “Characterizing Adolescent Prescription Misusers: A Population-Based Study” is posted at<www.jaacap.com/pt/re/jaacap/abstract.00004583-200807000-00006.htm>.▪ ISSUES NewArchived

PUBLIC HEALTH APPROACH TO OPIOID OVERDOSE

Drug overdose is a public health concern, and the opioid class of drugs is a significant cause of overdose-related fatalities.1,2 Hundreds of deaths associated with fentanyl-laced heroin and findings that 19% of US adolescents have taken prescription pain killers to get high underscore the need for attention.3,4 New York State, a large jurisdiction, has recognized the need to respond. As noted by Paulozzi, regulating and monitoring controlled substances is important for an effective public health response.1 One of New York State’s most important tools in preventing prescription drug abuse is the Official Prescription Program, a prescription monitoring program that has successfully combated diversion and abuse of prescription opioids since 1972. The program also provides an effective forum to educate practitioners and the health care community and to initiate public health interventions regarding prescription drug abuse. Other features of New York’s approach include: support for comprehensive harm reduction programs for injection drug users (IDUs), including syringe exchange and active referral to drug treatment; development of opioid overdose prevention programs to prepare IDUs, and others, to recognize signs of overdose, provide rescue breathing, administer naloxone, and call emergency medical services; outreach to health care professionals regarding taking steps with patients and caregivers to highlight risks and safety concerns when prescribing opioids, as well as detection and prevention of diversion of drugs; and issuance of health alerts. Pharmacoepidemiologic surveillance, utilizing data from medical examiners, emergency medical services, hospitals, overdose prevention programs, and law enforcement, can provide a better understanding of the extent of overdose and help target programs. Some surveillance tools are in place in some jurisdictions. Better data can also support another public health goal: “relieving pain and improving the quality of life of patients with a legitimate need for a prescription opioid.”5(p633) Several issues related to clinical practice, addiction services, drug development, and opiod overdose prevention require attention.6 Comprehensive public health responses to opioid overdose take time and resources. For those who have yet to develop comprehensive approaches, opioid overdose prevention programs, such as those in Baltimore, Md; Chicago, Ill; San Francisco, Calif; New York, NY; and several cities in New Mexico, have been effective in preventing opioid overdose fatalities and can be replicated.7–10 Outreach to IDUs regarding emerging threats (i.e., fentanyl-laced heroin) saves lives, extends access to drug treatment, and offers opportunities to address other public health concerns among IDUs, including communicable diseases such as HIV, sexually transmitted diseases, and hepatitis.

NIDA Says Doctors Can Prevent Drug Misuse

Back to table of contents Previous article Next article Government NewsFull AccessNIDA Says Doctors Can Prevent Drug MisuseEve KupersaninEve KupersaninSearch for more papers by this authorPublished Online:18 May 2001https://doi.org/10.1176/pn.36.10.0006The National Institute on Drug Abuse (NIDA) launched a major public health initiative in March in response to a dramatic rise in prescription drug misuse and abuse in the U.S.As part of the initiative, NIDA released a research report on March 10 that documents the rise of prescription drug abuse in the last few years, explains how to detect and treat prescription drug addiction, and provides information on the adverse health consequences that result from prescription drug misuse.NIDA’s report cited data gathered by the Substance Abuse and Mental Health Services Administration, which found through its 1999 National Household Survey that there were about 1.6 million new users of prescription pain medication for nonmedical purposes in the previous year.In 1985 this number was comparatively small—341,000 new users of pain medications for nonmedical purposes. These drugs included codeine, morphine, and percodan, for example.According to the research, users either did not have a prescription for the medicine or did have one but were using the medication because they liked the way it made them feel. American youth are well represented in the statistics. Data from the survey show a dramatic increase in the number of new users of prescription painkillers for nonmedical purposes aged 12 to 17. In 1985 there were only four people per thousand who began using the painkillers for nonmedical purposes, but in 1998, 32.4 per thousand began using prescription drugs nonmedically.The problem is also serious among the elderly, according to researchers. NIDA’s report stated that up to 17 percent of adults aged 60 or older abuse prescription drugs.In an introduction to the report, NIDA director Alan I. Leshner, Ph.D., commented about the susceptibility of the elderly to prescription drug misuse and abuse due to the number of medications they take for different conditions.“We hope this scientific report is useful to the public, particularly to individuals working with the elderly. . .who may be more vulnerable to misuse and abuse of prescribed medications.”The report calls for physicians, nurse practitioners, physician assistants, and pharmacists to help prevent prescription drug abuse in people of all ages.It advises that physicians routinely screen for substance abuse when taking a patient’s history. The assessment should incorporate questions about what prescription and over-the-counter medications the patient is taking and why.Pharmacists should provide clear information to patients about how to take a medication appropriately, as well as telling patients about possible drug interactions and side effects to which they should be alert, the report stated. NIDA also distributed 400,000 postcards with messages about the dangers of prescription drugs as part of the new public health initiative.The cards went to restaurants, college campuses, bookstores, clubs, coffee shops, and gyms, for example, in six major cities across the U.S.—Los Angeles, San Francisco, Seattle, Miami, New York, and Mesa, Ariz. The report noted that Mesa is one of the largest retirement communities in the U.S.Joining NIDA in the initiative are other national organizations such as the American Pharmaceutical Association, American Association of Retired Persons, and American Academy of Family Physicians (AAFP).AAFP representative and board member Karla Birkholz, M.D., relishes the opportunity to advance understanding of prescription drug abuse. “It’s a chance to develop some guidelines and information that we can bring back to our members about prescription drug misuse and abuse,” Birkholz said.Since many AAFP members have patients with chronic pain, the issue of abuse and misuse is an important one, according to Birkholz.“The larger problem for our members is that they may undertreat chronic pain because they fear that [the patients] will misuse or abuse the pain medications,” she said.Birkholz emphasized the value of education for family physicians about detection and treatment of prescription drug misuse and abuse.The NIDA research report, “Prescription Drugs: Abuse and Addiction,” is posted at www.drugabuse.gov/ResearchReports/Prescription/Prescription.html.▪ ISSUES NewArchived

Preventing prescription drug abuse.

Prescription drug abuse is a problem with potentially grave consequences for patients and their families. Primary care physicians can play a major role in curbing prescription drug abuse by learning to recognize drug-seeking behavior and other warning signs, by educating patients about their drug regimens, and by setting firm but reasonable prescribing guidelines for their practices.