et al., 2010). These numbers led to collaborative action on the part of the Institute of Medicine (IOM; now the National Academy of Medicine) and the Department of Defense (DoD). Their plan included the following actions for active duty military personnel and their families: providing accessible information regarding recent trends and evidence-based prevention behaviors, ensuring proper testing, developing methods to ensure proper diagnosis of those affected, and addressing the long-lived stigma that exists for those seeking treatment in this “zero-tolerance policy” climate (i.e., the Army is experimenting with confidential counseling programs; IOM, 2012; Military OneSource, 2018; NIDA, 2016). In 2010, in response to increased prescription drug abuse among military personnel, a $6 million federal grant was presented to NIDA, other institutions within the NIH, and the U.S. Department of Veterans Affairs to address this crisis. In 2012, the Department of Defense responded to abuse of prescription drugs by expanding drug testing requirements for service members to include “some of the most abused prescription drugs containing hydrocodone and benzodiazepine.” It also set a 6-month limit on prescriptions for commonly abused drugs (Davis, 2015). The Millennium Cohort Study is following a sample of military personnel through the year 2022 (DoD, n.d.). Researchers hope to identify patterns that may lead to relapse of abuse by documenting via smartphones and wireless devices the real-time stresses of veterans with trauma and addiction histories. Older adults As a group, the elderly have distinctive characteristics regarding their health status and drug use that put them at a higher risk for misuse behaviors. These characteristics add to their vulnerability and may increase unwanted and unexpected dependence and abuse. These factors include a decline in cognitive and motor skills; the use of multidrug therapies, including many OTC remedies (traditionally termed polypharmacy ); the presence of complicated health histories requiring treatment from several physicians (often leading to duplicate prescriptions); and potentially delayed metabolism of medications (Oakley et al., 2011). As a result, these individuals are at risk for unpredictable drug interactions and resulting complications from these interactions that may necessitate additional changes to their already complicated drug regimens. More than 80% of older patients (ages 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50% taking more than five medications or supplements daily. This can potentially lead to health issues resulting from unintentionally using a prescription medication in a manner other than how it was prescribed or from intentional nonmedical use. The high rates of multiple (comorbid) chronic illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions make medication (and other substance) misuse more dangerous in older people than in A 2009 survey reported that 6.2% of Native American and Alaska Native populations had abused prescription drugs in the past Access and diversion According to the Centers for Medicare and Medicaid Services (2015), drug diversion is “the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber.” In other words, legitimately made and controlled prescription drugs are diverted from their lawful purpose to an unlawful use (DEA, n.d.b). Diversion is a significant contributor to the escalation of prescription drug abuse. Prescription drug diversion has important health, legal, and social implications. Examples of diversion include: ● Fraudulent prescription requests, which can be seen in “doctor shopping,” claiming to have lost prescriptions, or demanding early refills (NIDA, 2018c). ● Other illegal uses or behaviors, such as taking prescription opioids to relieve anxiety symptoms or to feel the euphoric younger populations (NIDA, 2018i). Native Americans/Alaska natives
month (ONDCP, n.d.b). Statistics show that prescription drug abuse impacts American Indian/Alaska Native communities at a higher rate than any other racial group. In response, the National Indian Health Board has implemented programs such as prescription drug take-back days, proper drug disposal, and outreach and education programs (National Indian Health Board, n.d.) Gender differences According to NIDA, 19.5 million females (or 15.4%) aged 18 or older have used illicit drugs in the past year; “illicit” refers to the use of illegal drugs, including marijuana, and misuse of prescription medications (NIDA, 2019c). Recent evidence suggests that gender differences may deserve consideration when evaluating those most at risk for prescription drug abuse (SAMHSA, 2014a). Women exhibit abuse behaviors for reasons that are different from men. Psychological or emotional distress may contribute to opioid abuse for women, whereas social or behavioral issues, such as having difficulty with personal interactions, contribute to opioid abuse among men (Jamison et al., 2020. Prescribing healthcare professionals, including dentists, are in a position to consider these differences when making decisions related to drug therapies, advising patients regarding the proper use of medications, and referring patients to colleagues to treat underlying issues that may contribute to drug dependence and abuse behaviors. Individuals with other health-related conditions Individuals, including athletes, who have other health-related conditions, such as emotional or psychiatric disorders, chronic pain, or who are recovering from surgery, are often prescribed highly addictive pain or mood-altering medications as part of comprehensive therapy to treat their condition (American Academy of Orthopaedic Surgeons, 2015; Jenkins & Maese, 2013). Access to these medications, coupled with the issues underlying these health-related conditions, elevates this group’s risk for abusing prescription drugs. Chronic use can lead to drug dependence, which can in turn lead to unintentional misuse, thus paving the way for future abuse. Attention should be focused on prescribing safe yet effective quantities to these patients to avoid precipitating misuse and subsequent abuse patterns. Individuals with abusive tendencies Certain abusive tendencies represented by a past history of drug abuse or familial history of drug abuse should be considered in identifying risk factors for future abuse of prescription drugs. Pergolizzi and colleagues (2012) have shown that excessive use of gateway drugs, such as alcohol, nicotine, marijuana, and other illicit drugs, can contribute to opioid abuse. They also found a higher incidence of aberrant drug-related behaviors (including claims of having lost prescriptions, hoarding, selling prescriptions, and “doctor shopping”) among those who have a familial history of drug abuse. Their research notes that first- degree relatives of opioid-dependent individuals are more likely to develop a drug-related disorder themselves (Pergolizzi et al., 2012). This biological connection may help to explain why some people have a greater propensity for addictive behaviors than other people in the same circumstances. effect, using “pill mills,” stealing drugs/prescriptions, and prescription forgery. People who doctor shop have been known to target a varied assortment of practitioners, including physicians, dentists, and even veterinarians. Law enforcement has increased its focus on the activities of healthcare providers managing clinics suspected of being “pill mills” (DoJ, 2019; Potter, 2015). The sole purpose of these operations is to reap the profits of placing inordinate quantities of prescription drugs in the hands of those who do not require them for medical use. Additionally, the individuals working in these pill mills have access to these medications; the temptation to steal and sell or use these drugs poses a real problem. Popular prescription drugs may be stolen by
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