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Opioid Pain Reliever Abuse Called Top Public Health Challenge

Emergency medicine pharmacist offers insights into growing addiction cycle

The Centers for Disease Control and Prevention has called prescription painkiller abuse “one of the worst drug overdose epidemics in history.”

New studies on prescription painkillers show that from 1999 to 2011, the consumption of hydrocodone more than doubled and oxycodone use increased by 500%. During that time, overdoses from opioid pain relievers (OPRs) nearly quadrupled.

“The rise in opioid consumption has resulted in a doubling in visits to the emergency department for nonmedical OPR use, but I also see patients who make errors with medications they are legitimately supposed to be taking,” said Dr. Megan Rech, an emergency medicine pharmacist in the Loyola University Health System.

Addicts will frequent emergency rooms complaining of phantom conditions to try to get painkillers. “At Loyola, we limit painkiller prescriptions to last between 7 and 10 days with no refills to avoid abuse and to make sure people who are genuinely ill see their doctor for follow-up care,” Rech said. “At Loyola, we utilize an Illinois database that tracks scheduled prescriptions to help identify OPR addicts.”

Addiction is defined as continued use of a drug despite negative consequences.

“Red flags that a patient may be an addict include complaining of general pain or excess pain compared to the exam; refusing to see a specialist or to contact his or her primary care physician; asking for brand-name painkillers; or displaying an over-familiarity with opioids,” Rech said.

Loyola emergency-medicine physicians often will opt for non-opioid forms of pain relief. As an emergency department pharmacist, Rech screens patients for the presence of medications or substances and counsels staff and patients on prescriptions.

Rech also emphasizes the importance of patient education. “Many patients are unaware that they can build up a tolerance to medications. If they stop taking prescribed painkillers for a while, the tolerance decreases,” she said. “A patient can then restart the medication at the previous dose, which is now too high, increasing the risk of an overdose.”

“When physicians prescribe a medication, they need to be very clear with the patient on what it is, when it should be taken, when it should be stopped and disposed of, and if it is habit-forming,” Rech added. “Some patients make honest mistakes with self-dosage that unfortunately result in overdose.”

Sources: Medical Xpress; February 24, 2015; and Loyola Medicine; February 17, 2015.


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