Nearly half of all adults in a survey of over 26,000 participants reported at least 1 case of prescription drug abuse (PDM) between 18 and 50, according to the results of a new longitudinal study. year.
In new research published at JAMA network open this week, investigators from the Center for the Study of Drugs, Alcohol, Smoking and Health (DASH) at the University of Michigan School of Nursing reported a high prevalence of PDM among nationally representative adult participants, as well as a significant risk of substance use disorder. among those with a history of PDM.
In an interview with HCPLive Regarding the findings, study author and director of DASH, Sean Esteban McCabe, PhD, discussed the history of the research leading up to this PDM assessment, the diversity of caregivers involved in health care. prescription drug abuse, the effect of COVID-19 on drug abuse and abuse, and solutions to alleviate the rate of PDM.
HCPLive: What was our previous understanding of risk factors associated with prescription drug abuse? Is there any rationale / sustained evidence for the belief that experimental drug use is often a “gateway” to PDM?
McCabe: The early use of alcohol and other drugs has been shown to be a constant risk factor for prescription drug abuse. We also know that the use of multiple substances is extremely high among those who report prescription drug abuse (often over 90%). Screening can help identify people who are at increased risk for the abuse of prescription drugs that can be used before prescribing those drugs to people. Our team and others are using risk factors to find new ways to improve the drug screening and monitoring process.
The team of authors in your institution is quite diverse in their professional backgrounds. How important is a multifaceted expert representation and perspective when considering the effects of drug abuse / abuse on users?
McCabe: Our team of authors are all affiliated with the DASH Center and come from a variety of professional backgrounds including nursing, psychology, psychiatry, social work, sociology, and public health. Most importantly, the DASH Center is made up of members with lived experience of substance abuse and substance use disorders who help inform our research. The multidisciplinary team guided by this lived experience has resulted in some of the best science teams I have seen in my career.
There are multiple entry and exit routes from substance abuse and often individual work histories are limited by their disciplinary lens to fully understand the complexity of substance abuse. For example, our team’s developmental psychologist emphasizes the developmental changes that occur when adolescents leave their parents’ home and take responsibility for their own medication management in early adulthood. People with lived experience share their experiences of how these changes impacted the way they obtained prescription drugs. Psychiatrists discuss the conditions treated with these drugs, prescribing guidelines, and the current course and severity of the disease. The public health expert assesses the health benefits and risks associated with various interventions while nurses and social workers explain the associated comorbidities and what is realistic to expect in terms of families and resources in the community.
Through our scientific team approach, our team is able to answer critical research questions that are highly relevant. For example, a common misconception is that the abuse of prescription stimulants during adolescence or early adulthood has no long-term consequences. Some high school and college students engage in this behavior to improve concentration or help study. This study provides evidence that shows that prescription stimulant abuse in late adolescence or early adulthood is associated with a significantly increased risk of symptoms of substance use disorders later in life. in life. These results are important for changing misperceptions.
What surprised you the most about your team’s conclusions?
McCabe: We expected the prevalence of prescription drug abuse to be higher than in previous studies because we were following the same people aged 17-18 and 50. We were somewhat surprised to find that almost half of people reported prescription drug abuse between the ages of 18 and 50. is important because it serves as a major red flag to take a closer look at our country’s relationship with these drugs.
What mitigation practices can best be implemented to reduce the likelihood that patients will not report / discuss their prescription drug misuse? Which members of the healthcare team are most involved?
McCabe: Healthcare professionals are always looking for ways to identify who will develop problems and who will not. As I mentioned earlier, our team and others are using risk factors to find new ways to improve the drug screening and monitoring process. Members of the healthcare team are often uncomfortable having these crucial, non-judgmental conversations. Sometimes patients fill out the practice admission form or talk to members of the healthcare team and want to talk to them about their drug use, but it is easier to check the “no” boxes. “.
The first important question our healthcare team should ask themselves is, “What are we doing to encourage these people – who often go under the radar of the current screening and surveillance process – to be more comfortable with disclosing?” their drug use? ‘
The second question that members of our care team should ask themselves is: “What services for accurate diagnosis, effective treatment and appropriate care can be offered or referred after screening?” Screening is recommended when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.
A final takeaway from this study was our finding that most adults who reported prescription drug abuse shared households with their children. With more than 20 million adults suffering from substance use disorders in the United States, we need to pay more attention to children in these households. Our research team has consistently found that most children in the United States who have controlled substances in their own homes have unattended access to these drugs. When prescribing controlled substances to patients, healthcare professionals and families should consider others in the household and how safety will be maintained. My own home has a controlled substance safe, and I encourage others to do the same.
How is the current pandemic likely to affect the burden of PDM in the United States?
McCabe: In the beginning, the pandemic was the perfect storm for relapses, overdoses, and substance-related issues. The pandemic has changed the number of people who use drugs while obtaining drugs, and also the way people get help if they develop serious problems. Increasingly, fentanyl is added to a wide variety of drugs, including fake prescription drugs, which has increased the risk of overdose. The pandemic has also increased stress for many recovering, due to loss of jobs or full-time work from home without child care, decreased responsibilities, disrupted sleep routines and decreased workload. face to face social support. There is a saying in the recovery community: “Stay in the midst of the recovery herd where you are less likely to be shot. Initially, the pandemic made it more difficult for some people to stay in the midst of their recovering herd.
Over time, the pandemic has forced people recovering from a substance use disorder to pivot and find new tools to recover. Substance abuse treatment is still available to those in need of treatment, as is transitional housing, but the reduction in face-to-face social support has made it more difficult for people to connect to the help they need. Before COVID, only one in four people with an addiction sought treatment for their substance abuse disorder. Finding help and support during COVID has become more difficult for those most at risk such as the homeless, those on parole, and those leaving drug treatment.
One of the benefits of COVID is that it has forced healthcare professionals to adapt and provide more telehealth assessments, counseling and treatment. Some organizations were already offering this service but many others had to pivot to offer these services due to COVID. This opened up new opportunities that weren’t available before COVID. The online recovery community has grown significantly during COVID and will continue to be an important resource for people who need virtual options for support meetings, such as people who contract COVID or people at high levels. risk who cannot attend face-to-face support meetings for health reasons. or other reasons.
I can envision more opportunities for precision medicine and opportunities to tailor addiction treatment with all the resources that will be available through telehealth to match the right treatment delivered by the right person at the right time. This also applies to long term recovery. For example, I am aware of a recovery group that has met online throughout the pandemic and healthcare professionals refer their patients to the meeting while in hospital, so they have a supportive recovery community. before their release. This would not have been possible before COVID. We need to learn from COVID to improve our batting average to get the help people need because our batting average was not good enough to keep us on a team before COVID.
Finally, prescription drug abuse and substance use disorders impact the whole family, and resources are available for family members and children who need support. Sometimes people live with loved ones who refuse to get help for their prescription drug abuse. There are programs designed to help people in these situations take care of themselves whether or not their loved one is quitting. There are support groups online and healthcare professionals are finding new ways to support families during the pandemic.