'Prescribing Controlled Substances: Problematic Use of ...

[Pages:92]"Prescribing Controlled Substances: Problematic Use of Opioids and Benzodiazepines in Clinical Care"

Daryl Shorter, MD Staff Psychiatrist Michael E. DeBakey VA Medical Center March 2, 2017

Objectives - By the completion of the presentation, learners will be able to: (1) List risk factors for misuse, diversion, and/or dependence upon opioid medications and benzodiazepines (2) Identify clinical scenarios in which there is problematic use/prescribing of opioid medications and benzodiazepines (3) Employ treatment algorithms to successfully taper opioid medications and benzodiazepines (4) Discuss strategies for patient monitoring and mitigating risk factors for opioid and benzodiazepine misuse

Definitions

? Misuse ? Diversion ? Dependence

Definitions

? Misuse ? Diversion ? Dependence

Misuse (1)

? Any medication use that occurs without prescription (therapeutic benefit v intoxication?)

? Legitimately prescribed medication used for intoxication/euphoria

? Medication use in context of dependence (methadone, buprenorphine)

Misuse (2)

? Motives for Non-Prescribed Medication Use

? Intoxication

? High dose, intravenous ? Combined with alcohol or other drugs

? Therapeutic use

? Bona fide condition/appropriate indication ? Correct dosing pattern

Barrett SP et al. What constitutes prescription drug misuse? Problems and current conceptualizations. Curr Drug Abuse Reviews. 2008;1:255-62.

Misuse (3)

? Group differences

? Adolescents

? Sedative/hypnotics, opiates = therapeutic > recreation ? Stimulant medications = recreation

? College students

? Therapeutic benefit > recreation

? Older adults

? Withdrawal, dependence

Misuse (4)

? Quasi-legitimate Reasons?

? Immediate/acute need ? Unable to seek formal medical consultation ? Barriers to access

? Socioeconomic ? Geographic ? Temporal

? Provider reluctance to prescribe ? Under-medication

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