may also be more likely to abuse prescription drugs alone or in combination (NIDA, 2018b; Regier et al., 1990). The prescription drug abuse epidemic affects society as well as individuals. Economic costs in the form of lost productivity, healthcare expenses, and law enforcement costs, to name a few, amount to tens of billions of U.S. dollars annually (NIDA, 2017). Inadequate or insufficient treatment of individuals suffering from abuse or addiction exacerbates this drain on the country’s resources. can effectively prevent abuse through awareness of the scope of the problem and identification of patients who are at risk for abuse or addiction, or who are currently abusing prescription medications. Education of both patients and staff can raise awareness, and identification of at-risk patients can result from the collaborative efforts of dentists, staff, physicians, and pharmacists. A thorough history that includes specific questions regarding past use of prescription drugs (California Dental Association, 2015) can identify potential abuse, yet research has shown that these questions are not frequently asked during the health history interview (Brown University, 2011). The use of screening tools in the dental office and frank conversations with the patient’s network of healthcare providers when abuse is suspected or identified can curtail the problem of abuse. Having knowledge of the common characteristics and tactics of drug-seeking patients helps dental professionals identify these patients in their practice. Clarification of terminology regarding addiction and physical dependence is also important, particularly to avoid overdiagnosis of addiction when discussing issues of pain management. Addiction and physical dependence can occur together (NIDA, 2018d) or can be independent from each other. Addiction is compulsive drug use despite harmful consequences and is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and sometimes (depending on the drug), tolerance and withdrawal (NIDA, 2018b). Therefore, a patient with chronic pain who is physically dependent on her medication in order to perform the necessary daily activities that allow her to get to work may not necessarily crave the medication or exhibit other signs of addiction; however, she may exhibit withdrawal symptoms if her medication regimen is significantly altered. Tolerance refers to the need to use a higher dose of a drug to achieve the same effects previously achieved by a lower dose (Volkow, 2010). Tolerance occurs as the drug is used over time and, depending on the drug, can result from different physiological mechanisms. Tolerance to a drug is not synonymous with addiction, although the drug being used may also have addictive potential (Volkow, 2010). A patient with chronic pain, for example, may require an increase in the dosage of medication over time in order to provide adequate pain relief without exhibiting signs of addiction. It is important to note, however, that tolerance can occur alongside addiction.
women may exhibit neonatal abstinence syndrome (NAS), and are more likely to have a developmental delay or speech or language impairment in early childhood compared with children born without NAS (CDC, 2018a,b). Patients with comorbidities (defined as two or more conditions that occur at the same time but for which there is not necessarily a cause-and-effect relationship), particularly psychiatric disorders, are significantly more likely to also abuse prescription drugs. Individuals who abuse other substances (for example, alcohol or illicit drugs) The role of the dental professional Dentists are mentioned less frequently than other healthcare providers in the literature or on websites addressing the prescription drug abuse problem, yet dental providers can contribute to both the scope and prevention of this growing epidemic. Although there are fewer indications for dentists to prescribe stimulants or CNS depressants, the use of prescription pain relievers such as opioids is quite common in dental practices. Opioids are frequently used for the relief of acute pain resulting from infection or following invasive treatment procedures such as the extraction of third molars. In addition, the dental office can be a target for patients seeking prescription drugs for nonmedical use, including patients who engage in “doctor shopping” as a source of drugs. The dental provider can take steps to avoid becoming an unwitting participant in the growth of the prescription drug abuse epidemic, including reviewing current prescribing practices and considering alternative medications for the control of pain. Working together, the dentist and office staff Definitions The terminology surrounding drug abuse requires some standardization to enable practitioners to communicate effectively with patients and colleagues. In this course, the term prescription drug s refers to those controlled substances that are prescribed and dispensed legally by dental providers. In contrast, the term illicit drugs refers to those drugs that are not legally permitted and includes references to street drugs. The terms prescription drug abuse and nonmedical use have the same meaning for the purposes of this discussion and are in keeping with accepted terminology in the literature. These terms are defined as “the intentional use of an approved medication either without a prescription, in a manner other than how it was prescribed, for purposes other than prescribed, or for the experience or feeling the medication can produce” (Volkow, 2010). This includes a teenager sharing his narcotic pain reliever prescribed following third molar extractions with his best friend, for example, or this same patient continuing to use his medication for its pleasurable effects long after the need for pain management has ceased. This is in contrast to the term misuse , which generally refers to the unintentional and incorrect use of a medication by patients who may use a drug for other than the prescribed purpose, take too little or too much, take it too often, or take it for too long. The term “misuse” is also sometimes employed to refer to the behavior of dentists or other healthcare providers who prescribe medications for the wrong indication, at too high a dose, or for too long (Volkow, 2010).
HISTORY OF UNITED STATES DRUG LAW
● Establish uniformity between federal and state law, and uniformity among states, in the control of scheduled drugs. ● Classify all currently available substances into appropriate schedules. ● Anticipate the classification of drugs not yet available, such as newer “designer drugs” that might be developed in the future (Braun, 1991).
Throughout this course, reference is made to scheduled or controlled drugs. Scheduled or controlled drugs are drugs whose use and distribution are tightly controlled because of their potential or risk of abuse. These drugs are classified into one of five schedules (see Table 1) based on whether they are otherwise useful in medical treatment. This drug scheduling system was first promulgated under the Uniform Controlled Substances Act of 1970, which was later superseded by the Uniform Controlled Substances Act of 1990. The 1990 Act attempted to:
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