Preventing and recognizing prescription drug abuse

The risks for addiction to prescription drugs increase when the drugs are used in ways other than for those prescribed. Healthcare providers, primary care physicians, and pharmacists, as well as patients themselves, all can play a role in identifying and preventing prescription drug abuse.

Physicians. Because about 70 percent of Americans (approximately 191 million people) visit their primary care physician at least once every 2 years, these doctors are in a unique position-not only to prescribe medications, but also to identify prescription drug abuse when it exists, help the patient recognize the problem, set recovery goals, and seek appropriate treatment. Screening for prescription drug abuse can be incorporated into routine medical visits by asking about substance abuse history, current prescription and OTC use, and reasons for use. Doctors should take note of rapid increases in the amount of medication needed, or frequent, unscheduled refill requests. Doctors also should be alert to the fact that those addicted to prescription drugs may engage in "doctor shopping"- moving from provider to providerÑin an effort to obtain multiple prescriptions for the drug(s) they abuse.

Preventing or stopping prescription drug abuse is an important part of patient care. However, healthcare providers should not avoid prescribing or administering stimulants, CNS depressants, or opioid pain relievers if needed. (See text box on "Pain Treatment and Addiction.")

Pharmacists. By providing clear information on how to take a medication appropriately and describing possible side effects or drug interactions, pharmacists also can play a key role in preventing prescription drug abuse. Moreover, by monitoring prescriptions for falsification or alterations and being aware of potential "doctor shopping," pharmacists can be the first line of defense in recognizing prescription drug abuse. Some pharmacies have developed hotlines to alert other pharmacies in the region when a fraudulent prescription is detected.

Patients. There are also steps a patient can take to ensure that they use prescription medications appropriately. Patients should always follow the prescribed directions, be aware of potential interactions with other drugs, never stop or change a dosing regimen without first discussing it with their healthcare provider, and never use another person's prescription. Patients should inform their healthcare professionals about all the prescription and OTC medicines and dietary and herbal supplements they are taking, in addition to a full description of their presenting complaint, before they obtain any other medications.

About 70 percent of Americans - approximately 191 million people - visit a health care provider, such as a primary care physician, at least once every 2 years. Thus, health care providers are in a unique position not only to prescribe needed medications appropriately, but also to identify prescription drug abuse when it exists and help the patient recognize the problem, set goals for recovery, and seek appropriate treatment when necessary. Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why. Screening also can be performed if a patient presents with specific symptoms associated with problem use of a substance.

Over time, providers should note any rapid increases in the amount of a medication needed - which may indicate the development of tolerance - or frequent requests for refills before the quantity prescribed should have been used. They should also be alert to the fact that those addicted to prescription medications may engage in "doctor shopping," moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse.

Preventing or stopping prescription drug abuse is an important part of patient care. However, health care providers should not avoid prescribing or administering strong CNS depressants and painkillers, if they are needed. (See box on pain and opiophobia.)

Pharmacists can play a key role in preventing prescription drug misuse and abuse by providing clear information and advice about how to take a medication appropriately, about the effects the medication may have, and about any possible drug interactions. Pharmacists can help prevent prescription fraud or diversion by looking for false or altered prescription forms. Many pharmacies have developed "hotlines" to alert other pharmacies in the region when a fraud is detected.

There are several ways that patients can prevent prescription drug abuse. When visiting the doctor, provide a complete medical history and a description of the reason for the visit to ensure that the doctor understands the complaint and can prescribe appropriate medication. If a doctor prescribes a pain medication, stimulant, or CNS depressant, follow the directions for use carefully and learn about the effects that the drug could have, especially during the first few days during which the body is adapting to the medication. Also be aware of potential interactions with other drugs by reading all information provided by the pharmacist. Do not increase or decrease doses or abruptly stop taking a prescription without consulting a health care provider first. For example, if you are taking a pain reliever for chronic pain and the medication no longer seems to be effectively controlling the pain, speak with your physician; do not increase the dose on your own. Finally, never use another person's prescription.