Prescription Drug Use and Abuse : Complexities of Addiction

by Food and Drug Administration (FDA)

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It's not that potentially addictive medications shouldn't be used, says Richard Brown, M.D., M.P.H., associate professor of family medicine at the University of Wisconsin Medical School. "They have an important place in the treatment of debilitating conditions." According to NIDA, drug addiction — characterized by drug craving that is out of control — is actually uncommon among people who use drugs as prescribed.

NIDA, along with several health organizations, has launched a national initiative to educate the public about the dangers of the non-medical use of prescription drugs, and the potential for abuse and addiction. With psychological addiction, there is a preoccupation with obtaining and using drugs that persists despite the consequences. Psychological addiction is distinct from physical dependence and tolerance, but the presence of these problems can complicate the treatment of addiction, says Alice Young, Ph.D., a professor in the department of psychology at Wayne State University in Detroit. "It is true that both psychological addiction and physical dependence can happen together," she says, "but they are not the same."

Young says that physical dependence, which is sometimes unavoidable, develops when an individual is exposed to a drug at a high enough dose for long enough that the body adapts and develops a tolerance for the drug. This means that higher doses are needed to achieve a drug's original effects. "If the patient stops taking the drug, then withdrawal will occur," Young says. But the development of physical dependence doesn't necessarily lead to addiction in all cases, she explains. "It means that the individual can't just stop taking the drug; the dose has to be tapered," a method to gradually decrease a drug's amount over time to prevent withdrawal reactions.

In addition to promoting public education, NIDA's initiative will foster new research on why certain people become addicted, says Leshner. "Some choose prescription drugs as the drug of choice, and others become addicted inadvertently," he says. "We want to learn more about what makes some people more likely to stray from the prescribed plan than others." NIDA also will support research into the mechanisms by which certain substances produce addiction.

Appropriate Use Is Key

Physician supervision and appropriate use is critical for all prescription drugs. Doctors consider a patient's diagnosis and whether non-addictive treatments should be considered first.

"Very strong opiate drugs play a critical role in pain management," FDA's Leiderman says. "But they aren't appropriate for all pain. Treatment needs to be tailored depending on a patient's specific condition."

Brown says doctors must also consider the patient's medical history and whether an individual has had addictive disorders in the past. But a history of substance abuse doesn't necessarily rule out using potentially addictive medications. "Patients should be honest about their substance abuse history because then it tells me to watch them even more closely," Brown says.

A good rapport between a patient and doctor can make it easier to discuss problems that come up, and health-care professionals should carefully monitor patients who take potentially addictive medication. For some, that might require a periodic urine drug screen, Brown says. "This is not an issue of distrust or intrusiveness," he says. "I explain to patients that it's a way to help protect them, especially because people who are addicted may not recognize it. Addiction can make people do things they wouldn't normally do."

A couple of Brown's patients experienced trouble with opioids and impulsivity — symptoms that led them to take more medicine than prescribed instead of waiting for the initial medicine to work. Brown picked up on the problems because both patients requested early refills. He switched them to non-drug treatments, such as physical therapy and relaxation techniques, until they could more successfully take prescription drugs.

Complicating matters is the fact that physicians are vastly undertrained in identifying drug abuse. "The average physician gets little training in drug abuse, mainly because drug abuse has only been recently recognized as a health problem," Leshner says. Brown says that some doctors are so concerned about penalties for overprescribing potentially addictive medications that they don't treat patients appropriately. "Other physicians mean well and prescribe the drugs, but don't know the warning signs of abuse," he says. "Then there are those who just can't say 'No' to patients who violate the prescribed plan."

One recent survey from the National Center on Addiction and Substance Abuse at Columbia University in New York City indicated that nearly half of primary care physicians report having difficulty talking about substance abuse with patients. H. Westley Clark, M.D., J.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), says his agency began a training program last year to help address this major problem.

The joint project with the Health Resources and Services Administration will train faculty members in the health professions. "It's not only for doctors," Clark says. "Other health professionals, including nurses and pharmacists, should also learn about recognizing the signs of substance abuse, talking about it, and knowing when patients should be referred for treatment."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.