prescription drug presentation

8/12/2019 Prescription Drug Presentation

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Could YOU Be a

Pusher?Prescription Drug Abuse and Implications for

Medical and Mental Health Practitioners

Presented by Jan-Sheri Morris and Alissa Wulff


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A Call For Action


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Statistics

2010: 2.4 Million People Age 12+ Began Using Prescription

Drug Medication for Non-Medical Reasons

1992 to 2002: The Number of Prescriptions for Controlled

Drugs Increased 154.3%

1997 to 2007: Milligram per Person of Opioids Prescribed 74mg to

369mgIncrease of 402%

2008: CDC Reported 15,000 Deaths From Overdoses of Pain

Medication


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Types and Costs of Drugs

In 2002: Abuse of Prescription Drugs cost U.S. nearly $181Billion

Commonly Abused Prescription Drugs

Opioids:Used to Treat Pain

Oxycodone (Percocet, Tylox, OxyContin)

Hydrocodone (Vicodin, Lortab)

Methadone (Dolophine)

Central Nervous System (CNS) Depressants:Used to TreatAnxiety and Sleep Disorders

Butalbital (Fiorinal/Fioricet) Diazepam (Valium)

Alprazolam (Xanax)

Stimulants: Used to Treat ADHD, ADD

Methylphenidate (Ritalin, Concerta)

Amphetamine/Dextroamphetamine (Adderall, Dexedrine)


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Types and Costs of Drugs

Generic Name Brand Name Brand Cost

Per Pill

Street Value

Per Pill

Acetaminophen

w/Codeine (30mg)

Tylenol #3 $5.64 $8.00

Diazepam (10mg) Valium $29.80 $100.00Fentanyl Patch Duragesic

Patches

$24.35 $40.00

Hydromorphone

(4mg)

Dilaudid $8.84 $5.00-100.00

Methylphenidate Ritalin $8.82 $15.00

Oxycodone (80mg) OxyContin $108.13 $800.00


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Physical Warning SignsIt is important at a physician to be aware of the warning signs that your client may be abusingprescriptive drugs. There are many factors that can help you to determine if they indeed are

misusing the drugs you prescribe. Here are a list of physical signs of abuse:

Stimulants (medications used to speed up brain activity causing increased alertness, attention, andenergy that come with elevated blood pressure, increased heart rate and breathing)

Hyperactivity

Shaking

Sweating

Dilated pupils

Fast or irregular heart beat

Elevated body temperature

Seizures

Paranoia/nervousness

Repetitive behaviors

Loss of appetite or sudden and unexplained weight loss

Sedatives/depressants (medications used to slow down or depress the functions of the brain and

central nervous system) Loss of coordination

Respiratory depression

Slowed reflexes

Slurred speech

Coma

Opioid analgesics (medications used to treat moderate-to-severe pain)

Sleep deprivation or "nodding Pinpoint/constricted pupils, watery or droopy eyes


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Behavioral Warning SignsBehavior changes may include:

Sudden mood changes, including irritability, negative attitude, personality

change

Extreme changes in groups of friends or hangout locations

Forgetfulness or clumsiness

Lying or being deceitful, unaccounted time away from home/missedschool days,

Avoiding eye contact

Losing interest in personal appearance, extracurricular activities or sports

"Munchies" or sudden changes in appetite

Unusually poor performance in school, on the field, in debate club or other

activities

Borrowing money or having extra cash

Acting especially angry or abusive, or engaging in reckless behavior

Visiting pro-drug websites


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Approach To identify potential abusers physicians can employ

risk stratification Patients at low risk need minimal structure, whereas those at greatest risk

need more frequent visits, fewer

pills per prescription, specialist-level care, and urine drug tests

Consider saliva drug testing (FDA-approved; CLIA-waived office-based

rapid screening kits are available) Consider hair drug testing for measuring long-term use (use a reliable lab)

Screen patients for substance abuse and other forms of psychologicaldependence prior to prescribing controlled substances.

Treating AddictionsAddiction in pain patients is rare and occurs in approximately 4 in 10,000patients treated with opioids. Addiction is often difficult to detect in thispopulation. While true opioid addiction is rare in patients with chronic pain, itdoes occur and needs to be treated with firm compassion. Addiction and abuseaffects people of all ages and all races. It is important to treat addiction as youwould any other medical condition by avoiding defensiveness, avoidance, anger

and display a professional, empathetic and non-judgmental.


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Creating New Behavior As a physician it is important to teach your client coping skills in

order to kick the prescription abuse. If you as the primaryprovider are unable to provide help to your client it is always

best to refer them to an addition specialist or to a facility that

specializes in helping people withdraw from drugs.

Below are some cue questions to ask your client about their abuse:

How long have you had this problem?

What, if anything, prompted it?

How severe are your symptoms?

Do you have a past history of drug abuse or addiction?

Has anyone in your family had a history of drug abuse or

addiction?


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Being Productive Many physicians have difficulty discussing critical issues with

patients. A CASA report finds that over 40% of physicians havedifficulty discussing substance abuse, including abuse of prescriptiondrugs, with their patients compared with less than 20% havingdifficulty discussing depression. Some conversations will be needed

just to convince patients to take their medication; other conversationswill focus on taking medication properly, and still others on the touchysubject of abuse.

Always be proactive with teaching your clients the proper way to usetheir prescriptive drugs so that they are using them properly. If you dosuspect that abuse is present be firm and offer alternatives. Tips such

as practicing verbal responses to handle difficult situation such andsaying it is not your choice to prescribe at this time. Another optioncould be to refer them to the clinics policy when prescribing

prescriptive drugs to a client who may be experiencing dependenceproblems. Another option is to direct them to the licensing board andfederal government rules and regulations.


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Medical Training with SA Less than 40% of National Physicians Receive Training in

Medical School to Identify Prescription Drug Abuse orRecognize the Warning Signs

More than 90% Fail to Detect Symptoms of Substance Abuse

National Center on Addiction and Substance Abuse at ColumbiaUniversity Survey: 648 Primary Care Physicians with 510 AdultsReceiving Care for 10 Substance Abuse Programs

More that 50% Patients Reported Primary Care Physician DidntAddress Their Substance Abuse

More than 40% Patients Reported Primary Care Physician MissedDiagnosis of Substance Abuse Disorder

Only 25% Patients Were Involved In Their Decision To SeekTreatment

Less than 20% Primary Care Physicians Considered Themselves

Very Prepared to Identify Alcohol or Drug Dependence


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Monitoring Prescription Drug Monitoring Programs

State By StateNo National Database; Most States Allow NeighboringStates to Access Database

43 States Have Databases to Track Pain Prescriptions; Only 35 HaveOperational PDMPs

9 States Require Doctors to Access PDMP Under Certain Circumstances

Studyby University of Toledos College of Medicine Found Doctorsor Pharmacists Who Reviewed State Drug Data Changed How TheyManaged Their Cases 41% Of The Time

61% Prescribed Non-Opioid Drug or Less Dosage Than OriginallyPlanned

39% Prescribed More Than Originally Planned After Determining PatientDid Not Have History of Opioid Use

Future Implications Call For Compliance on Federal, State, and Local

Levels to Maximize Efficient Data Collection and Analysis


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What Do YOU Think?

Should Doctors Be Mandated to Check Electronic Databasesfor Prior Drug Abuse or Doctor Shopping?

Does This Breach Patient Confidentiality?


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New York State: I-Stop Bill

Goal: Keeping Powerful Opioid and Anti-Anxiety Drugs Out of

Hands of Addicts and Dealers

Requiring New Electronic Prescription Database; Electronic Scripting

Physicians and Pharmacists Writing or Filling Schedule II, III, IV, and V

drugs MUST Enter Prescriptions Into Database Immediately

Currently They Have 45 Days to Enter Prescriptions

Complaint of Current Slow Functioning System

Bill Will Place Fines on Doctors Failing to Immediately Report

$500 for First Time Offenders; Up to Thousands for Repeated Offenses

Thoughts?


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We Must Work Towards Efficient

Practices and CommunicationQuestions?Comments?


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References

American College of Preventive Medicine. (2011). Use, Abuse, Misuse, andDisposal of Prescription Pain Medication Time Tool. Retrieved fromhttp://www.acpm.org/?UseAbuseRxClinRef#.

Farley, J. (June 15, 2012). Regulation of Prescription Drugs Could Spell Troublefor Patients. Retrieved from http://www.thirteen.org/metrofocus/2012/06/

regulation-of-prescription-drugs-could-spell-trouble-for-patients/.

Office of National Drug Control Policy. (2011). A Response to the Epidemic ofPrescription Drug Abuse. Retrieved from http://www.whitehouse.gov/ ondcp/prescription-drug-abuse.

Office of National Drug Control Policy. (2011). Epidemic: Responding ToAmericas Prescription Drug Abuse Crisis. Retrieved from http://

www.whitehouse.gov/sites/default/files/ondcp/issues-content/ prescription-drugs/rx_abuse_plan_0.pdf.

Polydorou, S., Gunderson, E.W., & Levin, F.R. (2008). TrainingPhysicians To Treat Substance Use Disorders. Retrieved fromwww.ncbi.nlm.nih.gov/pmc/articles/PMC2741399/.

Wisniewski, M. (May 20, 2012). Doctor Shopping: States Cracking DownOn Prescription Drug Abuse.Huffington Post. Retrieved fromwww.huffingtonpost.com/2012/05/031/doctor-shopping- prescription-

drugs-abuse-states_n_1557728.html.

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