Preventing and recognizing prescription drug abuse
The risks for addiction to prescription drugs increase when they are used in ways other than as prescribed (e.g., at higher doses, by different routes of administration, or combined with alcohol or other drugs). Physicians, their patients, and pharmacists all can play a role in identifying and preventing prescription drug abuse.
Physicians. More than 80 percent of Americans had contact with a healthcare professional in the past year, placing doctors in a unique position, not only to prescribe medications, but also to identify abuse (or nonmedical use) of prescription drugs and prevent the escalation to addiction. By asking about all drugs, physicians can help their patients recognize that a problem exists, set recovery goals, and seek appropriate treatment. Screening for prescription drug abuse can be incorporated into routine medical visits. Doctors should also take note of rapid increases in the amount of medication needed or frequent, unscheduled refill requests. Doctors should be alert to the fact that those addicted to prescription drugs may engage in "doctor shopping"—moving from provider to provider—in 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 stimulants, CNS depressants, or opioid pain relievers if needed. (See "Chronic Pain Treatment and Addiction".)
Patients. For their part, patients can take steps to ensure that they use prescription medications appropriately: 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 a healthcare provider, and never use another person's prescription. In addition to describing their medical problem, patients should always inform their healthcare professionals about all the prescriptions, OTC medicines, and dietary and herbal supplements they are taking, before they obtain any other medications. Additionally, unused or expired medications should be properly discarded per U.S. Food and Drug Administration (FDA) guidelines or at U.S. Drug Enforcement Administration collection sites.
Prescription Drug Monitoring Programs allow physicians and pharmacists to track prescriptions and help identify patients who are "doctor shopping."
Pharmacists. Pharmacists dispense medications and can help patients understand instructions for taking them. By being watchful for prescription falsifications or alterations, pharmacists can serve as 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. Moreover, prescription drug monitoring programs (PDMPs), which require physicians and pharmacists to log each filled prescription into a State database, can assist medical professionals in identifying patients who are getting prescriptions from multiple sources. As of May 2011, 48 States and 1 territory have enacted legislation authorizing PDMPs, 34 of which are operational.