Transcript “Prescription Drug Abuse: Medication Assisted Therapy: Appropriate

“Providers, Parents, and Patients-An
Unholy Alliance of Co-Conspirators”
Prescription Drug Abuse
Louis E. Baxter, Sr., M.D., FASAM
Executive Medical Director
Professional Assistance Program NJ
President
American Society Addiction Medicine
Clinical Assistant Professor Medicine
University of Medicine & Dentistry New Jersey
Goals and Objectives
• Learn the scope of Rx drug abuse
• How Rx drugs are obtained and abused
• How prescription drug abuse impacts
medical care
• How Screening and Brief Intervention and
Referral to Treatment (SBIRT) is
effective
Why do people misuse & abuse Rx Drugs?
• Misconceptions: “Rx drugs safer than street drugs”
• Misconception: “Rx drug use won’t lead to
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dependence”
People use Rx drugs because they ARE Addicted
Poorly or misinformed providers “It’s not habit
forming”
Parents and Friends … well meaning; misguided
Provide “Expedience” … poor medical care
Criminal Financial Gain
Prevalence: National Survey on
Drug Use and Health NSDUH 2004
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48 million have abused Rx drugs (lifetime)
14.6 million within the past year
6 million with in the past month
11.3 million misused or abused Rx pain
medication (annually)
Persons age 18-25 were the highest rate @
14.5%; 9% youth; 4.4% older adults
Whites 6.7%; Hispanics 6.3% Blacks 3.9%;
Asians 3%
How Are drugs Obtained?
• Medicine cabinets of friends & relatives
• Borrowing or lending from family & friends
• Healthcare Professionals
• Internet Purchasing
• Street Market Vendors (Dealers)
How Rx Drugs Are Abused
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Taking more than prescribed
Mixing Medication with alcohol and other Rx’s
Opiates may be crushed injected or insufflated
Stimulants may be crushed injected or
insufflated
Benzodiazepines usually taken in larger
amount – rarely injected
Opiate Patches are chewed, swallowed whole,
or degraded for injection
Clinical Signs and Symptoms Rx SUD
Behavior Patterns
 Sedation
 Inebriation
 Euphoria
 Agitation
 Disorientation
 Prescription drug seeking
behavior
 Suicidal ideations/attempt
Medical History
 Frequent hospitalizations
 Gunshot/knife wound
 Unusual infections
 Cirrhosis
 Hepatitis
 Pancreatitis
 Diabetes
 Frequent falls,
unexplained bruises
 Chronic mental illness
Physical Signs
 Dilated or constricted pupils
 Tremors
 Track marks or
abscesses/injection sites
 Inflamed/eroded nasal
mucosa
 Increased pulse and blood
pressure
 Hallucinations
 Nystagmus
Laboratory
 Elevated MCH, GGT,
SGOT, Bilirubin,
Triglycerides
 Anemia
 Positive urine toxicology for
drugs
 MCV over 95
Emergency Room-Rx Drug Data
(SAMHSA News Release 3/13/07-DAWN 2005)
• ER Visits increased 21% from 2004-2005
• Total # of drug related admissions are stable
• ER visits related to Rx and OTC increased from
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495,732 to 598,542
Benzodiazepines 19%
Rx pain relievers 24%
Methadone 29%
1.4 mill. Visits; 31% illicit; 27% Rx; 36% both
Consequences of Rx Abuse
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Intoxication and Impairment
Coma and respiratory depression from OD
Complicates diagnosis and emergency care
Prolongs hospital lengths of stay (critical care)
Physical dependence and Addiction
Complicates other medical management
Loss productivity and absenteeism at work
Jail – illegal acts, sales, and injury to others
How to Avoid Rx Abuse
(Physicians)
• Better Physician Education about Rx drug abuse
• Better Physician supervision of prescribing
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(frequent re-evaluations of conditions)
Better Physician utilization of non - CDS
medications to maximum doses before
prescribing CDS
Use of non-drug modalities (stimulators; biofeed back)
Awareness of previous drug and alcohol
personal and family histories
Better education of patients regarding the
proper use and storing of CDS medications
Better recognition and referral for intervention
and treatment
How to Avoid Rx Drug Abuse (Parents)
• Become aware of the signs and symptoms
of Rx abuse in children
• Discard old and unused Rx medication
• Lock up Rx medications in a safe place
• Confront children when concerned about
Rx abuse
• Facilitate an Substance Use Evaluation
Intervention for RX drug Abuse
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Address concerns with patients – directly
Detoxification – tapering off medications
Send for rehabilitation counseling
Refer to an Addiction Medicine physician
Early referral to pain management specialists
in appropriate cases
Education for all healthcare providers regarding
the signs and symptoms of Rx Abuse
Educate Parents and Patients about safe
handling of Rx medications
Screening, Brief Intervention, and
Referral to Treatment (SBIRT)
• SBIRT is an integrated approach identify and refer
patients for treatment of SUD
• SBIRT can be used in primary care, emergency rooms,
hospitals and clinics
• SBIRT assess the severity of SUD and initiates the
appropriate level of care for SUD
• SBIRT increases patient awareness and motivates
toward behavioral change
• SBIRT provides opportunities for referral for
specialized care
Is SBIRT Effective?
• Has been shown to decrease frequency and
severity of SUD
• Reduce the risk of trauma
• Increase % of patients entering into SUD
treatment
• Shorten hospital length of stays
• Has been shown to reduce “repeat (future) ER
visits”
(Http://sbirt.samhsa.gov)
SBIRT in Trauma Centers
• Requirement by American College of Surgeons’
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Committee on Trauma (ACS-COT)
ACS-COT requires Level I and Level II to have a
mechanism to identify patients with SUD
ACS-COT requires Level I to have the capacity
to provide screening and brief interventions
for “positive” patients
SCREENING TOOLS for SBIRT
• AUDIT
• ASSIST
• DAST
• CAGE -AID
CAGE-AID Questionnaire
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Cut down on drug or alcohol use? Y_ or N_
Annoyance when criticized re: use? Y_ or N_
Guilt about use ? Y__ or N__
Have you used in the morning? Y__ or N__
• “yes” 1-2 questions = Possible
• “yes” 3-4 questions = Probable
• CAGE Score > 1 require Brief Intervention
Positive Screen – Addiction Medical
Specialist
• Refer to Addiction Medicine Consult Service or
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Certified Addiction Physician - evaluation
Certified Addiction Registered Nurse (CARN)
Certified Addiction Psychologist – evaluation
Licensed Certified Drug and Alcohol Counselor
Network SUD Treatment facility
County or local SUD agency for follow-up and
treatment
Related SAMSHA Reports
• Misuse of Prescription Drugs: Data from
2002, 2003, and 2004 National Surveys on
Drug Use and Health
• The National Survey of Substance Abuse
Treatment Services (N-SSATS):2005
• www. samhsa. gov