Strategies to Stop Abuse of Prescribed Opioid Drugs

Prescription opioids have substantially and safely improved the quality of life for many patients disabled by pain, but they are also commonly misused and abused. Opioid analgesics are the second most commonly abused drugs in the country, falling after marijuana and before cocaine, according to the National Survey on Drug Use and Health by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The addictive nature of opioids is nothing new; however, there has been an alarming increase in the number of people misusing and becoming addicted to these prescription analgesics.

Consider the growth in the number of first-time initiates to prescription opioid misuse. In 1990, 600 000 persons reported first-time nonmedical use of prescription analgesics; according to SAMHSA, that figure increased to 2 million in 2001. Meanwhile, the annual admission rate for narcotic painkillers at publicly funded substance abuse treatment facilities increased by 155% between 1992 and 2002. Furthermore, more people are overdosing or experiencing other serious complications from prescription opioid misuse. According to the Drug Abuse Warning Network report, the estimated number of emergency department visits involving narcotic analgesic abuse rose from 41 687 in 1994 to 90 232 in 2002 —an increase of 117%.

Some behaviors among patients taking prescription opioids raise alarm immediately—prescription forgery, multiple unsanctioned dose escalations, repeated reports of lost prescriptions, concurrent abuse of related illicit drugs, or stealing or using another patient's drugs. Physicians are also likely to worry when patients request specific opioid drugs, acquire similar drugs from other medical sources, frequently request early prescription renewals, or complain aggressively about needing higher doses.

Physicians who observe such obviously suspicious behaviors often change the way they prescribe opioids. However, the signs of misuse are usually far more ambiguous and subtle. Patients may look increasingly unkempt over time, have a negative mood change, appear intoxicated, or …