Use and Misuse

June is National Safety Month (https://healthfinder.gov/NHO/JuneToolkit2.aspx). With the many safety topics to consider, I decided we should take a look at our medicine cabinets, where we can often find prescription drug misuse going on.

Just because a drug is prescribed, it doesn’t mean it is free of risk. When a provider decides to treat a patient with a prescription drug, that provider is taking into account the benefits and risks for the individual. If that drug is misused it can be just as dangerous as an illegal drug. Misuse of prescription drugs is defined as “taking a medication in a manner or dose other than prescribed” (https://www.drugabuse.gov/publications/misuse-prescription-drugs/overview).

What types of misuse occur?
(https://teens.drugabuse.gov/drug-facts/prescription-drugs)

1. Using someone else’s prescription medication (People frequently will do this with pain medication)
   
2. Not taking the prescription as directed (For example: Crushing a pill or capsule when it should be taken whole or not taking the medication at the prescribed frequency)
   
3. Mixing the prescription with other drugs or other items that are contraindicated (This happens when people mix alcohol with drugs or take them with or without food, in contradiction to the instructions)
   
4. Acquiring the prescription medication to get high and not for its prescribed use
   
5. Not storing prescription drugs safely (especially opioids, sedatives and stimulants), which can result in others taking the prescriptions
   
6. Discarding the drugs inappropriately or taking medications that have expired
   
7. Stopping the drug too soon. Unless there are unexpected side effects, allergic reactions, or other problems with the prescription, the medication should be completed for the length of time it was prescribed. Otherwise, contact the provider about any contraindications. Often people stop medications, such as antibiotics, once they start to feel better. It is important to follow the directions; your physician has made the determinations for a reason. For example, with antibiotics for “strep throat,” complete the prescription for the designated time. The organism that causes step throat (streptococcal bacteria) can damage the kidney or heart, resulting in potential serious complications. Do not let strep throat go untreated, nor stop the prescription before it is completed (https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338).
   

Drug misuse can lead to abuse, which is at a crisis level in our society. Here are some definitions for a few terms, which may help to clarify the progression from misuse to abuse:
“Dependence means you will feel uncomfortable or ill when you try to stop taking the drug, and it can lead to tolerance and addiction.”
“Tolerance: This dependence on the drug happens because the brain and body adapt to having drugs in the system for a while. A person may need larger doses of the drug to get the same initial effects.”
“Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, despite the harm they cause” (https://teens.drugabuse.gov/drug-facts/prescription-drugs).

Certainly, drug problems can begin with prescription drugs. What happens to the brain (and body) with some prescription drugs? “In the brain, neurotransmitters, such as dopamine, send messages by attaching to receptors on nearby cells. The actions of these neurotransmitters and receptors cause the effects from prescription drugs” (https://teens.drugabuse.gov/drug-facts/prescription-drugs). For example, opioids bind to opioid receptors in the brain and the body’s nerve cells, which involve pain and pleasure perception, resulting in pain relief and feeling better. Stimulants such as Adderall and Ritalin build up dopamine and norepinephrine, resulting in increased energy and cognitive clarity. Depressants increase gamma-aminobutyric acid (GABA) activity, which slows down brain activity, resulting in a relaxing effect. It is easy to see how the effects of these drugs can lead to increased use, misuse, and eventually possible abuse.

Who is at risk for prescription drug misuse? Although the highest groups to misuse prescription drugs include teenagers (12-17) and young adults (18-25), the older adult population has a complex drug misuse problem. Over 80 % of the population, ages 57-85, take at least one prescription drug and 50% of that same population take five or more (https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse). These large numbers of prescriptions simply result in intentional or unintentional drug misuse. Older adults suffer with more complications of drug misuse due to their higher rates of co-morbidities and metabolic differences.

What measures can we take to reduce prescription drug misuse?

1. Clinicians can help curtail prescription misuse by taking a complete drug history, ask questions that screen for use, track frequency of refills, and educate patients about proper drug use.
   
2. State-run electronic databases for prescriptions can track patient usage of drugs, overprescribing and multiple–provider prescription patterns.
   
3. The federal government and the Centers for Disease Control and Prevention (CDC) have initiated measures for promoting more cautious opioid prescriptions.
   
4. Patients can help by following steps to prevent misuse.  Look at the seven types of misuse (as noted above) and take measures to reduce these problems, such as safely storing medications, following directions as prescribed by your physician, and not sharing prescriptions with others, etc.
   

Next time you go into your medicine cabinet, try to be mindful about safe prescription drug usage.
 
Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions.