Educate Patients on the Risks of Prescription and Non-Prescription Drugs
There is a common misperception in the United States that prescription drug use is without risks since these drugs are legal and used for medical purposes. Pain relievers, along with other prescription drugs such as sedatives, stimulants, and tranquilizers, are highly prescribed in the United States and have the potential for misuse, dependence, overdose, and even death when used inappropriately . In the late 1990s, healthcare providers began to prescribe opioid pain relievers at high rates due to pharmaceutical companies’ reassurance that patients would not likely become addicted to this medication . However, the increase in prescription use soon led to misuse of prescription and to nonprescription opioid use . In 2015, the National Survey on Drug Use and Health reported that 91.8 million adults used prescription pain relievers. The individuals who reported misuse of prescription pain relievers stated that they did so in order to relieve pain, relax, help with sleep, and relieve tension. The two most commonly reported sources of obtaining pain relievers that were misused came from friends or relatives and healthcare providers. For this reason, physicians should consider speaking with their patients about potential risks of misusing medication, not sharing prescription medication with friends or family members, keeping medication out of reach from others, and appropriately disposing of remaining dosages.
The most common types of prescription medication that are misused are: opioids used to treat pain, central nervous system depressants used to treat anxiety and sleep issues, and stimulants used to treat attention deficit disorders . Over the past 15 years, the United States has experienced a rise in emergency room visits, overdoses leading to death, and increased drug treatment admissions. Fatality rates from overdose rose from 3,442 in 1999 to 17,029 in 2017 . In 2020, the most commonly misused prescription drug was psychotherapeutic medication. That year, almost 17 million people, or about 6% of people 12 and older, attested to misusing this type of medication within the past 12 months . Also in 2020, SAMHSA reported 9.5 million people ages 12 and older had misused opioids (both prescription and non-prescription) . Clearly, prescription and non-prescription substance use is beginning to spiral out of control, causing personal, financial, physical, and mental health issues for victims of addiction and those close to them.
Many times, individuals can become addicted to non-prescription narcotics after being prescribed medication to treat a condition. Prescription opioids, for example, are used to treat pain and are highly addictive the longer an individual uses them. One can take prescription opioids and develop a tolerance over time. Physicians are aware that it may be difficult for some patients to continue to receive a prescription or be prescribed an increased dosage. In some cases, this can lead to patients trying to seek out medication not prescribed to them or non-prescription narcotics like heroin or other opioids .
Risk Factors for Prescription and Non-prescription Drug Misuse
The misuse of prescription medication far surpasses the rate of misuse of illicit substances, except for marijuana usage, with the largest users being adolescents and young adults . For this reason, it is important that care providers provide adequate education on the risk factors of prescription drug use and screen patients for common risk factors before prescribing addictive medication. Individuals are at a heightened risk for misusing drugs if they have experienced or are currently experiencing the following:
- Stressful circumstances
- Family history of substance use
- Personal history of substance use
- Mental disorders
- History of criminal activity or DUIs
- Contact with high-risk environments or individuals who use substances
The Role of Physicians and Primary Care Providers
Identifying ways to educate patients about the risks and consequences of misusing substances is vital in order to reduce the impact addiction has on society. One survey found that 87% of U.S. adults visited a healthcare professional at least once during 2018, with 53% of Americans seeing a primary care provider during the same year . This information lends itself to the potential for physicians to incorporate approaches that educate individuals on the risks of misusing substances, incorporate effective screening practices, and develop other ways to reduce the harmful effects of prescription and non-prescription misuse. Since physicians frequently come into contact with people at risk for misusing substances, they are in a unique position to also provide valuable information that could not only prevent misuse but prevent detrimental impacts on the patients such as death, loss of wages, criminal justice involvement, and disruption of household functioning. Many individuals consider it the responsibility of physicians and pharmacists to increase their monitoring of when and how often addictive drugs are prescribed to patients. SAMHSA reports that more doctors readily prescribe highly addictive painkillers far more frequently than a decade ago. Pharmacists can aid in this effort to reduce the addiction by regularly checking prescription drug registries to identify patients who may be overprescribed by their physicians.
- Improved Screening Methods for Misuse in Primary Care Setting. Many times, observation alone can not aid in identifying intoxication or someone under the influence of substances. Therefore, it is extremely important for primary care physicians to routinely ask all patients about all substance use, amount, and frequency . This creates a safe space and opens the dialogue for patients to disclose any issues they are facing, as well as providing an opportunity for professionals to offer helpful information. For many people, a long-standing relationship with their doctor may feel like the safest place to disclose any information they may not feel comfortable bringing up to family members. A positive screen might give someone a better chance at recovery with early intervention. A negative screening allows the care provider to remind patients about the risks of misusing substances.
- Referring at Risk or In-Need Patients to Community Resources. Emergency Rooms that provide counseling, medication, and referrals to treatment centers have a significant and positive impact on the patients who come in for drug-related issues or complaints. A doctor can identify and screen for all types of drug use and assist their patients in recognizing any risky behavior or existing drug addiction. In conjunction with Prescription Drug Monitoring Programs (PDMP), doctors can begin to identify patients who have drug-seeking behaviors and refer them to community resources. See the SAFE wiki on PDMPs.  This approach may reduce the number of individuals who escalate prescription drug misuse to illicit non-prescription drug abuse or other dangerous street narcotics.
In 2018, over 50 million people over the age of 12 reported using prescription medication in a way not intended, using medication that was not prescribed to them, or using illegal drugs . Substance use comes with a myriad of social stigmas and criminal repercussions that typically keep people struggling with substance use from seeking help. In 2019, over 60,000 people died from a drug overdose in the United States . Even more, people continue to live with harmful impacts such as loss of family members, loss of relationships, employment issues, loss of child custody and destroyed finances because of drugs. In rural communities especially, it can be difficult for people to gain access to treatment and in many instances, treatment may not even exist nearby. Scientific evidence shows that substance use treatment, screening, and education programs that are integrated into mainstream health care in rural communities have promising impacts on patients. By integrating physical health care, mental health care, and substance use treatment, effective and efficient health care can be available for those who struggle with or are at risk for substance use. Many primary care offices can begin to implement screening, education, and case management services as the first step toward integration.
Impactful Federal, State, and Local Policies
In April of 2022, the Biden Administration released the National Drug Control Strategy in an effort to address addiction and overdoses in the United States. A major focus of this strategy is emphasizing the need for developing stronger data collection systems in order to implement better public health interventions. The administration’s effort to build trust and engagement with those struggling with addiction could lead to more individuals seeking help, gaining education, and reducing overdose and drug dependency .
Available Tools and Resources
"Words Matter - Preferred Language for Talking about Addiction" This NIDA article discusses how language can impact those living with substance use disorders. It provides valuable information for care providers and loved ones to become informed about how language can cause people to feel stigmatized and therefore may prevent them from starting treatment .
The Primary Care Development Corporation (PCDC) Through the Transformation Loan Fund, the Community Health and Wellness Center of Greater Torrington serves rural communities in Connecticut by providing an opioid treatment program that combines medication-assisted treatment, patient education, counseling, and other behavioral therapies to prevent overdose. It has also aided in the implementation of integrated substance abuse treatment into the primary care setting. A plethora of research shows promising results when substance use treatment and prevention is added to mainstream healthcare .