Urine monitoring is also an aid. "Oftentimes, people who abuse prescription drugs take them by mouth, so they don't have track marks or other stigmata of using drugs. They may appear healthier looking that those who inject drugs, yet they may be taking large amount of prescription opiates," Vocci said. "Use of urine drug monitoring might keep them more honest."
Physicians also need to assess what is actually going on with patients and whether patients actually need narcotics for a certain duration. Look for patterns that do not match the clinical situation, Vocci advised. For example, patients who postoperatively should be gradually feeling better yet they ask their physicians to increase their dose of painkillers.
If a physician feels a patient is developing chronic pain problem or addiction to medication, Vocci suggested the physician consider referring the patient to a chronic pain specialist.
Volkow was asked during her lecture about the role of 12-step groups, given the biochemical underpinnings of addiction. She explained that when individuals become addicted to illicit or prescription drugs, they often lose their jobs and their families and start to isolate themselves. The biochemical changes in their brains make them much less sensitive to natural reinforcers, and they become socially isolated.
"Basically, the addicted individuals are cornered into the utilization of drugs as the only mechanism by which they can escape the state of discomfort," she said. "But bringing them to [Alcoholics Anonymous], you are doing a therapeutic intervention. Why? One of the most powerful social drives we have as humans is that of belonging to a group," she said. "You are giving the individual an alternative behavior other than the drug. Also, you are decreasing the stresses associated with the loss of control that they feel vis-à-vis their intake of the drug. So those two components are likely to play an extremely important role in helping the person who is addicted to overcome the compulsion to take drugs."
References
Drug Abuse Warning Network (2004), The DAWN Report: Narcotic Analgesics, 2002 Update. Available at: http://dawninfo.samhsa.gov/old_dawn/pubs_94_02/shortreports/
files/DAWN_tdr_na2002.pdf. Accessed Dec. 16.
NIDA (2004), NIDA InfoFacts: Prescription Pain and Other Medications. Available at: www.nida.nih.gov/infofax/painmed.html. Accessed Nov. 22.
