| Patterns and Characteristics of Prescription Opioid Abuse in the United States
Theodore J. Cicero, PhD1, Michael Lynskey, PhD1, Alexandre Todorov, PhD1, James Inciardi, PhD2, Hilary Surratt, PhD2Initially, this paper will discuss the basis for scheduling drugs under the Controlled Substances Act and the impact of scheduling on the therapeutic use of opioid analgesics. Second, we will discuss the highly favorable risk-benefit ratio for opioid analgesics and the inappropriate use of abuse as an adverse event in the risk-benefit analysis: abuse is rarely an adverse event of the therapeutic use of opioids, but rather occurs in the individuals who have diverted the drug for off-label, inappropriate use. Third, and perhaps most important, we have reviewed the relationship between therapeutic exposure to opioid analgesics and abuse of those drugs. In so doing, it is possible to define “outliers” in which abuse is disproportionately high relative to exposure. Using the latter method, geographic areas can be found where focused efforts should be made to understand the nature of disproportionate abuse. Finally, we will review the characteristics of those at risk for abuse to help physicians treating pain to recognize those vulnerable individuals who may be at risk for abuse and, therefore, should be monitored closely.
Neurobiology of Addiction and the Adolescent Brain
Deborah R. Simkin, M.D., Section Head, Division of Child and Adolescent Psychiatry, Residency Director Department of Psychiatry, University of South Alabama College of MedicineExamining the neurobiology of addiction, the roles that comorbidity, stressors and genes play in brain reward circuitry and the changes in the adolescent brain enable us to understand why adolescence is a time of increased risk taking and, subsequently, increased risk of substance abuse. Untreated comorbid disorders, genetic predisposition, environmental stressors, personality and age of onset of use are factors which may add to both risk and a more chronic and severe form of addiction.
Physicians Impaired by Substance Abuse Disorders
Kimberly B. Gold, MS4, Yale University School of Medicine, Scott A. Teitelbaum, M.D., F.A.A.P., A.S.A.M., Associate Professor, University of Florida School of Medicine Physicians are at risk for substance abuse disorders at rates comparable to non-physicians. While overall substance abuse is no more common in physicians than in age-matched controls, abuse of prescription drugs and opiates is more common in physicians. Also, certain specialties, such as anesthesiology, are overrepresented among substance abusers. Detection of a physician impaired by substance abuse is a challenge, since a physician’s practice is often the last segment of life to be impacted. While colleagues are ethically obligated to report an impaired physician, they are less likely to do so if the physician’s career and reputation will be immediately destroyed. Physician Health Programs (PHPs) in each state have guidelines for treatment and monitoring, and the prognosis for the physician addict is excellent.
The Use of Intervention and Case Management Models in Maximizing Recovery and Reducing Relapse Risks for Substance Abusers
Kate Caravella, CAC, NCAC 1, BRI 1This paper will explore the use of intervention and case management models in working with individuals who have been diagnosed with substance use disorders. Substance use disorders, or addictions, are defined as a disease; a concept supported by the medical and psychiatric communities. As such, it is considered chronic and progressive, and without a cure. Individuals diagnosed with substance use disorders are especially prone to relapse. High incidences of relapse will be discussed and relapse prevention measures as used during the course of treatment will be reviewed. Substance abuse disorders tend to be difficult to treat, which has impelled treating professions to investigate alternate avenues of treatment delivery, such as intervention and case management. The utilization of both methods will be reviewed in depth. The rationale for the use of these models will be explored throughout. The continuum of substance abuse treatment will be identified as paramount in effectively decreasing the risk of relapse. Deficits in continuing care planning during the course of residential treatment and subsequent transition to an outpatient level of care will be reviewed. For reasons outlined within this paper, acceptance of both intervention and case management models can be challenging. | |
