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