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Recognition and Early Prevention of Drug Misuse and Abuse

Many people in chronic pain need medical help to manage their daily lives. Opioid medications are very helpful. But they have the adverse side effect of dependence and addiction.

In this article, staff from the Pain Management Center at the Brigham & Women's Hospital in Boston offer a review of the problem. They clear up some confusion about the terms used such as misuse, abuse, dependence, tolerance, and addiction.

They offer physicians a strategy for helping manage patients taking high-risk medications. The first step is to recognize risk factors for opioid misuse. A special screening tool can be used to help in this process.

A personal or family history of substance abuse is a red flag. Other risk factors include heavy tobacco use, risk-taking or thrill-seeking behavior, and history of depression or anxiety. Previous alcohol or other drug rehab can be predictors of future drug problems. Likewise, a history of criminal activity or legal problems are also important risk factors.

Patients at risk for drug misuse or abuse can be asked to sign a treatment agreement. The agreement includes statements of intention. For example, I will use the substances only as directed by my doctor. I will get these drugs only from one doctor. Any drugs lost or stolen will not be replaced.

Controlled substance agreements help improve patient cooperation. They provide education and guidance about acceptable behavior when taking these drugs. There must be agreement not to use recreational drugs or prescription meds from anyone else.

Patients must agree to see a trained behavioral counselor or psychologist for addiction counseling and pain management. Routine but random drug testing is also required. And the patient must keep regularly scheduled appointments with doctors and counselors. Failure to comply with each step may mean discharge from treatment with opioids.

References: Edgar L. Ross, MD, et al. Chronic Pain Update: Addressing Abuse and Misuse of Opioid Analgesics. In The Journal of Musculoskeletal Medicine. June 2008. Vol. 25. No. 6. Pp. 268-277.

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