Research Update (2002 February): Pain Medications and Dependence

2 Pages·2002·0.22 MB·English

by  Butler Center for Research

0•
HazeLDeN
Research Update is published bythe ButlerCenter
for Researchto share significantscientificfindings
from thefield ofaddictiontreatment research.
RESEARCH U PDATE
BUTLER CENTER FOR RESEARCH FEBRUARY 2002
Pain Medications and
THEHAZELDEN EXPERIENCE
Dependence Hazeldentreats peoplewithopioid addictionandtheir
outcomesappearsimilartothosedependentonother
drugs. In addition, Hazelden’sPhysicians-in-Residence
When used responsibly, prescription pain medications reduce severe pain, allowingsufferers programteachesdoctorstorecognizeand assess
to function more productisely. Unfortunately, the use of pain medications for non-medical substanceabuseand dependence, includingabuseof
purposes is increasingand fuelingan epidemic ofaddiction. pain medications.This program increasestheirskill in
addressingaddictionamong medical patients.
Opioids
Most pain medicationsare partofthe opioid class ofdrugs. Because opiates are used legally CONTROVERSIES&QUESTIONS
to reduce severe pain, theyare sometimes referred to as analgesics,” a misleadingterm since Question: Whatshouldpeoplewithpainfulillnessesor
notall analgesicsare opiate based (for example, non-steroidal anti inflamatory drugs). Opioids injuriesdotorelievepain?
reduce pain by blocking pati receptors thattravel to the brain.
Response:When usedforlegitimatepurposesand under
Common opiold pain medications include morphine, codeine. oxycodone, hydrocodone close medicalsupervision, pain medicationscan bevery
(Vicodin), and meperidine (Demerol), among others. OxyContin, which contains a high helpfultothosewhootherwisewould notbeabletofunction.
concentration ofoxycodone, has been mentioned in the news frequently. Many abusers and When pain becomeschronic, alternativemethodscan
suppliers ofthe drug have been arrested, including several physicians. effectivelyreducepain and restorefunctioning.
Chronic use ofopioids can result in physical dependenceand addiction. When used in high HOWTO USETHIS INFORMATION
doses, opioid pain medicationswill depress respiration and cause death. Withdrawal symptoms
— RecoveringPeople: Befrankwith doctorsabout
from opioid pain medications include insomnia, diarrhea, restlessness, muscleand bone pain, your recoveryfrom dependence andaskfor
chills, nausea and vomiting, and muscle spasms. alternativestoaddicting medications. Ifopioid
based pain medication Is necessary, minimize
thedangersassociated with use bydiscussing
Prevalence of Use and Dependence the issuewith yoursponsororAAINAgroupand
The numberoffirst time users of pain medicationsfor non-medical purposes is growing by havinga close relativeorfriend dispensethe
medication as prescribed.
dramatically (see Figure). Accordingto the National Household Survey cii Drug Abuse, in
1969an estimated 265,000 people in the U.S. first used pain medicationsfor non-medical — Health Care Providers: Carefullyassessfor
prescription drugabuseamongyour patrent. Refer
purposes. By 1989, that numberwas up to 571,000. By 1999, it had jumped substantiallyto
patientswith abuseordependencetoappropriate
over 1.4 million. Most recentdata indicateapproximately2.8 million people in the U.S. used treatmentfacilities.
pain medicationsfor non-medical purposes in 2000. Particularly high increases in new users
— Counselors: Educatesubstance-dependent
patientsabouthandlingfutureevents inwhichthe
Numbers(inthousands)ofnewusers ofpain medications useofpain medication may be necessary.
fornon-medicalpurposesbyyear. — Policy: Support lawmakers and otheragenciesin
theireffortsto prevent prescriptionfraud.
1600
1400
1200
iuou
ow
600
mu
200
1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1971 1993 1995 1997 1999
SouRcE:SubstanceAbuseandOnntsiHealthSeru,.,sAdministrabon,2001.’
>CONTINUEDONBACK
<CONTINUEDFROMFRONT
Pain Medications and Dependence
HazeLDeN
have occurred amongyoung people ages 12 to 17. In 1985, this groupaccounted for 78,000
ofthe new users of pain medications. In 1999, that number had jumped to 722,000.°
As the number offirst-time users has increased, sotoo (lasthe numberofadmissionsto References
treatment centers for pain medication deperldence. Accordingto the Treatment Episode Data 1. FloridaDept.ofLawEnforcement.(2001).Overviewofprescription
Set, which compiles information on admissions reported by U.S. states, the numberof people dregabuseandtheoxycodoneprotdnmisFloridalOn-linel.Available
www.fdIn.atate.fLus.
admitted to treatmentwho declared pain medications astheir primary drug ofabuse rosefrom
2. Thonrason,H.H.,&Dilts,S.L1199)1.Opivids.InB.i.Frances&S.I.
14,044 in 1994 to over 20,000 in 1999: Men and women were equally represented among Miller(Edo.),Clinicaltextbookofaddictivedisorders(pp.103-1201.
NewYork:Guilford.
admissions in 1999. The majoritywere Caucasian (85%) and their average age was 37.
3. SubstanceAbuseandMentalHealthServicesAdnvnislration.12001a(.
Forty-four percent ofthem reported no other substances ofabuse otherthan the use of Sunirivaryoffindingsfronttire2000NationalHouse/mIdSurveyon
Drvgdbuse,NHSDASeriesH-13.DHHSPeblicutionUs.ISMI01-2549.
prescription painkillers. Rockuille,MD:Author.Available:www.samhsa.gov.
4. SubstanceAbuseandMental HealthServicesAdministration.
(2001b(. TreatmentEpisodeDataSet(TEDS)1994-1999:National
Deaths Attributed to Pain Medication Abuse admissionstosobstanceabovetreatmentservices(On-line).
Available:www.samhsa.gov.
Abuseof pain medicationscan be fatal. The Drug AbuseWarning Network reports annual data
5. SubstanceAbuseandMentalHealthServicesAdministration.(2000).
from 139 medical examiners located in 40 metropolitan areas acrossthe US: Reported deaths Drug,lboseWarningNetyorkannualmedicalexaminerdata19911
(On-line).Available:www.samhsa.gov.
are either drug-induced (any death caused directly bythe drug) ordrug-related (the drug
6. NIDA12001).NIDAnewsrelease:N/DOandpartnersannouncenational
contributed to the death butwas notthe onlycause, e.g., car accident). Irl 1999, over 2000 initiativeonprescriptiondregnrisvseandabuse(On-line).Available:
wecm.nida.nibgov.
deathswere directly caused by pain medications, whether used singlyor in combination with .
7. Hatchinson,A.(December11,2001kStatementofAsaHutclrinson,
otherdrugs: Pain niedication-related deaths numbered over600 in the sameyear. adnvvistratotDrugEnforcenrentAdministrationbeforetheHouse
CommitteeonAppropriationsSvbconrnritteeonConrmerce,Justice,
State,andJvdiciaiy)On-line).Available:c:wei.dea.gev/pubv/
testirnony.htm.
What Is Being Done?
8. CenterforAddictionandSubstairceAbuse.(2000).Missed
In response to growing problemswith prescription drugabuse, including pain medications, the opportunity:Nationalsurveyofprimna,ycarephysiciansavdpatients
onsubstanceabove[On-line).Available:www.cusacolunibia.org.
National Institute on Drug Abuse has partnered with several organizations to launch a national
9. NIDA.(2002).Prescriptiondrugs:Abuseandaddiction(On-line].
initiative on this topic. The main goals ofthe effortare to promote research and educate the Available:svmvw.nidu.rvh.gov.
public, including health care providers, aboutthe misuseand abuse ofthese medications. 10. Stinclitield,B.,&Owen.P.119981.Hazelden’smodeloftreatmentand
itsoutcome.AddictiveBehaviors,23,669-603.
The Drug EnforcementAgency has also launched a plan to aggressivelytargetfraudulent
1). Loom,ER.etal.09991.Droolstamrdardizedpatientstoevaloate
prescriptions, doctor shopping, and other illegal practices related specificallyto the abuse of thePhysiciansinResidenceProgram:Asubstanceabusetraining
approach.JournalofAddictiveDiseases,18,39-50.
OxyContin.
12. Compas,B.E.,Haaga,U.A.F.,Keefe,F.i..Leitenberg,H.,&F/illiavis,
0.A.1)9901.Sampliimgofenipiricallysuppvitedpsychological
Effective prevention efforts are necessaryto combatthis growing problem. A recentsurvey treatmentstrainhealth psychology:Smoking.chronicpain,cancer,
of primarycare physiciansacrossthe U.S. found less than one-third felt very prepared” andbulirnianervosa.JournalofConsultingandClinicalPsychology
66,89-112.
to recognize prescription drugabuse amongtheir patients and over46% said theywere
uncomfortable discussingthe issue. Clearly, educating physiciansto assessand diagnose this
problem is necessary.
Pharmacists are also in a unique position to prevent pain medication abuse and dependence.
In addition to providingcleardirectionson appropriate use ofthese medications, theycan
watch foraltered or forged prescriptions. In an effortto reduce prescription fraud, pharmacies
have developed systemsto report illegal prescription activityto other pharmacies nearby.
Summary
While the growing numberof people abusing and dependent upon pain medications is
disturbing, there is good news. Treatmentfor pain medication dependence is availableand
effective. It is important to rememberthateach year pain medications are used appropriately
by millions ofAmericanswith legitimate needs. Even so, given the consequences ofabuse and
dependency on these drugs, keeping a closewatch on their use is essential.
hazelden.org
BUTLER CENTER FOR RESEARCH FEBRUARY 2002
The ButlerCenterfur Research informs arid irispruves recovery’servicesand producesresearch
dat henefnv the kcld ofaddiction treatment.\1e\arededicated toconductingclinical research,
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