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Vital Signs

Fall 2009

Abuse of Prescription Drugs on the Rise


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Recent deaths of celebrities from accidental overdoses of prescription painkillers, anti-anxiety drugs and sleeping pills have reprised the cautionary tale that all drugs can be addictive and dangerous — even those prescribed by a physician.

“Over the years, physicians have been encouraged to do a better job of managing patients’ pain and, as a result, many physicians are prescribing more medications, particularly for nonmalignant chronic pain,” explains Karen Miotto, M.D., who specializes in addiction psychiatry and directs the UCLA Alcoholism and Addiction Medicine Service. “The challenge is to ensure patients receive medications necessary to appropriately manage their conditions while avoiding abuse or addiction.”

An estimated 20 percent of people in the U.S. abuse prescription painkillers, sedatives and stimulants, according to the National Institute on Drug Abuse. Abusing these medications can lead to addiction.

“One in five teens says he or she has access to prescription medications,” Dr. Miotto says. “Most adults also have easy access to prescription drugs because their doctors prescribe medications for legitimate health conditions. Abuse often starts innocently, such as taking pain medication after a stressful day or an argument. But then the use becomes compulsive and spirals out of control.”

Potential signs of addiction, Dr. Miotto says, include increasing dose or frequency of medication without consulting a doctor, going to different physicians for the same medication, getting medication from sources other than physicians and borrowing or stealing medication from friends and family, and continuing to use the medication despite severe adverse consequences.

Prescription Drug abuseTreatment for drug addiction, Dr. Miotto explains, may include behavioral or pharmacological therapies. Behavioral therapies encourage patients to stop drug use and teach them how to function without drugs, handle cravings and avoid situations that could lead to drug use. Pharmacological therapies, such as methadone or buprenorphine, may be used to relieve opiate withdrawal symptoms, diminish drug cravings, re-establish normal brain function and prevent relapse.

“What complicates the problem is that people with addictions are usually afraid to give up their medications,” Dr. Miotto says. “They become quite skilled at hiding their addiction from their families, friends and even their doctors.”

Dr. Miotto says physicians are now being encouraged to perform more drug testing to monitor their patients’ use of medications and screen for other drugs of abuse. According to Dr. Miotto, many states, including California, have established prescription-medicationmonitoring programs, which enable physicians to access a statewide database to review all medications prescribed to their patients before ordering additional drugs. But, in the end, she says, it all boils down to awareness.

“Addressing the abuse of prescription drugs will require improved monitoring by physicians and pharmacists, better education of patients and a greater acceptance of addiction screening and treatment,” Dr. Miotto says.

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