Opioid prescriptions have increased three-fold over the past two decades, and we have seen how this skyrocketing availability of medications has helped create a new drug abusing population, some of whom suffer severe health consequences. More deaths now occur as a result of overdosing on prescription opioids than from all other drug overdoses combined, including heroin and cocaine. The opioid epidemic is tied closely to another epidemic in our country, that of chronic pain—although the ties are very complex.
Abuse of prescription opioids, stimulants, and other psychotherapeutic medications presents unique challenges. On the one hand, these drugs can produce serious harm (even death) when not taken as prescribed; on the other, they are powerful clinical allies that can be life saving. Thus, the approach we take and the messages we convey to minimize harm need to be nuanced and multipronged.
Almost one-third (32 percent) of the roughly 42,000 Monitoring the Future survey respondents reported having used marijuana during their lifetime. However, abuse of many other drugs—methamphetamine, heroin, cocaine, and some prescription medications—declined.
Combating the epidemic of opioid abuse—including prescription painkillers and, increasingly, heroin—requires a multi-pronged approach that involves reducing drug diversion, expanding delivery of existing treatments (including medication-assisted treatments), and development of new medications for pain that can augment our existing treatment arsenal. But another crucial component we must not forget is that people who abuse or are addicted to opioids need to be kept alive long enough that they can be treated successfully. In this, the drug naloxone has a large potential role to play.
Presents research-based principles of adolescent substance use disorder treatment; covers treatment for a variety of drugs including, illicit and prescription drugs, alcohol, and tobacco; presents settings and evidence-based approaches unique to treating adolescents.
The epidemic of prescription opioid abuse in this country is linked partly to the dramatic rise in prescriptions for these medicines over the last two decades, as well as the fact that many clinicians are inadequately trained to safely treat pain in their patients. Most medical schools only offer a few hours of instruction in safe prescribing of opioids for pain management. A recent review showed that only 3% of U.S. medical schools offer integrated pain management courses.