Ways Meds Get Abused
Medications are abused in many different ways, and our patients are harmed in equally diverse number of ways. We may fail to diagnose an existing misuse or abuse risk or to monitor for emerging risk.
Medication abuse is not just John buying on the street, or Tara sneaking from her parents’ medicine cabinet: our own prescribing practices may increase the likelihood of patient problems. Patients may misuse or abuse the medications we ourselves prescribe for them, and we may play an enabling role in such abuse by either not identifying those already at risk or by not carefully monitoring those for whom we have prescribed medications with increased risk of abuse/misuse.
Although correlations between total opioid daily dose and risk of opioid overdose and other causes of death exist, a disturbing number of deaths from overdose occur in patients prescribed relatively low doses of opioid analgesics. This may reflect patients varying their dosing of the opioids for “good and bad days” of pain, or interactions with alcohol or other medications (e.g. sedatives). Obviously, patients getting medications from more than one physician risk overdose, and patients may not understand that medications with different brand names may contain the same or similar opioids, and thus unintentionally overdose. They may overdose on other medications combined with opioids (e.g., acetaminophen). Finally, there is the whole problem that opioids do not, by themselves, control chronic pain all that well: if the patient expects complete relief, there is the temptation to increase the dose to the point of overdose. This points to a great need for increased monitoring and multimodal management of chronic pain.
Client Case: Mr. Hawkins
Mr. Hawkins saw his previous primary care physician twice for this problem in the past and was referred to physical therapy after another set of spine x-rays showed “nothing wrong.” He completed 6 weeks of therapy over 18 months ago but states he got little relief from the pain as a result. He does continue to do the home exercises he was given about 3 times a week.