Prescription drug abuse - A timely update.

BACKGROUND: Prescription drug abuse is a rising problem in Australia and pharmaceutical drugs have been the most frequent contributors to overdose deaths in Victoria in recent years. OBJECTIVE: The objectives of this article are to examine the main prescription drugs contributing to overdose deaths and to consider how doctors may help in reducing this problem. DISCUSSION: Data from the Coroners Court of Victoria list the main drugs that contributed to drug-related deaths in 2009-15. Analysis of the data reveals that pharmaceutical drugs contributed to 80% of overdose deaths; benzodiazepines and opioids were the main drug groups involved. Strategies for reducing and managing prescription drug abuse in primary care settings are outlined in this article, including references to published evidence-based clinical guidelines from The Royal Australian College of General Practitioners (RACGP). The safety profile of buprenorphine/ naloxone over methadone is noted and raised as a consideration for clinicians when assessing a patient for opioid replacement therapy.

Prescription drug misuse.

BACKGROUND: Recognising and dealing with patients who seek drugs for nonmedical purposes can be a difficult problem in general practice. 'Prescription shoppers' and patients with chronic nonmalignant pain problems are the main people who constitute this small but problematic group. The main drugs they seek are benzodiazepines and opioids. OBJECTIVE: To provide data on current trends in prescription drug abuse and to discuss different strategies on how to deal with this issue in the clinic setting. DISCUSSION: Misuse of prescription drugs can take the form of injecting oral drugs, selling them on the street, or simply overusing the prescribed amount so that patients run short before the due date and then request extra prescriptions from the doctor. Currently oxycontin and alprazolam are the most abused drugs in Australia. Adequate prescription monitoring mechanisms at the systems level are lacking so we need to rely on our clinical skills and the patient's behaviour pattern over time to detect problematic prescription drug misuse. Management strategies may include saying 'no' to patients, having a treatment plan, and adopting a universal precaution approach toward all patients prescribed drugs of addiction. Among patients with chronic nonmalignant pain, requests for increasing opioid doses need careful assessment to elucidate any nonmedical factors that may be at play.

Addiction medicine--training for general practice registrars.

INTRODUCTION: Illicit drug use is a significant problem within Australia. However, GPs are reluctant to treat these problems due to a perceived lack of knowledge and confidence. METHOD: All advanced general practice registrars training through the Victorian Metropolitan Alliance in 2004 attended a 1 day pilot addiction medicine workshop, followed by completion of a questionnaire to assess the acceptability of the training and its impact on their knowledge and confidence. RESULTS: Forty-six general practice registrars attended the workshops with all but one (98%) completing the postworkshop questionnaire. More than 90% of registrars agreed that the material presented was relevant to their work and that they felt more confident dealing with addiction issues in practice. DISCUSSION: Addiction medicine training is relevant to the work of doctors training to become GPs and can increase knowledge and confidence. More extensive research is needed to assess whether this increase in knowledge and confidence is sustained over time and is translated into practice.