ABSTRACT
The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chronic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask patients about their substance-use history, including alcohol, illicit drugs and prescription drugs. Patients who abuse prescription drugs may exhibit certain patterns, such as escalating use, drug-seeking behavior and doctor shopping. A basic clinical survival skill in situations in which patients exert pressure on the physician to obtain a prescription drug is to say "no" and stick with it. Physicians who overprescribe can be characterized by the four "Ds"-dated, duped, dishonest and disabled. Maintaining a current knowledge base, documenting the decisions that guide the treatment process and seeking consultation are important risk-management strategies that improve clinical care and outcomes.
Subject(s)
Drug Prescriptions , Family Practice/methods , Patient Acceptance of Health Care , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy , Acute Disease , Anxiety Disorders/complications , Attention Deficit Disorder with Hyperactivity/complications , Chronic Disease , Deception , Drug and Narcotic Control/legislation & jurisprudence , Family Practice/legislation & jurisprudence , Humans , Mass Screening , Medical History Taking , Pain/complications , Patient Acceptance of Health Care/psychology , Physician-Patient Relations , Risk Factors , Risk Management/legislation & jurisprudence , Substance-Related Disorders/etiology , Substance-Related Disorders/psychology , United StatesABSTRACT
Benzodiazepines are widely prescribed for a variety of conditions, particularly anxiety and insomnia. They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be addicting. These agents are often taken in combination with other drugs of abuse by patients with addiction disorders. In such patients, alternatives to benzodiazepines may be preferable and may include antidepressants, anticonvulsants, buspirone, antihypertensive agents and the newer neuroleptic medications. Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse.
