INTRODUCTION
Learning objectives After completing this course, the learner will be able to: Describe the history and scope of prescription drug abuse and the role of the dental professional. Define the terminology used in discussing prescription drug abuse. Course overview National concern is growing regarding the rise in prescription drug abuse in the United States. Addressing the abuse of drugs in general has been a long-standing battle for healthcare providers and law enforcement agencies, but the increased nonmedical use of therapeutic agents is particularly disturbing. Abuse of prescription drugs has increased so dramatically that in 2017 the United States Department of Health and Human Services (HHS) declared a public health emergency (HHS, 2019b). Prescription drugs carry an aura of acceptability because they are legal and prescribed by professionals, yet the repercussions of using them for other than their intended purpose are often neither recognized by the user nor discussed by the prescriber. Prescription drug abuse, like other forms of drug abuse, spares no one; it crosses boundaries of gender, age, race, and socioeconomic status. The abuse of prescription drugs is both an individual and a public health concern, costing individuals and the nation in terms of lost productivity and resulting healthcare costs, in addition to the devastating effects on families and significant others. Dental providers frequently prescribe medications for their patients, especially for the control of pain. Although initially prescribed to help alleviate pain, their pleasurable side effects cause these drugs to be among those that carry the highest risk of abuse. Pain is often an unavoidable sequela to invasive dental procedures and untreated or long-standing oral disease. Balancing the desire to alleviate pain against the suspicion that the patient may be a drug seeker is just one of the issues that confront dental providers. The patient’s past medical, dental, and social history; current history; chief complaint; and history of prescription drug use all contribute to the impression received by the dental provider. How the dental provider manages this information is critical to the result of the visit and subsequent outcome for the patient. Diversion of prescription drugs is another part of the growing abuse problem. Diversion refers to the illegal use of legal drugs; it is seen most frequently with those drugs used to relieve pain (Coalition Against Insurance Fraud [CAIF], 2007). Diversion of drugs can occur when drugs are stolen or prescriptions are forged, as in the submission of fraudulent prescription claims to insurance companies, which is a significant portion of the problem (CAIF, 2007; U.S. Drug Enforcement Administration [DEA], n.d.b). Diversion also occurs when healthcare providers sell prescriptions to known abusers, or when pharmacists falsify records and sell the drugs involved (DEA, n.d.b). These forms of diversion all involve blatant criminal activity, but diversion can also occur when medications are shared with others for nonmedical use – actions that are also illegal. In fact, the primary source of prescription drugs for nonmedical users is through family and friends (Lipari & Hughes, 2017). “Doctor shopping,” the practice of going to multiple healthcare providers to obtain prescription drugs for nonmedical use, is also considered to be
Explain the pharmacology, physiology, and regulatory control of the prescription drugs that are most commonly abused and the extent and impact of their nonmedical use. Describe the populations most at risk for abusing prescription drugs and their access to these drugs. Discuss the tactics and resources available to manage and prevent prescription drug abuse in the dental practice. a form of diversion (National Institute on Drug Abuse [NIDA], 2018c). Over-the-counter (OTC) medications, although not the focus of this course, are also part of the problem of prescription drug abuse. These readily available medications, particularly cough and cold preparations, are often among the first drugs abused by adolescents. It is estimated that 1 in 11 teens have abused cough medicine or other OTC products (Stanford Children’s Health, 2019). As dental providers explore their patients’ histories of prescription drug use, they should also consider OTC preparation use and abuse (NIDA, n.d.e). Although prescription drugs have been identified as essential tools to treat a myriad of illnesses as well as manage various levels of pain, it has been their recent “misuse” and its relation to the opioid overdose epidemic that has caught the attention of the nation (Blanco et al., 2007; Office of National Drug Control Policy [ONDCP], n.d.c). People across all demographics can appreciate the pleasurable side effects of these drugs and can be at risk for addictive behaviors. Additionally, life- threatening complications can occur when an individual other than the intended recipient takes these medications, or when the intended recipient takes them in a manner outside of their prescribed purpose. From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999 (Centers for Disease Control and Prevention [CDC], 2018d). In March of 2007, in response to these trends, and in recognition of this problem as a serious healthcare issue facing our nation, NIDA, a component of the National Institutes of Health, initiated its first large-scale national study related to prescription drug abuse (NIDA, 2007). Focused education and collaborative efforts are required to properly position healthcare professionals to help manage and prevent continued abuse of prescription drugs (Riggs, 2008). The information provided in this course is applicable to all dental team members, regardless of their practice setting or scope of practice. The information is of interest to dental team members in private practice, academic institutions, military service positions, hospitals, and community health centers. The purpose of this basic-level course is to provide dental practitioners with an appreciation of the scope of the problem of prescription drug abuse and a realization that the misuse and abuse of these drugs likely take place among the patient populations they serve. By becoming familiar with the pharmacology of the most commonly abused drugs, the risk factors for developing addictive behaviors, and the manner in which these medications are commonly acquired, dental providers will be positioned to curb prescribing practices that contribute to this growing problem and will be better able to serve their patients and their communities as informed prevention advocates.
THE ROLE OF PRESCRIPTION DRUGS
(CNS) depressants, and stimulants – play an important role in mitigating the devastating manifestations of the diseases they treat and are used responsibly by most people (Mayo Clinic, 2018b; National Institute on Drug Abuse [NIDA], 2011b, 2018i). Opioids are prescribed to relieve pain that ranges from mild to severe and, when taken as prescribed, can be very effective.
Prescription drugs have undoubtedly contributed to both the life expectancy and quality of life of countless individuals in the United States. However, use of prescription drugs is not without hazards. Some carry a significant risk for abuse and a potential for addiction. The three most commonly abused prescription drug categories – opioids, central nervous system
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