Prescription Drug Abuse

Question 1

Preventing prescription drug abuse

Answer 1

• consider alternatives
• avoid or minimize use in drug abusers
• write smaller scripts
• avoid refills
• avoid prescribing most abusable versions
• Educate public and physicians
• Manufacture drugs that are less abusable
  
  • e.g. w/ naloxone, gel cap instead of grindable pill, combine with antagonist, prodrugs

Question 2

Sedatives: Benzodiazepines - versions & abuse frequencies

Answer 2

• High-potency, short half-life (e.g. Xanax, ativan) are most often abused
• Low poteny, short half life – least likely to be abused –> preferred choice when needed for a substance abuser

Question 3

Sedatives: Benzodiazepines - indicated use

Answer 3

• Indicated use:
  
  • anxiety
  • promote sleep
  • etoh withdrawal (low potency, long half-life versions, e.g. Valium)
  • seizures

Question 4

Sedatives: Benzos – mechanism of action, tolerance & withdrawal, cross-tolerance

Answer 4

• Bind GABA-A receptor
• potentiate GABA receptor indirectly
• Tolerance:
  
  • receptor changes over time w/ prolonged benzo attachment
  • Lessens the effect of the benzo
• Withdrawal
  
  • the altered receptor is less efficient with and without benzo bound –> symptoms that are opposite the effect of the drug
• Cross tolerance
  
  • ETOH and barbiturates bind to similar places as benzos –> use benzos to tx etoh withdrawal

Question 5

Sedatives: Benzo – withdrawal sx

Answer 5

• Anxiety
• Agitation
• paresthesias
• mm cramps
• insomnia
• seizures, delirium
• ** similar to ETOH but timing differs depending on benzo half-life (within a few days to 1 week)
• ** withdrawal sx usually only after tx for 4+ months

Question 6

Stimulant drugs: types, reasons for abuse

Answer 6

Types:

• amphetamines
  
  • adderall
• diet pills
• Methylphenidate (ritalin)

Reasons (can depend on drug):

• Improve attention, study habits (#1 reason for abuse in college age students)
• stay awake
• party drug
• the high

Question 7

Stimulants: mechanism

Answer 7

• increase release and block reuptake of norepi and dopamine
• increase dopamine in nucleus accumbens by stimulating dopaminergic neurons in the ventral tegmental area (VTA)
  *

Question 8

Prescription Opiates: epi, source

Answer 8

• oxycontin/oxycodon = most abused version
• different demographic than heroin users (younger, use smaller doses, fewer psychosocial problems)
• intranasal = most common method of administration
• gateway drug to snorting heroin and injecting heroin (suburban slide)
• Source: physicians, pain patients selling on street, friends/family

Question 9

POD: ideal medication to treat dependence

Answer 9

• Stop withdrawal:
  
  • partial agonist of the receptor that binds w/ higher affinity than the drug
• Reduce craving
• Blocks the high if indiv relapses and uses opiates again

Question 10

POD: current meds to tx dependence

Answer 10

• Methadone
  
  • full opiate agonist
  • doesn’t have higher affinity than heroin
  • good at stopping withdrawal, reducing craving
  • gradually increaes dose to build up indiv’s tolerance so they can’t get high on heroin (blockign dose)
• Naltrexone
  
  • Opioid antagonist
  • Blocks the high, can reduce craving
• Buprenorphine
  
  • better at targeting withdrawal, craving and the high

Question 11

Pseudo-addiction

Answer 11

• individuals w/ uncontrolled pain
• Looks like addiction
  
  • manipulation, multiple doctors/ED visits
• behaviors disappear with adequate meds

Question 12

Non-opiate alternatives

Answer 12

• NSAIDS, combinations w/ caffeine, anti-convulsants, anti-depressants
• hypnosis, therapy (group, indiv, cognitive), exercise, acupuncture, nerve blocs