Table 2. Definitions Related to Prescription Drug Use and Misuse
Term
Definition
● Not the same as addiction ● Occurs because of physiological adaptations to chronic exposure to a drug ● Withdrawal symptoms occur when medicine is suddenly reduced or stopped or when antagonist is administered ● Symptoms can be mild or severe and can usually be managed medically or avoided through slow drug taper ● Same dose of drug given repeatedly produces reduced biological response ● Higher dose of drug is necessary to achieve initial level of response ● Taking medication in a manner or dose other than prescribed ● Taking someone else’s prescription, even if for a medical complaint like pain ● Primary, chronic disease of brain reward, motivation, memory, and related circuitry ● Dysfunction in circuits leads to characteristic biological, psychological, social, and spiritual manifestations as individual pathologically pursues reward and/or relief by substance use and other behaviors ● Characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and dysfunctional emotional response ● Involves cycles of relapse and remission ● Without treatment or recovery activities, is progressive and results in disability or premature death ● A problematic pattern of opioid use leading to clinically significant impairment or distress ● Defined in DSM-5* ● Previously classified as “opioid abuse” or “opioid dependence” in DSM-4 ● Also referred to as “opioid addiction” ● Taking medication to feel euphoria (i.e., to get high) ● Nonmedical use of prescription drugs refers to misuse
Physical dependence
Tolerance
Misuse
Addiction
Opioid-use disorder
*DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; diagnostic criteria given later in this activity The Purpose of a Prescription in Legitimate Medical Practice
The DEA tracks the flow of CS from manufacture to ultimate use and enforces the CSA, including the tenets of lawful prescribing. 12 In order to be legal, a CS prescription must be issued for a legitimate medical purpose in the course of professional practice. 23 In
general, this means HCPs must practice in accordance with medical standards recognized and accepted in the United States. 22 The totality of circumstances particular to each HCP and patient must be evaluated on its own merits. ● Committed an act that would render DEA registration inconsistent with public interest ● Been excluded from participation in a Medicaid or Medicare program Considerations in determining the public interest include recommendations of state licensing boards, compliance with CS law at the state, federal, or local level, conviction record pertaining to CS, experience with respect to CS, and “such other conduct” that may threaten public health and safety. 22 The registrant takes responsibility for compliance with the CSA and for ensuring CS are distributed only to those authorized to receive them. 22 A registrant must notify the localDEA Diversion Field Office in writing within a business day of discovery of a theft or significant loss ofa CS. 19 The DEA may also move to investigate a prescriber for alleged criminal acts. The agency assures HCPs that investigation and prosecution are reserved
Registration Requirements to Prescribe Controlled Substances The cornerstone of CS regulation is that all handlers of CS must register with the DEA. The registration requirement extends to HCPs, drug manufacturers, wholesale distributors, hospitals, pharmacies, and scientific researchers. 24 One person or the institution
itself (for example, a hospital) may serve as the registrant, and nonregistered agents may write prescriptions under that registration. 22 If an HCP has more than one practice, each location must have its own DEA registration to prescribe CS. 22 This applies to a business location and not to HCPs who practice at multiple locations within the same state. The DEA may act to suspend or revoke a prescriber’s registration, for example, if the prescriber has: 22 ● Falsified any application ● Been convicted of a felony related to a CS ● Had a state license or registration suspended, revoked, or denied
Page 6
Book Code: TN24CME
Powered by FlippingBook