Prescription drug misuse Flashcards
(30 cards)
How is PDM defined? (3 points)
- use without Rx for the experience/feeling the drugs cause
- use without Rx to get high, create an altered state or for reasons other than the Rxer intended
- misuse or non-medical use of a drug for something other than intended medical/psychiatric purpose
What is overuse?
-therapeutic drug is being used at higher doses or for a longer duration than prescribed or directed
What is intentional misuse? (2 points)
- where pharmaceutical drugs are used, often in large doses for their intoxicating effects
- or to enhance intoxicating effects of other substances
What is diversion?
-prescribed pharmaceutical drugs are transferred from original user to others through on-sale via illegal markets for profit
What are the characteristics of “intentional abusers”? (4 points)
- archetypal drug seeker
- seeks drug for own use for the high or selling on illicit market
- known addicts or drug abusers
- considered to be devious
What are the characteristics of “unintentional overusers”? (5 points)
- secondary group
- initially sought meds for legitimate medical condition
- misuse/abuse developed over time
- older patients, benzo users
- less underhand
What are PDM patients like in reality? (2 points)
- can’t categorise them into binary class
- drug misuse is a spectrum of safe, hazardous, harmful and dependent increments
Why is PDM a problem? (4 points)
- PDM is a problem in western world and many developing nations
- linked ti social and health harms
- a lot of research data is available internationally
- OTC misuse is less of an issue but still concerning
Is PDM a big problem?
-in some regions, people abuse licitly produced Rx meds in quantities similar to or greater than the quantities of illicitly manufactured heroin, cocaine, amphetamine and opioids that are abused (in USA)
How does PDM apply to the NZ setting? (2 points)
- significant problem in NZ and concern has been expressed by both professional and official agencies
- NZ’s geographical isolation makes importing heroin and raw opium in bulk difficult, so majority of opioid abusers have been Rx meds, poppies and homebake
How does the NZ drug strategy (2007-2012) fit? (3 points)
- focuses on harm minimisation
- harm reduction, demand reduction, supply reduction
- new strategy is likely to follow the same plan
How are Rx drugs obtained for misuse? (7 points)
- Dr shopping
- Fabricated medical conditions/Sx
- seeking replacement Rxs
- inappropriate OTC purchases from community pharmacies
- Fraudulent Rxs
- Theft
- Via other people’s supplies
What are some indications of drug seeking? (5 points)
- specific requests for meds with potential for abuse
- requests for dose increases of meds with potential for abuse
- uneasy/agitated manner exhibited during consultation
- visits to HCPs at recognised busy periods
- targeting of new PHCPs within practice/pharmacy
What are some actions that can be taken if suspecting a Px of drug diversion? (10 points)
- call Rxer
- refuse to fill Rx
- documentation
- contact police
- counsel Px on dangers
- confront Px with suspicions
- ask opinion of another Phx
- tell Px to leave the pharmacy
- offer educational materials
- take no action
What are the consequences of PDM? (6 points)
- inaccurate self diagnosis
- drug interactions
- underdosing
- inappropriate meds/contraindications
- over dose, esp when mixing CNS depressants like opioids and benzos
- addiction & related consequences
Why is it important to know about PDM? (2 points)
- users: health and social problems, legal problems, Tx issues
- Health professionals: legal and ethical obligations, impacts their work, staff, other patients and customers
What are the main drugs of abuse? (4 points)
- opioids
- benzos
- stimulants
- other drugs
What is the issue with opioids? (9 points)
- risk of overdose, esp. if combined with other CNS depressants
- injecting - blood borne viruses
- tolerance
- dependence
- withdrawal Sx
- sedation
- constipation
- immunological
- hormonal (men & women)
What is the issue with benzos? (3 points)
- long term use: depression, memory loss, lethargy, anxiety, aggression
- tolerance develops very quickly
- withdrawal from dependent use can lead to panic attacks, vomiting, depression, paranoia
What is the issue with stimulants? (4 points)
- long term: tolerance, dependence, cardiovascular, paranoia, mental health, weight loss
- injecting: blood borne viruses
- inhaled: lung damage
- withdrawal
What are some other drugs that can be abused? (3 points)
- antidepressants
- steroids
- whatever’s new in the pharmacy
What are some examples of supply control interventions? (5 points)
- direct refusal to supply
- supplying in restricted amounts
- ban Px from practice/pharmacy
- seek for Px to be restricted
- contact police
What are examples of harm reduction interventions? (5 points)
- Question Px about their drugs use
- Offer help/assistance
- provide info
- refer to specialist service
- restructure frequency of Rx
What are the challenges faced by GPs and CPs? (7 points)
- IDing drug seekers
- difficult Px
- workload
- time
- managing professional relationships
- inhertied Px
- rural/locum/sole practitioner
