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Article Summary

Preventing the Abuse of Prescription Pain Medications

Although most patients use medications as directed, abuse of and addiction to prescription drugs are public health problems for many Americans.

However, addiction rarely occurs among those who use medications as prescribed; the risk for addiction exists when medications are used in ways other than as prescribed.

Patients, pharmacists, and health care providers all play a role in preventing and detecting prescription drug abuse.

Pain and Opiophobia
When treating pain, health care providers have long wrestled with a dilemma:

How to adequately relieve a patient's suffering while avoiding the potential for that patient to become addicted to pain medication?

Many doctors underprescribe painkillers because they overestimate the potential for patients to become addicted to medications such as morphine and codeine. Although these drugs carry a heightened risk of addiction, research has shown that providers' concerns that patients will become addicted to pain medication are largely unfounded. This fear of prescribing opioid pain medications is known as "opiophobia."

Most patients who are prescribed opioids for pain, even those undergoing long-term therapy, do not become addicted. The few patients who do develop rapid and marked tolerance for and addiction to opioids usually have a history of psychological problems or prior substance abuse. In fact, studies have shown that abuse potential of opioid medications is generally low in healthy, nondrug-abusing volunteers. One study found that only 4 out of about 12,000 patients who were given opioids for acute pain became addicted. In a study of 38 chronic pain patients, most of whom received opioids for 4 to 7 years, only 2 became addicted, and both had a history of drug abuse.

The issues of underprescription of opioids and the suffering of millions of patients who don't receive adequate pain relief has led to the development of guidelines for pain treatment. This may help bring an end to underprescribing, but alternative forms of pain control are still needed. NIDA-funded scientists continue to search for new ways to control pain and to develop new pain medications that are effective but don't have the potential for addiction.

Assessing Prescription Drug Abuse: Four Simple Questions

  1. Have you ever felt the need to cut down on your use of prescription drugs?
  2. Have you ever felt annoyed by remarks your friends or loved ones made about your use of prescription drugs?
  3. Have you ever felt guilty or remorseful about your use of prescription drugs?
  4. Have you ever used prescription drugs as a way to "get going" or to "calm down?"

Role Of Patients
There are several ways that patients can prevent prescription drug abuse.

  • When visiting the doctor, provide a complete medical history and a description of the reason for the visit to ensure that the doctor understands the complaint and can prescribe appropriate medication.
  • If a doctor prescribes medicine, follow the directions for use carefully and learn about the effects that the drug could have, especially during the first few days during which the body is adapting to the medication.
  • Be aware of potential interactions with other drugs.
  • Do not increase or decrease doses or abruptly stop taking a drug without consulting a health care provider first.
  • Never use another person's prescription.

Role Of Pharmacists

Pharmacists play a role in preventing prescription drug misuse and abuse by:

  • Explaining how to take a medication appropriately.
  • Providing clear information about the effects the medication may have.
  • Providing advice about any possible drug interactions.

They can also help prevent prescription fraud or diversion by looking for false or altered prescriptions.

Role Of Health Care Providers
Health care providers are in an unique position not only to prescribe needed medications appropriately, but also:

    Identify prescription drug abuse when it exists

  • Help the patient recognize the problem.
  • Set goals for recovery, and seek appropriate treatment when necessary.

Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-the-counter drugs the patient is taking and why. Screening also can be performed if a patient presents with specific symptoms associated with problem use of a substance.

Over time, providers should note any rapid increases in the amount of a drug needed - which may indicate the development of tolerance - or frequent requests for refills before the quantity prescribed should have been used. They should also be alert to the fact that those addicted to prescription medications may engage in "doctor shopping," moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse.

Preventing or stopping prescription drug abuse is an important part of patient care. However, health care providers should not avoid prescribing painkillers, if they are needed.

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