Prescription drug abuse is a serious problem in the US. Now a major doctors’ organization is urging its members to practice greater caution and restraint when prescribing such medications.
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In a recent policy paper, The American College of Physicians (ACP), recommended both important procedural and clinical changes that will hopefully make it more difficult for those who abuse common prescription drugs–such as Percocet, Oxycontin or Vicodin or sell them on the street–to continue this dangerous and unethical practice.
The policy paper was published online December 10 in the Journal, Annals of Internal Medicine.
Faced with the difficulty of preventing or reducing prescription drug abuse while preserving patient access to appropriate treatment, the Health and Public Policy Committee of ACP developed the position paper to provide proper guidance to medical providers as well as those helping to develop appropriate policies.
Prescription drug abuse is now the leading cause of accidental death in the US, according to a review of preliminary data from the Centers for Disease Control and Prevention (CDC). In fact, the National Institute on Drug Abuse (NIDA) revealed in a 2010 survey that nearly 16 million people in the US above the age of 12 had taken a tranquilizer, prescription pain medication sedative or stimulant for nonmedical purposes at least once in the previous year.
ACP takes a strong position–among the 10 recommendations outlined in the policy paper—in support of physician, patient, and public education on the dangers and consequences of both medical and nonmedical use of prescription drugs.
According to the policy paper, important changes include an evidence-based, nonbinding guidelines should be developed to help guide doctors’ treatment decisions. Secondly, ACP supports the establishment of a national Prescription Drug Monitoring Program (PDMP) so that medical providers may check such a database carefully before writing prescriptions for substances with an elevated potential for abuse.
Janina Kean, substance abuse and addiction expert and President and CEO of High Watch Recovery Center, the world’s first 12 Step treatment center, feels that what the ACP has done with its Prescription Drug Abuse Policy Paper is commendable and forward thinking in making needed change in existing policies. However, it stops short by not address one crucial area–the failure of medical schools to provide proper education to its medical students in the field of addiction.
“The American College of Physicians’ positions and recommendations are spot on and can be effective, but in order to have any real impact on prescription drug abuse, the most important strategy they need to recommend would be a proper addiction curriculum and education programs for all medical schools,” said Kean. “There is a fundamental lack of education about addiction medicine and treating patients with substance use disorder provided in medical school, as well as internships and residency programs.”
As a result, Keen believes that the majority of physicians are ill-prepared to recognize and treat patients with substance abuse. “Separate courses in addiction medicine are rarely taught in medical school and addiction content on board exams is minimal and often identified only as possible sub-topics”, said Kean.
For example, she explains, the very person whose specialty is behavioral health–psychiatrists–in many cases, do not appropriately treat patients who have a co-existing addiction disorder, along with mental illness.
“At High Watch, in case after case, we have been confronted with patients who have achieved sobriety, then see a psychiatrist for an anxiety disorder and relapse after being prescribed an anxiolytic, which is an addictive controlled substance,” Kean explains.
Alternative treatments for anxiety in the acute phase would be ideal, Kean explains. “ You could use high doses of the SSRIs for anxiety disorder, or medications such as Gabapentin (Neurontin) or even Hydroxyzine (Vistaril).
The bottom line is that Kean feels that physicians need to learn how to do a better assessment of patients with substance abuse or potential for substance abuse, or patients who have parents where they are “genetically loaded” for substance abuse. “These should all be red flags on how you prescribe”, stated Kean.
Kean goes even further, advocating that the ACP invest in more formal education for medical schools and their students as a way to effect true change in approaching addiction.
“The number one strategy that should be included in the ACP’s recommendations would be for it to develop formal education programs across all medical disciplines to be able to recognize and treat addiction, along with a mandate that all medical students participate in rotations during their third or fourth year at a substance abuse treatment facility.”
Kean knows first hand the global reach of addiction: She led the first AA meeting to ever take place in the so- called Opiate Triangle of the World, the Yunnan Province of China, where she was invited to teach physicians how to properly care for patients with heroin addiction.
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