The Prescription Drug Abuse Epidemic : Incidence, Treatment, Prevention, and Policy

This overview of prescription drug abuse includes historical background, key concepts, and discussion of the prevalence of drug abuse, treatments, and policy issues implicated in ending the epidemic. • Zooms in on legal and policy issues related to the ongoing opioid epidemic in the U.S., providing insight into current and potential actions to limit the epidemic • Describes each prescription drug among the most commonly abused, for what it is prescribed, how it works, economic cost, and the damage that abuse of the drug may cause to both individual health and social wellbeing • Identifies each of the most common groups of people who abuse prescription drugs, their motivations for doing so, and the special risks for each • Addresses commonly co-abused drugs and the risks of using them concurrently • Includes comparative text examining prescription drug abuse in Canada and the United Kingdom Cover......Page 1 Title......Page 4 Copyright......Page 5 Contents......Page 6 Acknowledgments......Page 8 Chapter 1: Introduction......Page 10 Chapter Overview......Page 12 References......Page 13 Chapter 2: Opioids......Page 15 Pharmacology......Page 16 Medical Uses......Page 19 Opioid Prescribing: Past and Present......Page 20 Special Populations......Page 21 Gastrointestinal Adverse Effects......Page 24 Respiratory Adverse Effects......Page 25 Pruritus (Itching)......Page 26 Overdose......Page 27 Risk Factors for Overdose......Page 28 Misuse......Page 30 Treatment of Opioid Use Disorder......Page 31 References......Page 32 Introduction and Therapeutic Uses......Page 40 Pharmacodynamics and Pharmacokinetics......Page 41 Pharmacology......Page 43 Physiologic and Adverse Effects......Page 45 Acute versus Chronic Effects......Page 46 Abuse Potential......Page 47 Pharmacokinetic Contribution......Page 48 Individual Characteristics......Page 49 Summary......Page 51 References......Page 52 Chapter 4: Benzodiazepines......Page 56 Uses......Page 57 Self-Medication......Page 58 Sedative Use Disorder......Page 60 Risk Factors for Misuse......Page 63 Prescription Drug Monitoring Programs......Page 64 Urine Drug Screening......Page 65 Medication Monitoring......Page 66 Intoxication......Page 67 Presentation......Page 68 Pharmacologic Treatment......Page 70 Treatment of Sedative Use Disorder......Page 71 References......Page 72 Introduction......Page 78 Key Categories of OTC Medicines of Abuse and Misuse......Page 79 Opioids and Compound Analgesics......Page 80 Stimulants......Page 81 Dextromethorphan......Page 82 Laxatives......Page 83 Preventing Harm and Providing Support......Page 84 Relationship between OTC and Prescription Medicine Use and Abuse......Page 86 Summary......Page 87 References......Page 88 Chapter 6: Nonmedical Prescription Drug Use in Adolescents and Young Adults......Page 92 Health Burden of Nonmedical Prescription Drug Use in the United States......Page 94 Historical Trends among Adolescents......Page 95 Public Health Significance and Correlates of NMPO among Adolescents......Page 96 Historical Trends among Young Adults......Page 98 Public Health Significance and Correlates of NMPO among Young Adults......Page 99 Public Health Significance and Correlates of NMPS among Adolescents......Page 101 Historical Trends among Young Adults......Page 103 Public Health Significance and Correlates of NMPS among Young Adults......Page 104 Historical Trends among Adolescents......Page 106 Public Health Significance and Correlates of Nonmedical Prescription Tranquilizer and Sedative Use among Adolescents......Page 107 Historical Trends among Young Adults......Page 109 Public Health Significance and Correlates of Nonmedical Prescription Tranquilizer\and Sedative Use among Young Adults......Page 110 Conclusion......Page 113 References......Page 114 Epidemiology and Trends of Prescription Drug Misuse among Young Adults......Page 124 Transitions from Adolescence to Adulthood......Page 127 Acquisition of Prescription Drugs......Page 129 The Role of Peers in PDM......Page 131 Prescription Drugs and Nightlife Involvement among Young Adults......Page 132 Incorporation of Prescription Pills into the Polydrug Routines of Young Adults......Page 134 Escalation......Page 135 Conclusions......Page 136 References......Page 138 Chapter 8: Prescription Drug Misuse in Older Adults......Page 142 Opioid Epidemic in the United States......Page 143 Opioid Misuse in Older Adults......Page 144 Prescription Opioid Misuse in Older Adults with Chronic Nonmalignant Pain......Page 145 Use of Benzodiazepines in Older Adults......Page 146 Correlates of Prescription Opioid Misuse......Page 147 Behavioral Intervention to Reduce Prescription Opioid Misuse in Older Adults......Page 149 Conclusion......Page 151 References......Page 152 Introduction......Page 159 Terminology......Page 160 Opioid Use Disorder......Page 161 Morbidity and Mortality......Page 162 Evolving Guidance on the Use of Opioids in the Treatment of Chronic Pain......Page 163 Assessing Risks and Benefits......Page 164 Limiting Opioid Exposure......Page 165 Drug Testing......Page 166 Addressing Opioid Misuse......Page 167 Conclusions......Page 168 References......Page 169 Chapter 10: Opioids in the Emergency Setting......Page 173 Opioids for Acute Pain......Page 174 Opioids and Chronic Pain......Page 175 Risk of Use......Page 177 Responsible Prescribing Practices......Page 179 Pain Management in Patients with Substance Use Disorders......Page 181 Alternatives and Nonopioid Adjuncts......Page 183 Best Practices in Opioid Overdose......Page 187 Conclusion......Page 189 References......Page 190 Opioid Problem in the United States......Page 202 Government Regulations......Page 204 Regulatory Response to the Current Opioid Problem in the United States......Page 205 Urine Drug Screening......Page 208 Transitions of Care in Chronic Opioid Management......Page 210 Conclusion......Page 211 References......Page 212 Chapter 12: Promoting Prescription Drug Monitoring Programs for Population Health: Research and Policy Implications......Page 215 Development of the Modern PDMP......Page 216 Early Prescription Drug Monitoring Programs......Page 217 PDMPs in the Digital Age......Page 218 Effect of PDMPs on Prescribing Behavior......Page 220 Attenuated Effect of PDMPs on Opioid Prescribing......Page 222 Effect of PDMPs on Population Health......Page 223 Fatal Drug-Related Overdose......Page 224 Prescription Drug Monitoring Programs: Operational Characteristics......Page 226 Can PDMPs Have Unintended Negative Consequences?......Page 227 Prescription Drug Monitoring Programs and Health Disparities......Page 228 Challenges in Existing Research and Directions for Future Research......Page 229 References......Page 230 Opioid History......Page 236 The Prescription Epidemic......Page 238 The Illicit Epidemic......Page 240 Overdose Prevention......Page 242 Operation Naloxone......Page 244 Policy Recommendations......Page 245 References......Page 247 Chapter 14: A Comparison of Recent Trends in Prescription Drug Misuse in the United States and the United Kingdom......Page 251 Trends in the General Population......Page 253 Trends among Prisoners......Page 254 Trends in Drug-Related Deaths......Page 255 Trends in the Number of Prescriptions Dispensed in the Community......Page 256 Trends in Seizures of Prescription Drugs......Page 257 Summary of PDM Trends in the United Kingdom......Page 258 Trends in the General Population......Page 259 Trends among Prisoners......Page 260 Trends in Drug-Related Deaths......Page 261 Trends in Seizures of Prescription Drugs......Page 262 PDM Trends in the United States and United Kingdom Compared......Page 263 Trends in PDM among Prisoners......Page 264 Trends in the Number of Prescriptions Dispensed in the Community......Page 265 Explanations......Page 266 Prevention......Page 268 Conclusions......Page 270 References......Page 271 Health, Health Behavior, and Health Behavior Theory......Page 274 The Theory of Planned Behavior—Applied to Prescription Stimulant Misuse......Page 275 The Theory of Planned Behavior—Applied to Prescription Opioid Misuse......Page 277 The Theory of Planned Behavior—Applied to Prescription Benzodiazepine Misuse......Page 278 Social Cognitive Theory—Applied to Prescription Stimulant Misuse......Page 279 Social Cognitive Theory—Applied to Prescription Opioid Misuse......Page 281 Ecological Health Behavior Theory—The Theory of Triadic Influence......Page 282 The Theory of Triadic Influence—Applied to Prescription Opioid Misuse......Page 283 The Theory of Triadic Influence—Applied to Prescription Benzodiazepine Misuse......Page 284 Prescription Opioids......Page 285 Summary and Next Steps......Page 286 References......Page 287 Chapter 16: Understanding Nonmedical Prescription Drug Use: The Importance of Criminological Theory......Page 292 Social Learning Theory......Page 293 Social Learning and NMPDU......Page 295 Self-Control......Page 296 Strain Theories......Page 297 Anomie Theory......Page 298 Strain Theory and NMPDU......Page 299 Life Course Theories......Page 300 Life Course Theories and NMPDU......Page 301 Rational Choice Theory......Page 302 Social Disorganization Theory......Page 303 Developmental Theory......Page 304 Biosocial Theory......Page 305 Conflict Theory......Page 306 Discussion......Page 307 References......Page 308 Chapter 17: Conclusions......Page 312 References......Page 314 Contributors......Page 316 Index......Page 328 "This overview of prescription drug abuse includes historical background, key concepts, and discussion of the prevalence of drug abuse, treatments, and policy issues implicated in ending the epidemic. Prescription opioid medication abuse has been declared a national crisis by experts in medicine, substance use, public health, and pain management, culminating in a declaration made by the President of the United States that opioid misuse and abuse is a national health emergency. In this comprehensive text, expert scholars analyze and address a wide range of issues in, obstacles to, and potential solutions for this emergency, which caused more than 50,000 deaths in 2016 alone. It covers a variety of topics related to prescription misuse from both clinical and academic perspectives. After an opening containing background material on the most commonly misused medications, chapters examine subgroups engaged in misuse and special medical environments where misuse issues are key. They then cover U.S. policy, perspectives outside the U.S., and theories that may explain the misuse phenomena. This book will serve as a resource for students and professionals in fields related to prescription drug abuse--including psychology, sociology, medicine, and public policy--and is accessible to individuals not trained in these fields." -- Publisher's description