In 2011, the National Institute of Drug Abuse began an Addiction Performance Project. The program was designed to educate primary care physicians about prescription drug addiction, screenings, and overcoming their resistance to addressing addiction with patients.
The program begins with professional actors reading Act III of Eugene O’Neill’s Long Day’s Journey into Night followed by discussion of addiction in the medical practice. The growing plague facing this nation is the scourge of substance abuse. Everywhere one looks, primary physicians (including pediatricians) are confronted with treating patients addicted to alcohol and/or drugs.
The need for attention and training is demonstrated by the American Board of Addiction Medicine Foundation’s 2011 spring accreditation of 10 training programs for post-graduate addiction medicine residencies for physicians.
NIDA Director, Dr. Nora Volkov, stated that “the challenge is that many doctors feel very uncomfortable with the possibility of addiction…They’ll say, ‘This woman looks respectable. I don’t want to ask her about it”. (Source:http://nihrecord.od.nih.gov/newsletters/2011/09_02_2011/story2.htm)
The American College of Physicians-American Society of Internal Medicine recommends asking patients several leading questions that can indicate a problem. Some of these questions include:
- How often does this patient present at your office?
- Is the patient paying cash?
- Are your prescription pads disappearing?
- Does the patient say that only a particular drug will work?
- Does the patient frequently report loosing medications?
- Does the patient request a specific drug?
Physicians need to circumspect about how, when and why they prescribed drugs. Reassessment after initially prescribing a drug should always take place. This may include a quick urine test or a more extensive blood work up. (Source: http://www.acpinternist.org/archives/2002/04/drug_abuse.htm)
Physicians are in a unique position to help educate patients about drug abuse, drug dependence, side effects and drug interactions.
A 1999 survey concluded that for primary care physicians there was a general lack of training and understanding the signs of addiction. “46.6 percent of physicians had difficulty discussing substance abuse with patients and only 32.1 percent carefully screened their patients for substance abuse.”
There is another version of the CAGE screening test for alcoholism that has been adapted for drug abuse. These four questions can open the broader conversation without judgment or bias.
- Have you ever felt the need to cut down on your use of prescription drugs?
- Have you ever felt annoyed by remarks made by your friends or family about your prescription use?
- Have you ever felt guilty or remorseful about your use of prescription drugs?
- Have you ever used prescription drugs as a way to get going or to calm down?
Every year millions of Americans, young and old, start using prescription drugs improperly. Unlike in years past when a person would get illicit drugs from a drug dealer, most people are engaged in medication sharing. In a 2007 report, 70% of prescription drug abusers got their drugs from friends and family.
Fueling the medication sharing is a misconception that prescription medicines are not dangerous because they have been prescribed by a medical professional.
If you find a sudden influx of first time patients suffering from a particular condition asking for a specific drug become cognizant of a potential problem.
If you have people who have several “conditions” that have previously been treated with mega doses of drugs such as oxycodone, be circumspect about prescribing more of the same.
The primary care physician or the health care professional is usually the first line of defense against prescription drug addiction. It is necessary to confront the patient from a patient center approach, do a full addiction assessment and then make sure patients come to follow up on those assessments. Physicians are in a unique position to help people break the bondage of addiction before it destroys his or her health, the health and well being of their family and perhaps financial ruin.
Understanding addiction is necessary, being able to do a formal or informal intervention followed by recommendations for substance abuse treatment can arrest addiction.