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MISUSE
BAREERA
RANA
Drug Abuse
Substance abuse
A maladaptive pattern of use of a substance
Compulsive, excessive, and self-damaging use of
drugs or substances
Excessive use from a harmful drug (Overuse)
psychoactive drugs or performance enhancing
drugs for a non-therapeutic or non-medical
effect
Drug Misuse
A term used commonly for prescription
medications with clinical efficacy but
abuse potential and known adverse
effects linked to improper use, such as
psychiatric medications with sedative,
anxiolytic,
analgesic,
or
stimulant
properties.
Epidemiology of Prescription
Drug Misuse and Abuse
Most commonly abused classes of
prescription drugs
Opioids, such as OxyContin and Vicodin, which
are most often prescribed to treat pain;
Central nervous system (CNS)
depressants, such as Valium and Xanax,
which are used to treat anxiety and sleep
disorders; and
Stimulants, which are prescribed to treat
certain sleep disorders and attention deficit
hyperactivity disorder (ADHD), and include
drugs such as Ritalin and Adderall.
History
In 1932, the American Psychiatric Association:
Informed Consent
SPECIFIC RISKS OF THE TREATMENT (longterm opioid use):
Periodic review:
Evidence of analgesia
Treat side effects
Enhanced social/employment functioning
Overall improved quality of life
Family assessment
Unsatisfactory: review other options
Identification of Prescription
Opioid Abusers
Deterioration in
home/work
Resistance to
changes in therapy
Use of drug by
injection or nasal
route
Early refills
Lost/stolen
prescriptions
Doctor shopping
Prescription forgery
Abuse of other
substances
Frequent retail visits
Unauthorized dose
increases
Nonmedical use
Refuses UDS/referral
to specialist
Therapeutic Options:
Combination of medication treatment
plus psychosocial/psychotherapeutic
interventions:
Inpatient (usually detoxification; short
term pharmacotherapy) followed by:
Residential
Intensive outpatient
Individual/Group Drug Counseling
+/- Maintenance pharmacotherapy
Maintenance Medications
Antagonist treatment: Naltrexone 50
mg/d (oral)
Blocks opiate agonist effects
Infrequently used:
Maintenance Medications
Methadone
Most widely utilized pharmacotherapy for
opioid dependence
Schedule D drug
Specialized treatment programs must be used if
patient has opioid addiction
Restricted numbers of take-home doses
Induces tolerance to acute dose of opioid
Does not induce full tolerance to all opioid
effects (e.g. sedation at peak plasma
concentration)
Reduced crime, increased employment,
improved health, decreased risk related to
diseases common to drug users (HIV, Hep C)
Maintenance Medications
Buprenorphine
Opioid partial agonist
Lower abuse liability
Schedule D
Available by prescription
Waiver needed for physician to be
able to prescribe
Allows for office-based treatment
of opioid dependence
Conclusions
Prescription narcotic abuse and associated
addiction increasing
Consider non-opioid treatment options for chronic
pain
If chronic opioids are to be used:
Treatment Agreement/Informed Consent
Good documentation of treatment plan and responses
Get releases at outset for other treatment providers,
family member(s) important to therapy
Thank You !