1 Opioid Drug Abuse

Prescription Opioid Drug Abuse and How to Prevent It

Stephaine Ryan
Ferris State University










Author Note:
This paper was written for English 321, instructed by Dr. Garrelts
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Abstract
There is an increase of people seeing their physicians to be treated for chronic pain. To
help reduce the patients pain the physician will often use opioid medications. Opioids are most
often chosen to help with chronic pain because they decrease the pain so well, but they are also
the types of medications that are most likely to be misused and abused. To help prevent a patient
from misusing their medications the physicians, nurses and other medical staff is to obtain a
detailed psychological and medical history, decrease the time between doctors appointments,
preform patient answered and doctor answered assessments to determine the risk classification
the patient is, have the patient preform random urine drug testing and limit the amount of
medication in a script given to a patient. Many articles have studied chronic pain and the misuse
and abuse of opioid medications. Those articles have proven that they all the reasons above
separately decrease the amount of misuse and abuse. But, using all the reasons together decrease
the misuse and abuse by a greater number and should be used at hospitals and doctors offices to
help keep patients from improper use of their medications.
















3 Opioid Drug Abuse

Prescription Opioid Drug Abuse and How to Prevent It
As more and more patients are being treated for the presence of chronic pain, the amount
of opioid pain medication has also increased to treat that pain. There are many patients taking
these medications accurately and to they help to decrease their pain, but there are also patients
that use these same medications inaccurately and as a way to induce a high. This is why primary
care physicians as well as physicians that specialize in pain need to monitor their patients to
maintain proper use of their medications and be on the lookout for patients that are intentionally
misusing their medications. To help decide which patients is at most risk for the misuse and
abuse of their medications the doctors, nurses and other medical staff use many different ways to
monitor these patients and prevent the misuse and abuse. Some of the tools that are used are
urine drug testing, different computer programs that estimate the potential a patient has to abuse
and misuse the drug and a detailed medical and psychological history of the patient must be
done. Is there one test that is proven to prevent the misuse and abuse of prescribed medication
better? Or are multiple tools used together the best for preventing patient misuse and abuse of
medication?
What is Considered Chronic pain and how is it Treated?
According to Anita Gupta in the Journal of Pain & Palliative Care Pharmacotherapy
(2010) chronic pain includes persistent baseline pain (lasting 6 months) and breakthrough pain
(transient, abrupt with rapid onset, and intense in magnitude) (p. 71). Chronic pain is also
classified as pain that affects the patients sleep, work, social life and a patients daily living.
Most of the patients that have been diagnosed with chronic pain are treated with different
types of opioid medications including long or short acting opioid drugs. Long acting opioid
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drugs are drugs that give relief of pain for longer periods of time up to twelve hours at a dosing.
Some examples of long acting opioids are Methadone, Morphine, Fentanyl (used as a
transdermal patch), and Oxycodone CR to name just a few. Short acting opioid medications still
give patients relief but for not a long period of time up to four to six hours at a dosing. Some
examples of short acting opioids are Codeine, Tramadol, and Hydromorphone.
Because these drugs work so well at treating pain and giving relief these opioids are the
some of the most abused medications. According to Ms. Gupta, 5.2 million persons abused pain
relievers in 2006 (p. 72). Many of the articles have referenced that there has been a steady
increase of abuse since this study. In just one year there was an increase of 32% or 500,000
people abusing pain medications. Also with the unemployment poverty rates increasing, there is
an increase in the amount of opioid prescription misuse.
What Causes a Patient to Misuse or Abuse Their Pain Medication?
There are many different reasons that a person will misuse their medications. But, some
parts of a persons medical history put them at a higher potential to abusing their medications. In
the Pain Physician (2012), individuals with chronic pain and co-occurring substance use
disorders and/or mental health disorders, are at higher risk for misuse of prescribed opioids (p.
ES67). Some of these co-occurring disorders are depression, hypertension (or high blood
pressure), cancer, and anxiety. Patients that have a history of cigarette smoking, poor diet and
exercise have shown to have complaints of chronic pain.
There are other risk factors that can cause a patient to misuse their medications. Some of
these according to the Pain Physician (2012) are, sociodemographic factors, pain and drug-
related factors, genetics and environment, psychosocial and family history, psychopathology, and
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alcohol and substance use disorders (p. ES71). Studies have shown that the young adult
patients, the ones between the ages of 18 year and 25 years are the most likely to abuse their
medications as well as men were more likely to abuse their medications than women. People
that are seen with complaints of pain in multiple areas are at a greater risk of abusing pain
medication as well. But, many of the articles studied stated that people with a history themselves
of substance abuse are at the greatest risk.
Ways to Prevent Prescription Opioid Misuse and Abuse
There are many different ways to prevent a person from using an opioid prescription
improperly. Some of these ways according to research are urine drug testing, obtaining a detailed
medical and psychological history, limiting the amount of medication (the amount of tablets in a
script) the persons with the higher risks of misuse can obtain at a time, decreasing the time
between appointments with the doctor and being careful on the type of medications being
prescribed. The doctor has to also have to remember that they can still refuse to refill a
prescription. Saying no is an acceptable answer and trying a less addictive and/or misused drug
is always an option.
There are also many different screening tools that ask either the patient questions about
themselves or the doctor questions about the patient to determine the amount of risk a patient has
to abuse their medications. Some examples of these tools are the Screener and Opioid
Assessment for Patients with Pain, Pain Medication Questionnaire, Prescription abuse checklist,
Screening Tool for Abuse, and Screening Tool for Addiction Risk. The assessment tools listed
have roughly six different criteria to place a person answering these questions at a high risk for
abuse are according to the Pain Physician (2012) are: 1) focus on opioids, 2) opioid overuse, 3)
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other substance abuse, 4) low functional status, 5) unclear etiology of pain, and 6) exaggeration
of pain (p. ES77).
Another way to help decrease the amount of patients misusing their opioid medications
are to have the patient sign a controlled substance agreement as Robert N. Jamison, Juliana
Serraillier, and Edward Michna (2011) call it (p.5). In this agreement they should have different
items listed that the patient has to adhere by, such as, agree to get medications from only one
doctor, agree that they will not get any replacement medications if the medication is lost or
stolen, agree to participate in all aspects of treatment including but not limited to physical
therapy and psychological therapy, and agree to preform urine drug testing at any time.
According to Dr. Bill H. McCarberg MD (2011) urine drug testing is considered the
gold standard for assessing medication adherence in patients with chronic pain (p.126). Urine
drug testing should be random so that the patient will not have any notice of having to preform
urine test and then do something to cause the test to be inaccurate. Pain Physician says that the
patients at high risk for abuse should have a urine test at least four times a year for patients and
patients at low risk for abuse should have a urine test one or two times a year.
At the end of Dr. Bill H. McCarberg MDs article he stated that urine drug testing should
be used in conjunction with other tools to decrease the chances of opioid prescription misuse. All
of the articles that were used to research this topic, they all agreed that using multiple tools
would decrease the amount of patients abusing their medications. This means using the
assessment tools, obtaining a detailed medical and psychological history and using random urine
drug tests.
Preventing Opioid Prescription Abuse and Misuse
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When trying to prevent patients from misusing their medications their risk level needs to
be determined then, proper precautions can be made to help keep the patient safe. This may mean
to have them in to see the doctor more often, random urine drug testing, decreasing the amount
of medication in a script for the patient to have filled, and changing medications from one that is
known to be abused more often to one that is less likely to be abused.
The doctor should also make sure that when they are admitting or starting to evaluate a
patient in their office that they look to see how many different doctors have been seen. It has
been shown that people that have visited multiple doctors for pain are more likely to misuse their
medications. The doctor must also remember that they can say no to a patient. Saying no can
mean that they refuse to prescribe a particular medication or refuse to treat the patient. The
doctor always has the authority discharge the patient once it is proven that prescription misuse
has taken place.
Conclusion
While the amount of patients being treated for chronic pain with opioids has increased so
has the amount of patients misusing and abusing their medications. When they are being first
treated the patient should sign an agreement that states they will adhere to the rules of the clinic.
Some of the rules in the agreement should be completing a screening tool to assess risk of abuse
and to preforming random urine drug screening throughout treatment. All of the tools need to be
used together to decrease the risk of a patient misusing and abusing their medications. Those
tools are: lessening the amount of medications in a script, lessen the time between doctor
appointments, urine drug testing, signing a controlled substance agreement and the doctor
refusing to prescribe problem opioids as many of the articles studied have said.
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References
Atluri MD, S., Akbik MD, H., & Sudarshan MD, G. Prevention of opioid abuse in chronic
non-cancer pain: an algorithmic, evidence based approach. Pain Physician. Retrieved
from http://www,painphysicianjournal.com/
Gupta, A. (2010). Internet resources on managing chronic nonmalignant pain with opioids: the
risks of addiction. Journal of Pain & Palliative Care pharmacotherapy, 24, 71-75.
Doi:10.3109/15360280903583198
Heimer, R., Dasgupta, N., Irwin, K.S., Kinzly, M., Phinney Harvey, A., Givens, A., & Grau, L.E.
(2011). Chronic pain, addiction severity, and misuse of opioids in Cumberland county,
Maine. Addictive Behaviors, 30, 346-349. Doi:10.1016/j.addbeh.2011.11.017
Jamison, R.N., Serraillier, J., & Michna, E. (2011). Assessment and treatment of abuse risk in
opioid prescribing from chrionic pain. Pain Research and Treatment, 2011, 1-12.
Doi:10.1155/2011/941808
McCarberg MD, B. (2011). A critical assessment of opioid treatment adherence using urine drug
testing in chronic pain management. Post Graduate Medicine, 123, 124-131.
doi:10.3810/pgm.2011.11.2502
Monheit, B., (2010). Prescription drug misuse. Australian Family Physician.39, 540-546.
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Owen MD, G.T., Burton MD, A.W., Schade MD PhD, C.M., & Passik PhD, S. Urine Drug
testing: current recommendations and best practices. Pain Physician. Retreived from
http://www.painphysicianjournal.com/
Sehgal MD, N., Manchikanit MD, L., & Smith MD, H., (2012, July). Prescription opioid abuse
in chronic pain: a review of opioid abuse predictiors and strategies to curb opioid abuse.
Pain Physician. Retreived from http://www.painphysicaianjournal.com/