How physicians can prevent prescription drug abuse through education

Over six million Americans abuse prescription opioids, stimulants, or sedatives, and more men and women now die from prescription drug overdoses than die from all other drug or alcohol overdoses. This epidemic is often attributed to the skyrocketing numbers of prescriptions being written for these medications, which not only puts more of them directly in the hands of patients, but also makes them more available for diversion and abuse by others. Among those who abuse prescription drugs, 70 percent get them from their friends or relatives, not their doctor. This means that in addition to exercising greater care when prescribing these medications, physicians can also play an important role in curbing prescription drug abuse through education. Specifically, they can teach patients about the very real health (as well as legal) consequences of sharing their medications or using them in ways or for purposes not intended, and guide patients in safeguarding and disposing of unneeded medications to prevent their diversion and abuse.

For example, it is common practice for people to keep unused medications for “later use.” Few patients realize that this could open the door not only to their own abuse of these drugs, but to abuse by family members. When an unused opioid analgesic is kept available in a medicine cabinet, for instance, it may be tempting to give one to a spouse or child who is having a headache. Few people will pause to consider the possible hazards of that, or even be aware that there are hazards. (Nor would it occur to the average parent in such a case that they had illegally “diverted” a scheduled substance.) What’s more, if those unused pills are not kept in a locked cabinet, they are potentially accessible to other family members without the patient’s knowledge, as well as to visitors to their home.

Medications are powerful tools to treat circumscribed problems, but when used in other ways or by other people—the definition of “abuse” when the subject is prescription drugs—the end result is unpredictable and could lead to addiction, or worse. Unfortunately, many drug problems may begin with the casual sharing and borrowing of medications that routinely occurs in households (as well as offices and dorm rooms) when patients and their family members and friends are insufficiently aware of the risks involved.

Because they are prescribed by trusted physicians, prescription drugs tend to be seen as safe by the public. That perception is only reinforced—for instance in the eyes of children or teenagers—when parents and other role models are seen sharing their prescriptions. It sends the message that medications are safe because a doctor doesn’t need to be consulted before dispensing them to other people.

The reality, though, is that these drugs are chemically a little different from some notoriously addictive and dangerous illegal street drugs, and abuse can have disastrous consequences. The ADHD medication Adderall, for example, is increasingly being abused by teens and college students both as a study aid and as a party drug; when pills are crushed and snorted or injected, it can produce euphoria and energy similar to cocaine or methamphetamine, along with a similar risk for heart attack, stroke, or addiction. And when abused for their pleasurable effects, opioid analgesics like OxyContin act in the brain and body just like heroin, including suppressing respiration, which has contributed to an alarmingly high number of unintentional overdose deaths from these medications—nearly 14,000 in 2010 alone.

It is important not to frighten patients about medications that they need, but it is also essential to advise them of the potential hazards of taking them in ways or for purposes not intended. Physicians should stress the importance of taking opioids, stimulants, or sedatives only in the dose and for the duration prescribed, and provide instructions for safeguarding the medication and disposing of all unused pills. Parents can be specifically warned about the dangers of keeping their medications anywhere children or teenagers could get access to them. They can also be advised to set a good example for their kids by never sharing their medications with others, including their spouse, friends, or children.

Prescription drug abuse has its roots in a lack of awareness about the power and danger of substances generally perceived as helpful and, consequently, safe. It is often facilitated by well-meaning family members and friends. Besides closer monitoring of patients’ prescriptions and screening for signs of substance abuse, physicians can play an important role in preventing prescription drug abuse simply by educating their patients of the perils of abusing or sharing the contents of their medicine cabinets.



Dr. Dowling is currently the Branch Chief of the Science Policy Branch in the Office of Science Policy and Communications at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). She received her Ph.D. in Neurobiology from the University of California at Davis studying the developing nervous system prior to doing research on nicotine and Parkinson’s Disease at the Parkinson’s Institute. At NIDA, she helps to educate a variety of audiences – including Congress, the White House Office of National Drug Control Policy, and other Federal Agencies, constituency organizations, physicians and the general public – about the science of drug abuse and addiction. These efforts include working on Interagency Committees, giving presentations, representing NIDA to the media, and developing publications and other multi-media campaigns, including work on the Emmy-award winning HBO documentary “Addiction.” Dr. Dowling also serves on the advisory board for the National RX Drug Abuse Summit, which will be held in Atlanta, GA on April 22-24. (Bio courtesy of national RX Drug Abuse Summit)




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