The Good News

1. The Good News • Development and increased availability of prescription drugs have significantly improved treatment of pain, mental disorders, anxiety and other conditions . • Millions use prescription medications safely and responsibly

2. HOWEVER -- • Increased availability and variety of medications with psychoactive effects have contributed to prescription misuse, abuse, dependence and addiction. • The abuse of prescription pain killers now ranks second only behind marijuana as the nation’s most prevalent illegal drug problem.

3. Increasing Admissions • As a result, we are seeinghuge increases in treatment admissions for people abusing prescription drugs especially narcotics. • These individuals include those who began use for legitimate reasons, those who invent or magnify reasons to obtain prescriptions, and those who get them without prescriptions.

4. Client stories • These individuals come from all socio economic groups, ages and ethnicities and include as many women as men. • The stories from our agency are no different than those coming from across the nation -- • A teenager dies after partying with friends. • Registered nurses suffer multiple loss of license with each relapse • A young father lies unconscious with his young child running for help. • A 19 year old boy found by his roommates almost dead

5. Identifying the problem • There is a lack of knowledge concerning the dangers of prescription drug use, particularly among adolescents and often their parents as well. • As a result, many prescription addicts get well into their addictions before recognizing they have a problem. • In contrast, illegal drug use usually becomes obvious through family intervention, medical crisis, legal difficultiesand other issues inherent in use.

6. Recovery is difficult It makes recovery difficult partly because these drugs are so accessible and partly because people feel safe and okay about using them

7. Complicating this is the Challenge of Chronic Pain • Motivates drug seeking behavior • Decreases quality of life which likely increases attraction for any drug that produces euphoria • Can create psychiatric problems such as depression and anxiety • If pain is result of trauma may have symptoms related to that • Users can have functional and social disability that can impede participation and success in treatment

8. And deadly drug combinations • Combinations of drugs such as narcotics and benzodiazepines can be deadly yet they are often prescribed. • Often our clients take Xanax, Vicodin and Soma. • We encounter client after client who seeks and is prescribed these medically unjustified cocktails.

9. Monitoring use • All people treated with any controlled medication should be monitored closely for the development of a substance use disorder. • Physiological dependence may be the first symptom of a potential problem • While physiologically dependent people may also develop symptoms of abuse or psychological dependence.

10. TREATMENT • Traditional treatment is in many ways inadequate to address prescription abuse. The integration of substance abuse treatment and physical health cannot come quickly enough. • Counselors have neither the knowledge or the authority to practice medicine.

11. Treatment Challenges • When a client has a prescription it is very difficult for counselors to determine if there is abuse or not especially in the early phases • Non medical staff are left to determine whether the medical conditions being treated are consistent with the medication regime or if the complaints are magnified consciously or unconsciously to procure medication. • Even if a counselor could determine this he does not have the capacity to take the next step to determine if the clientcan stop using or needs tapering and the like.

12. ADDITIONALLY • With a diagnosis of substance abuse of prescription drugs individuals need to be evaluated as to tapering schedules, withdrawal management and treatment plan development include the assessment of the appropriateness of medication assisted therapy….again requiring medical support

13. Specific services • Effective counseling and review of the appropriateness of medication-assisted treatments should apply to all patients identified with any substance use disorder. • However, to ensure treatment effectiveness, clients with ongoing pain and those with underlying anxiety disorders, ADD, ADHD, and other mental health disorders will need services beyond standard addiction counseling. Not providing these services ensures treatment failure.

14. In combination with medical consultation treatment providers use or should use evidence based brief interventions such as motivational enhancement, cognitive behavioral therapy or 12 step facilitation

15. Summary • Not surprising that the availability of more, new, better, and safer psychotherapeutics has been followed by a huge upswing in the prevalence of their nonmedical use and abuse • While prescribed drugs can be powerful allies they also pose serious health risks related to their abuse that can lead to addiction and to death • We need to achieve a balance so that people suffering from chronic pain can get the relief they need while minimizing the potential to abuse

16. To reach this goal we need to develop more effective strategies for prevention and treatment, the foundation of which I believe is to integrate medical health with substance abuse treatment. • Will require us to address the many barriers that exist for people seeking recovery, including stigma, access, inadequate treatment, lack of funding for medications effective with narcotic dependence (i.e. Suboxone)and lifelong impacts of the consequences of addiction.