INTRODUCTION
In the United States, annual economic costs for substance use disorder (SUD) are staggering. Opiate use disorder (OUD) costs alone are estimated at $787 billion, of which $89 billion represent healthcare resource utilization costs. 1 Substance use disorders are complex phenomena affecting all aspects of individuals’ and families’ lives. The focus of this course is to review common substance use
disorders, including alcohol, anxiolytics, stimulants, hallucinogens, and tobacco/vaping. The course also reviews federal and state-controlled substance regulations and the prescribing practices for controlled substances. The focus is on clinical and safety considerations when prescribing non-cancer- related opioid medications for acute/chronic pain.
SUBSTANCE-RELATED DISORDERS
Substance use disorders are a significant public health problem with a wide range of negative effects on individuals’ mental, physical, and social well- being. Mental health problems co-occurring with substance use disorders include depressive, anxiety, and psychotic disorders, as well as organic brain syndromes. 2 Substance use disorders share many of the same features but differ in pharmacology and associated behaviors that account for the unique effects of each substance. 3 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision , often called the DSM-V-TR or DSM-5- TR, is the latest version of the American Psychiatric Association’s publication defining various conditions. 4 The DSM-5-TR recognizes substance-related disorders resulting from the use of 10 separate classes of substance including the following:
2. Wanting to cut down or stop using the substance but not managing to. 3. Spending a lot of time getting, using, or recovering from use of the substance. 4. Cravings and urges to use the substance. 5. Not managing responsibilities at work, home, or school because of substance use. 6. Continued use, even when it causes problems in relationships. 7. Giving up important social, occupational, or recreational activities because of substance use. 8. Using substances repeatedly, even after negative outcomes. 9. Continued use, even when physical or psychological problem have been caused or complicated by the substance. 10.Seeking more of the substance to get the effect you want (tolerance). 11.Development of withdrawal symptoms that are relieved by taking more of the substance. The hallmark of substance use disorders includes cognitive, behavioral, and physiological symptoms of intoxication, withdrawal, and dependence. 4 Diagnosis is based on pathological patterns of substance use. All substances activate the same brain reward pathway via dopaminergic neurotransmission. 5 Individuals who demonstrate a chronic loss of control or compulsive use of substances along with a wide range of negative effects (mental, physical, and social well-being) meet the criteria for substance related disorders. 3 Standardized screening is important to determine the stage of substance use, consequences, and functional impairment. 5
● Alcohol. ● Caffeine. ● Cannabis. ● Hallucinogens.
● Inhalants. ● Opioids. ● Sedatives. ● Hypnotics or anxiolytics.
● Stimulants (including amphetamine-type substances, cocaine, and other stimulants). ● Tobacco. The criteria used to diagnose and define substance use disorders spans a wide variety of problems arising from substance use, and they include the following: 1. Taking the substance in larger amounts or for longer than meant to.
CONTROLLED SUBSTANCE ACT (CSA)
The Comprehensive Drug Abuse Prevention and Control Act of 1970 or the Controlled Substance Act (CSA), regulates pharmaceutical and illicit controlled substances in the United States 2010 Statement of Policy: Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies. 6 The CSA requires registration, outlines specific rules about dispensing pharmaceutical controlled substances, and determines the legality of these substances. The U.S. Drug Enforcement Agency (DEA) was formed in 1973 to enforce the CSA. For pharmaceutical controlled substances, the DEA is responsible for preventing the diversion and abuse of controlled drug substances. The agency also ensures that an adequate and uninterrupted supply of pharmaceutical controlled substances is available
to meet legitimate medical, scientific, and research needs. Along with state and other federal agencies, the DEA regulates the registration of manufacturers, distributors, and dispensers of controlled pharmaceutical substances and the import and export of these substances. The DEA prosecutes anyone who violates this law. 7 The U.S. federal agencies involved in scheduling controlled substances include the Drug Enforcement Agency (DEA), Food and Drug Administration (FDA), and Department of Health and Human Services (HHS). Drugs and other substances that are considered controlled substances under the CSA are divided into five schedules. Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the
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Book Code: MDCO1025
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