STIMULANTS
Schedule II stimulants include amphetamine, methamphetamine, methylphenidate, lisdexamfetamine, and dextroamphetamine. 4 Prescriptions have increased significantly, 4 and involvement in overdose deaths is increasing. During 2015–2016, age-adjusted psychostimulant-involved overdose death rates increased by 33.3% as part of what has been called a “growing polysubstance landscape.” 67 From 2016 to 2017, death rates involving cocaine and psychostimulants increased across age groups, racial/ethnic groups, county urbanization levels, and multiple states. 67 Among all 2017 drug overdose deaths, 10,333 (14.7%) involved psychostimulants that include prescription drugs, such as dextroamphetamine and methylphenidate. 67 Opioids frequently contribute to stimulant-involved overdose deaths. 67 However, stimulant deaths are also increasing without opioid involvement. Death rates involving cocaine and psychostimulants, with
and without opioids, have increased, and synthetic opioids frequently are involved. 67 Responses should evolve to improve access to care, focus on protective and risk factors for substance use, and improve risk reduction messaging. 67 Harm reduction might also include expanded surveillance measures and naloxone availability. Effects of stimulants as a class include increased alertness, wakefulness, and concentration. 68 Common medical indications include ADHD, obesity, and narcolepsy. Stimulants are associated with adverse effects such as tolerance, risks with withdrawal, and potential for misuse and SUD. 68 With abrupt cessation, withdrawal can be marked by depression, anxiety, and extreme fatigue. 68 Signs of a stimulant overdose include high fever and convulsions, and cardiovascular collapse may precede death. 68 Physical exertion can increase these hazards.
CARISOPRODOL
Carisoprodol is the only muscle relaxant that is a scheduled drug (Schedule IV). 69 It metabolizes meprobamate with hypnotic, anti-anxiety, sedative, anticonvulsant, and some indirect muscle relaxant properties that can cause drowsiness and dizziness.
This medication is not recommended for long-term use or by those with a history of addiction. Because of its limited clinical effectiveness and elevated risks, general use of this medication is best avoided.
RECOGNIZING SUBSTANCE-USE DISORDER
The American Society of Addiction Medicine (ASAM) refined its definition of addiction in 2019. Its brief description may help HCPs view the condition as the “treatable, chronic medical disease” that it is, one which involves “complex interactions among brain circuits, genetics, the environment, and life experiences.” 176 The ASAM further described how behaviors become compulsive and often continue despite harmful consequences and suggested that prevention and treatment generally succeed on a par seen with other chronic diseases. 70
Clinically, an SUD is diagnosed using DSM-5 criteria; OUD is specified if opioids are the drugs used (Table 5). 71,72 A minimum of 2-3 criteria are required for a mild OUD diagnosis, while 4-5 is moderate, and >6 is severe. Addiction, while not a DSM-5 diagnosis, is a frequently used term and typically describes severe SUD. The presence of tolerance and physical dependence does not contribute to the diagnosis of OUD if opioids are prescribed, and the patient takes the medication as prescribed.
Table 5. DSM-5 OUD Criteria A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 of thte following, occurring within a 12-month period: ● Opioids are often taken in larger amounts or over a longer period of time than was intended ● There is a persistent desire or unsuccessful efforts to cut down or control opioid use ● A great deal of time is spent in activities to obtain the opioid, use the opioid, or recover from its effects ● Craving or a strong desire or urge to use opioids ● Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home ● Continued opioid use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of opioids ● Important social, occupational, or recreational activities are given up or reduced because of opioid use ● Recurrent opioid use in situations in which it is physically hazardous
Book Code: TN24CME
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