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Objective: Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants). Methods: National longitudinal multicohort panels (baseline cohort years 2005–2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19–24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM. Results: Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood. Conclusions: Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM. [ABSTRACT FROM AUTHOR]

Purpose Antibiotic use and misuse are common in pregnant women and young children. Few studies have assessed real-world discussions of antibiotics in these populations. Using social media posts of pregnant women and parents, our goal was to identify key themes about facilitators and barriers to appropriate antibiotic usage. Methods A purposive sample of public posts and comments relevant to antibiotic use was collected from the BabyCenter United States social media site. Using a directed content analysis, themes related to facilitators and barriers to appropriate antibiotic use were identified. Results Seven hundred and twenty-six posts and 5227 comments were analysed. Themes centred around individual factors, interpersonal factors, and structural factors. Individual factors included knowledge and beliefs. Though misinformation was present, most parents were aware of appropriate antibiotic usage and perceived antibiotics as safe and effective. Some hesitance around using antibiotics led to recommendations for home remedies or over-the-counter treatments. Interpersonal factors focused on a lack of available offline peer support, the expertise of providers, as well as a potential lack of attention from those providers. Structural factors, including access to care, also impacted parents' antibiotic use and misuse. Conclusion Though most parents demonstrated appropriate knowledge about antibiotics and a willingness to follow guidelines, negative experiences with their providers, a lack of support from peers, and structural factors presented as potential barriers to appropriate antibiotic use. Implementing avenues for peer support for parents, allowing more time for providers to address parents' concerns, and improving access to providers could improve appropriate antibiotic use in parents. [ABSTRACT FROM AUTHOR]

More than 1 billion people live with chronic pain, including 100 million Americans, with a majority utilizing prescription and over-the-counter (OTC) pain medications. OTC medications are readily available and facilitate generally positive efficacy, yet misuse leads to a high number of medication-related problems, with acetaminophen alone accounting for more than 50,000 emergency department visits annually. The West Virginia Health Sciences and Technology Academy (HSTA) high school student program and the West Virginia University Health Sciences Center collaborated to accomplish 2 objectives: to assess and compare knowledge and perceptions of OTC pain medications in the West Virginia community and to develop and provide educational interventions to high school students regarding knowledge and perceptions of OTC pain medications. Resulting student knowledge data illustrated a statistically significant improvement in knowledge. Community survey screening data resulted in 85% answering two-thirds of the knowledge questions incorrectly, with 12% (140 of 1174 participants) answering every single knowledge survey question incorrectly. These data strongly exhibit not only the incredible need for OTC pain medication community education but also that this study's educational methods were very effective at teaching high school students, with possible applicability to the entirety of society. [ABSTRACT FROM AUTHOR]

Introduction: The abuse potential of opioids and other controlled substances is well-known; however, reports of noncontrolled prescription medication (NCPM) misuse deserves further attention. Whereas several studies investigate patterns, motivations, and biochemical mechanisms underlying the misuse potential of NCPM, the clinical significance of NCPM misuse is not well-understood. The primary objectives of this project were to identify prescriber perceptions of NCPM misuse and evaluate patient reported patterns of misuse through survey responses. Methods: Adult patients admitted to psychiatry services and prescribers working in psychiatry or on a general medicine service during the study time frame were invited to participate. Surveys were collected anonymously for both patients and prescribers. Results: NCPM misuse was reported by 38.4% of patients. Trazodone (35%) and quetiapine (30%) were most commonly reported as being misused. Opioid (24.1% vs 4.3%; P = .023) and cannabis use disorders (13.8% vs 0%; P = .019) were reported more frequently in patients who misuse NCPM, whereas no difference was seen for other SUDs (P > .05). There was no difference between psychiatric and general medicine prescribers regarding familiarity with NCPM misuse (n = 21 [87.5%] vs n = 13 [81.3%]; P = .668). Discussion: High rates of NCPM misuse were seen in this patient population. Our findings confirm previous reports of quetiapine misuse and also reveal that trazodone is frequently misused. Based on the observations in this study, the misuse of NCPM is identified as prevalent and noteworthy at our institution, warranting provider education and future studies.

Background: There is little known regarding prescription and nonprescription medicine nonmedical use (abuse and misuse) in Iraq, with limited treatment. Pharmacists could be a valuable source of information in the absence of any national monitoring system., Aims: This study aimed to explore Iraqi community pharmacists' perspectives on prescription and nonprescription medicine abuse/misuse, including motives for use and how often they encounter people whom they think are misusing or abusing medicines., Methods: A cross-sectional survey was undertaken between November 2020 and February 2021. Community pharmacists in Iraq were asked to complete a prepiloted self-administered questionnaire, distributed through online social media platforms., Results: 300 pharmacists completed the questionnaire. The most commonly reported nonprescription drugs suspected of abuse/misuse were cough and cold medications (n = 80, 26.6%), topical corticosteroids (n = 54, 17.9%), and allergy products (n = 33, 11%). The most common reported prescription drugs suspected of abuse/misuse were systemic antibiotics (n = 111, 36.9%), gabapentinoids (n = 56, 18.6%), and moderate-weak opioids (n = 34, 11.3%). The most commonly method used by pharmacists to limit access to such drugs was responding that the requested medication was unavailable (n = 273, 51.7%), followed by advising on risks (n = 152, 33.2%)., Conclusions: Prescription/nonprescription medicine abuse and misuse are suspected in community pharmacies in Iraq. Current methods for controlling the problem are likely to be ineffective in the absence of prescription drug enforcement. Pharmacists could have a more proactive role in managing this issue, networking with other pharmacists, and referring suspected users to support., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Methotrexate (MTX) is an antifolate that has been used as a chemotherapeutic agent for the treatment of neoplasm, such as leukemia and osteosarcoma. Moreover, MTX is also commonly used for treatment of chronic rheumatoid arthritis (RA). Here, we report a case of severe stomatitis in a patient with RA, which was caused by misuse of MTX. An 83-year-old female patient visited our department with the chief complaint of oral mucosal pain, accompanied by extreme fatigue. Severe stomatitis lesions were observed throughout her oral mucosa. Moreover, blood examination revealed pancytopenia. The patient reported a history of RA, and had been prescribed MTX since 2004. Although 6 mg MTX should be used twice per week, the patient mistakenly used MTX every day following her last consultation, for a period of 1 month. These findings led to a diagnosis of severe stomatitis, pancytopenia, and sepsis, all induced by misuse of MTX. Ultimately, she was treated with blood transfusion, antibiotics, and intravenous hyper alimentation, as well as administration of granulocyte colony-stimulating factor. MTX for the treatment of RA should be carefully managed to limit the risk of its misuse, especially in elderly patients, because of the severity and potential lethality of symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence and correlates of self‐reported misuse of prescribed‐opioid medications in the US general population. Method: In 31 068 adult participants of the National Survey on Drug Use and Health (NSDUH) 2015 and 2016 who reported using opioids in the past year, we assessed the prevalence and correlates of self‐reported misuse of prescribed opioids, defined as using a larger dose, more frequently, or longer than prescribed. Multivariable logistic‐regression models and the machine‐learning method of boosted regression were used to identify the correlates of misuse. Results: On the basis of weighted NSDUH estimates, of more than 89 million US adults who used prescription opioids every year, close to 3.9 million (4.4%) reported misused the prescribed medications. Prescribed‐opioid misuse was most strongly associated with co‐occurring misuse of opioids without a prescription, misuse of benzodiazepines, other drug‐use disorders, history of illegal activity, and psychological distress. Misuse of prescribed opioids was also strongly associated with prescription opioid–use disorder, especially among those who misused more potent opioids or started misusing opioids before the current year. Conclusions: Misuse of prescribed opioids is associated with other high‐risk behaviors and adverse health outcomes. The findings call for better monitoring of opioid prescription in clinical practice. [ABSTRACT FROM AUTHOR]

Accurate assessment of inappropriate medication use events (ie, misuse, abuse, and related events) occurring in clinical trials is an important component in evaluating a medication's abuse potential. A meeting was convened to review all instruments measuring such events in clinical trials according to previously published standardized terminology and definitions. Only 2 approaches have been reported that are specifically designed to identify and classify misuse, abuse, and related events occurring in clinical trials, rather than to measure an individual's risk of using a medication inappropriately: the Self-Reported Misuse, Abuse, and Diversion (SR-MAD) instrument and the Misuse, Abuse, and Diversion Drug Event Reporting System (MADDERS). The conceptual basis, strengths, and limitations of these methods are discussed. To our knowledge, MADDERS is the only system available to comprehensively evaluate inappropriate medication use events prospectively to determine the underlying intent. MADDERS can also be applied retrospectively to completed trial data. SR-MAD can be used prospectively; additional development may be required to standardize its implementation and fully appraise the intent of inappropriate use events. Additional research is needed to further demonstrate the validity and utility of MADDERS as well as SR-MAD.Perspective: Identifying a medication's abuse potential requires assessing inappropriate medication use events in clinical trials on the basis of a standardized event classification system. The strengths and limitations of the 2 published methods designed to evaluate inappropriate medication use events are reviewed, with recommended considerations for further development and current implementation. [ABSTRACT FROM AUTHOR]

Substance use disorders are common among incarcerated individuals, and prescribed medications have been reported as abused, diverted, or otherwise misused in correctional settings. We conducted a retrospective chart review of electronic medical records and reports on institutional charges for misuse of authorized medication by inmates in the New Jersey Department of Corrections between 2003 and 2013. The most frequently cited medications for misuse were gabapentin, diphenhydramine, clonidine, and ibuprofen. When compared with the entire current inmate population, subjects were more likely to have any history of a substance use disorder, to be in treatment for a mental illness, to have any diagnosis of antisocial personality disorder, to have any history of malingering, and to be prescribed a greater number of medicines. Prescribers in correctional settings should be aware that medications not traditionally prescribed by a psychiatrist may also be misused, and caution should be taken to manage this risk. [ABSTRACT FROM AUTHOR]

There is increasing concern among primary care practitioners (PCPs) regarding medication misuse and noncompliance while attempting to effectively manage chronic pain patients prescribed opioids for pain. The aim of this study was to investigate the effect pain catastrophizing has on self-reported pain intensity, disability, side effects, and opioid misuse in chronic pain patients prescribed opioids within primary care. Fifty-six PCPs and 253 chronic pain patients prescribed opioids or considered for opioid therapy were recruited into the study. All patients completed baseline measures, including the Pain Catastrophizing Scale (PCS) and were followed for 6 months to monitor pain and opioid compliance. Patients were divided evenly based on median-split scores on the PCS and participated in phone interviews at 1 and 6 months. The subjects repeated the baseline measures and completed measures of opioid compliance at the end of the study period. Patients who scored high on catastrophizing reported significantly greater pain intensity, activity interference, negative affect, and a higher percentage of medication-related adverse effects compared with those lower on the Pain Catastrophizing Scale at the start of the study and over a 6-month period (p < .01). In addition, those chronic pain patients classified as high pain catastrophizers reported significantly higher opioid misuse (p < .01). This study demonstrates the important role of pain catastrophizing among chronic pain patients who are prescribed opioid medication for pain within primary care. These findings support the benefits of carefully monitoring patients who are prescribed opioids in primary care and possible benefits of offering interventions to reduce pain catastrophizing. [ABSTRACT FROM AUTHOR]

Unlabelled: The Opioid Compliance Checklist (OCC) is a self-report measure for chronic pain patients prescribed long-term opioid therapy. The original measure includes 'yes' or 'no' items that reflect the content of a typical opioid therapy agreement. The aim of the study was to assess the efficacy of the OCC for monitoring opioid adherence among chronic noncancer pain patients within primary care. One hundred seventy-seven chronic pain patients were recruited as part of a larger study from 8 primary care centers. All patients completed pre- and poststudy measures as well as the OCC once a month for 6 months. Patients were classified on the Drug Misuse Index on the basis of results of urine toxicology screens, physician misuse behavior ratings, and self-report questionnaire results. Patients treated in primary care reported fewer incidences of misuse compared with patients from pain specialty centers in the original study. Three items from the OCC were found to be most predictive of opioid misuse measured according to the area under the curve (AUC = .681) analyses, although use of the 8-item OCC seemed equally valid. By the end of the study the patients reported lower scores on the OCC (greater compliance with their opioid medication). Results of this study suggest that the psychometric parameters of the shortened 8-item OCC are not based solely on unique characteristics of the initial validation sample. The OCC seemed to be a reliable and valid screening tool to help detect current and future aberrant drug-related behavior and nonadherence among chronic pain patients in primary care.Perspective: The OCC is a brief 'yes' or 'no' questionnaire that reflects areas of compliance that are often included in an opioid therapy agreement. Repeated administrations of the OCC among patients who receive opioids for chronic pain can increase the chance of identifying those who misuse or are likely to misuse opioids. [ABSTRACT FROM AUTHOR]

Objective. There is increasing concern among primary care practitioners (PCPs) regarding medication misuse and noncompliance among chronic pain patients prescribed opioids for pain. This study investigated the benefits of interventions designed to track potential opioid misuse and to improve practitioner confidence in managing patients with chronic pain through the use of risk assessment, monthly monitoring of compliance, and specialty support. Methods. Fifty-six PCPs and 253 chronic pain patients were recruited into the study. All patients were assessed for risk and called once a month for 6 months to monitor pain and opioid compliance. Practitioner knowledge about opioids, concerns about analgesic prescriptions, practice behavior, and attitudes of managing chronic pain patients were assessed and questionnaires were repeated after 1 year. Practitioners in the experimental group received monthly patient summary reports that consisted of pain, mood, activity levels, healthcare utilization, and results of the Opioid Compliance Checklist, while practitioners in the control group did not receive the monthly reports. Results. After 1 year all the PCPs reported improvement in identifying patients at risk for misuse (P< 0.05), perceived confidence in prescribing opioids for pain (P< 0.05) and increased satisfaction with communication with pain specialists (P< 0.05). The patients reported greater compliance with their opioid medication and felt that the monthly monitoring was beneficial. Despite modest improvements, many PCPs still lacked confidence in managing pain patients and reported reluctance to prescribe opioids for chronic noncancer pain, especially among younger practitioners. This study demonstrates the benefits of careful monitoring of chronic pain patients and need for pain management support within primary care. [ABSTRACT FROM AUTHOR]

The manifestations of disorders of the mind may play a role in the occurrence of criminal behavior. In the majority of the cases, the presence of a psychiatric disorder is cited as the reason that an individual was not fully aware of his behavior. However, other conditions, such as seizure disorders or hypoglycemia, have also been linked to an inability to understand the nature and consequences of one's actions. On occasion, these situations can be explained by a state of automatism that may be described as insane or noninsane. In this article, we describe the case of a 77-year-old man, suffering from Parkinson's disease, where the issue of criminal responsibility associated with incapacity of the mind secondary to medication misuse was raised. We elaborate on the thinking behind this opinion and the implications according to Canadian law. Although the legal outcome of this case is specific to our jurisdiction, the clinical implication may be common to any patient suffering from a similar condition and may inform physicians, families, and lawyers. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students. Methods: A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524). Results: Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms. Conclusions: The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral. [Copyright &y& Elsevier]

Introduction: The abuse potential of opioids and other controlled substances is well-known; however, reports of noncontrolled prescription medication (NCPM) misuse deserves further attention. Whereas several studies investigate patterns, motivations, and biochemical mechanisms underlying the misuse potential of NCPM, the clinical significance of NCPM misuse is not well-understood. The primary objectives of this project were to identify prescriber perceptions of NCPM misuse and evaluate patient reported patterns of misuse through survey responses., Methods: Adult patients admitted to psychiatry services and prescribers working in psychiatry or on a general medicine service during the study time frame were invited to participate. Surveys were collected anonymously for both patients and prescribers., Results: NCPM misuse was reported by 38.4% of patients. Trazodone (35%) and quetiapine (30%) were most commonly reported as being misused. Opioid (24.1% vs 4.3%; P  = .023) and cannabis use disorders (13.8% vs 0%; P  = .019) were reported more frequently in patients who misuse NCPM, whereas no difference was seen for other SUDs ( P  > .05). There was no difference between psychiatric and general medicine prescribers regarding familiarity with NCPM misuse (n = 21 [87.5%] vs n = 13 [81.3%]; P  = .668)., Discussion: High rates of NCPM misuse were seen in this patient population. Our findings confirm previous reports of quetiapine misuse and also reveal that trazodone is frequently misused. Based on the observations in this study, the misuse of NCPM is identified as prevalent and noteworthy at our institution, warranting provider education and future studies., (© 2022 AAPP. The Mental Health Clinician is a publication of the American Association of Psychiatric Pharmacists.)

Abstract: The use of opioid medications for treating chronic noncancer pain is growing; however, there is a lack of good evidence regarding their long-term effectiveness, association with substance abuse, and proper prescribing guidelines. The current study directly compares for the first time in a randomized trial the effectiveness of a conservative, hold the line (Stable Dose) prescribing strategy for opioid medications with a more liberal dose escalation (Escalating Dose) approach. This 2-arm, parallel, randomized pragmatic clinical trial followed 135 patients referred to a specialty pain clinic at a Veterans Affairs Hospital for 12 months (94% male and 74% with musculoskeletal pain). Primary outcomes included monthly or quarterly evaluations of pain severity, pain relief from medications, pain-related functional disability, and opioid misuse behaviors. All subjects received identical pain treatment except for the application of treatment group specific strategies for opioid prescriptions. No group differences were found for primary outcomes of usual pain or functional disability although the Escalating Dose group did show a small but significantly larger increase in self-rated pain relief from medications. About 27% of patients were discharged over the course of the study due to opioid misuse/noncompliance, but there were no group differences in rate of opioid misuse. Perspective: The results of this study demonstrate that even in carefully selected patients there is a significant risk of problematic opioid misuse. Although in general there were no statistically significant differences in the primary outcomes between groups, the escalating dose strategy did lead to small improvements in self-reported acute relief from medications without an increase in opioid misuse, compared to the stable dose strategy. [Copyright &y& Elsevier]

Questions from patients about analgesic pharmacotherapy and responses are presented to help educate patient sand make them more effective self-advocates. This report addresses ways in which pharmacists help with pain management and keeping prescription medications safe. [ABSTRACT FROM AUTHOR]

Abstract: To examine the prevalence of pain, substance use disorder (SUD) diagnoses, and opioid analgesic prescription patterns among veterans infected with the hepatitis C virus (HCV), a retrospective review of the medical records of 8,224 HCV-positive (HCV+) veterans was performed. Twenty-nine percent and 46% of HCV+ patients were prescribed opioids in the prior one and three years, respectively. Sixty-seven percent of HCV+ patients had documented pain diagnoses and 56% had SUD diagnoses. Patients with co-occurring pain and SUD were less likely to be prescribed opioids than patients with pain only (prior year: 36% vs. 43%, P <0.001; three years: 56% vs. 60%, P <0.01). There were no differences in numbers of early opioid prescription fills or numbers of opioid prescribers when comparing patients with co-occurring pain and SUD to patients with pain only. Veterans with co-occurring pain and opioid use disorder had fewer early opioid fills than veterans with pain only (prior year: 2.6 vs. 5.3 days, P <0.01; three years: 6.1 vs. 13.4 days, P <0.001). These data demonstrate that pain and SUD diagnoses were common among HCV+ patients, and that opioids were frequently prescribed. Co-occurring SUD was not associated with indicators of prescription opioid misuse. [Copyright &y& Elsevier]

Abstract: Objective: The goal of this paper was to examine the relationship between history of substance use disorder (SUD) and self-reported prescription medication misuse in 127 primary care patients who receive opioid medications for treatment of chronic pain. Method: Participants completed measures of pain location, pain intensity, disability due to pain, and misuse of prescription medications. Other measures included demographic characteristics, psychiatric symptomatology and quality of life. Results: Seventy-eight percent of participants reported at least one indicator of medication misuse in the prior year. After adjusting for age and clinical factors (pain severity, depression severity, current alcohol or substance use disorder), participants with SUD history were significantly more likely than participants without SUD history to report borrowing pain medications from others (OR=6.62, 95% CI=1.4–30.7) and requesting an early refill of pain medication (OR=3.86, 95% CI=1.5–9.6). Conclusions: Misuse of prescription medications is a concern among primary care patients with chronic pain. Participants with a lifetime history of SUD are more likely to endorse some aberrant medication-related behaviors. Patients with SUD histories should be carefully evaluated for medication misuse potential and may require more intense assessment and follow-up. [Copyright &y& Elsevier]

Objectives To examine patterns and predictors of medication compliance, diversion, and misuse in a sample of adults with prescriptions for the stimulant medication methylphenidate (MPH). Methods Sixty-six adults currently prescribed MPH (53% male) completed structured interviews and provided details regarding their medication and other substance use histories. Results On average, participants reported using their medication as prescribed on 14.5 (SD 11.7) of the past 30 days; 44% admitted to diverting it and 29% admitted to inappropriate use. While analyses revealed that medication misuse, diversion, and level of compliance were interrelated and all associated with concurrent illicit substance use, each also had other distinct associations. Specifically, MPH misuse was associated with the use of illicit stimulants such as amphetamine and cocaine, diversion with age and age of MPH prescription, and compliance with participation in an attention deficit hyperactivity disorder (ADHD) support group. Regression analyses revealed that misuse and poor compliance were both best predicted by concurrent illicit substance use, while the model that best predicted diversion included age of first MPH prescription (younger) and MPH misuse. Conclusions Poor medication compliance, diversion, and misuse are relatively common and interrelated among adult MPH users. MPH prescriptions should be monitored closely in individuals with histories of illicit substance use. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article considers assessment and treatment issues for mental health practitioners working with patients using opiate medications to treat chronic pain with a particular emphasis on their potential relationship to substance abuse. We review general opiate medications, including a discussion of medications with increased addiction potential. Practice guidance is offered regarding long-term opiate treatment, including definitions of addiction, initial assessments, ongoing substance misuse monitoring, use of psychological assessment instruments, and managing medication misuse problems. Additionally, we examine the role of the mental health professional within this area and examine the incorporation of psychological interventions for patients using opiates. A case illustration includes several of these complicated issues of managing chronic pain with opiate medications. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 1397–1408, 2006. [ABSTRACT FROM AUTHOR]

Abstract: This study introduces the Addiction Behaviors Checklist (ABC), which is a brief (20-item) instrument designed to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain populations. Items are focused on observable behaviors noted both during and between clinic visits. One hundred thirty-six consecutive veterans in a multidisciplinary Veterans Affairs Chronic Pain Clinic who were receiving long-term opioid medication treatment were included in this study. This study represents one of the first to follow a sample of chronic pain patients on opioid therapy over time, using a structured assessment tool to evaluate and track behaviors suggestive of addiction. Interrater reliability and concurrent validity data are presented, as well as a cut-off score for use in determining inappropriate medication use. The psychometric findings support the ABC as a viable assessment tool that can increase a provider''s confidence in determinations of appropriate vs. inappropriate opioid use. [Copyright &y& Elsevier]

Objective: Describe the prevalence of self-prescribed use and misuse as well as users' opinions concerning nonprescription medications and dietary supplements in assisted living facilities.Design: Descriptive cross-sectional study.Setting: Two assisted living facilities (ALFs) in Oregon and Washington State.Participants: Convenience sample of 45 ALF residents.Intervention: Chart reviews and face-to-face interviews.Main Outcome Measures: Prevalence and types of use of self-prescribed over-the-counter (OTC) medications and dietary supplements; misuse of these products, and participants' opinions concerning use of these products.Results: Among 29 women and 16 men with a mean (+/- SD) age of 84.8 +/- 6.9 years and a mean of 9.9 +/- 6.4 years of education, 84.4% were using selfprescribed OTC medications and dietary supplements at the time of this study. A mean of 3.4 products was used per participant. Nutritional supplements were most frequently used (32% of products), followed by gastrointestinal products (17%), pain relievers (16.3%), herbals (14.4%), topical products (12%), and cold/cough products (8.5%). Potential misuse was identified in 23 (51%) of the participants. Problems in the use of products included duplication (70%), potential drug/disease/food interactions (20.8%), and other inappropriate use (9.1%). The majority (76%) of the participants believed the products were helpful in maintaining health, 56% of them wanted more product information, 49% sought product information from family and friends, 40% turned to their physicians and nurses for information, and 11% asked pharmacists for advice.Conclusion: The use of nonprescription medications and dietary supplements among ALF residents was high, and simultaneous use of multiple products with the same active ingredient was the most prevalent problem. The residents turned to family and friends, physicians, nurses, and ALF staff for information on these products more frequently than they did to pharmacists. [ABSTRACT FROM AUTHOR]

Objectives: To present current information about trends development and marketing of over-the-counter (OTC) medications and dietary supplement products and describe new products, delivery systems, home monitoring devices, and home accessories in these markets that are likely generating questions from or posing potential problems for patients.Data Sources: Recently published clinical and pharmaceutical industry literature.Study Selection: By the authors.Data Extraction: By the authors.Data Synthesis: Last year witnessed the first effort of the Food and Drug Administration (FDA) to remove a dietary supplement from the U.S. market. Ephedra, because of its imminent danger when used for weight reduction and athletic enhancement, was the target of FDA action. FDA has issued a final rule implementing this ban, which prohibits the sale of dietary supplements containing ephedrine alkaloids (e.g., ephedra). Two newer diet-aid products are being actively promoted with little or no safety and effectiveness data. Thus, pharmacist's vigilance is important along with sensible advice on how to lose weight safely and effectively. Further, two independent organizations have created certification programs for dietary supplements that ensure product purity, active ingredient strength, and compliance with good manufacturing practices. In addition, through recent changes in federal legislation, consumers are now able to obtain reimbursement for their nonprescription purchases through flexible spending accounts. Information is presented in this article about selected products in these OTC, home care, and dietary supplement categories: heartburn (proton pump inhibitors), allergy (second-generation antihistamines), constipation (laxatives), diabetes mellitus (blood glucose monitoring systems), home testing (fertility monitoring), nicotine addiction (smoking cessation products), otic disorders (ear syringes), contraceptives and sexual aids (condoms and lubricants), and dermatology (wart removal).Conclusion: Patients continue to increase their reliance on self-care. To assist them, pharmacists must remain up-to-date on trends and have an understanding of the nuances of consumers' behavior and thinking in relation to OTC products and their use. [ABSTRACT FROM AUTHOR]

This article focuses on social work practice. In the U.S., older adults (i.e., people who are 65 years of age and over) make up the fastest growing segment of the population. As the size of the elderly population grows, so will the problem of geriatric substance abuse. Research shows that alcohol use declines as people grow older, but the trend appears to be offset by increased misuse and abuse of over-the-counter and prescribed medications. Many older adults have a favorable attitude toward drinking, do not think alcohol is a drug, and believe modest amounts of alcohol have cardiovascular and other health benefits. Social workers, who constitute the largest group of mental health providers, are well suited to address the hidden epidemic of substance abuse among elders and the crisis in geriatric mental health. Social workers should screen all elders for substance-related and mental health problems, recognizing that alcohol and other drug abuse (AODA) are not easy to detect. Multiple physical and psychiatric problems mask substance-induced and substance use disorders.

The misuse of drugs has been shown to be a significant problem among older people, having a variety of causes and taking many different forms. The case of Mr. S is a useful illustration of several of the issues involved in prescription drug misuse with respect to the elderly and of the role of long-term care providers in its etiology, prevention, and remedy. Though significantly impaired by his several chronic health problems, Mr. S has been the beneficiary of reasonably sound and responsible care that has apparently minimized the effects of drug misuse and probably served to prevent his institutionalization. [ABSTRACT FROM PUBLISHER]

The case of Mr. S demonstrates that many aspects of medication misuse in the elderly are interrelated. It is clear from review of the case history that Mr. S has experienced significant physical, psychological, and economic consequences from a variety of drug-related sources, including his own self-medication practices, his non-compliance with prescribed therapy, and the polymedicine practiced by his physicians. [ABSTRACT FROM PUBLISHER]

Chronic care is constantly changing, which demands, among other things, a clear understanding of a patient's drug regimen. The regimen should be reviewed periodically in order to maximize therapeutic affects and minimize drug side effects. In the case of Mr. S, many of the chronic care guidelines apparently were overlooked. [ABSTRACT FROM PUBLISHER]

Background: There is increasing concern among primary care practitioners about the use of opioids for chronic pain, including their adverse effects, but little attention has been given to how reports of side effects from prescription medication can contribute to outcomes among patients with chronic pain. The aim of this study was to investigate the impact of frequently reported side effects on mood, disability, and opioid misuse in patients with chronic pain prescribed opioids within primary care., Methods: Two hundred (N = 200) patients with chronic pain taking opioids for pain were recruited into the study. All patients completed baseline measures and a monthly side effects checklist once a month for 6 months. Patients were divided evenly based on a median split of the number of endorsed side effects over 6 months. The subjects repeated the baseline measures at the end of the study period., Results: Over time, reports of medication side effects tended to decrease, but differences in frequency of reported side effects from baseline to follow-up (6-month time) were not significant, and the order of the frequency of the reported side effects remained similar. Patients who reported significant medication-related adverse effects reported significantly greater activity interference, negative affect, and catastrophizing compared with those with fewer side effects ( P < 0.01). In addition, those patients with pain who reported more side effects showed significantly higher scores on opioid misuse risk ( P < 0.001)., Discussion: This study demonstrates the important role of monitoring medication-related side effects among patients with chronic pain who are prescribed opioid medication for pain within primary care., Competing Interests: Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Background: Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. Objective: This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes. Methods: A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden. Results: All patients completed the study. Overall, the intervention had a moderate effect (F1.52=2.83, P=.03, η2=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=-1.5, P=.04, d=0.28; final assessment: mean difference=-1.6, P=.03, d=-0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups. Conclusions: Results suggest that interactive sections as part of Internet-based interventions can positively alter patients' feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. [ABSTRACT FROM AUTHOR]

The continued increase in the usage of medications has led to a variety of negative consequences, including adverse effects on our environment and an increase in misuse/abuse of these products. Improper disposal of unused medications results in significant effects to wildlife and the potential to adversely affect human cells. Increases in misuse/abuse have resulted in significant increases in emergency department visits for drug-related issues. Drug overdose is now the leading cause of accidental death in the United States. Education of both health care providers and the general public about these issues and the proper disposal of unused medications is crucial., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2014.)

Concomitant use of alcohol and medications may lead to potentially serious medical conditions. Increasing prescription medication abuse in today's society necessitates a deeper understanding of the mechanisms involved in alcohol-medication interactions in order to help prevent adverse events. Interactions of medications with alcohol result in altered bioavailability of the medication or alcohol (pharmacokinetic interactions) or modification of the effects at receptor or ion channel sites to alter behavioral or physical outcome (pharmacodynamic interactions). The nature of pharmacokinetic or pharmacodynamic interactions involved in alcohol-medication interactions may differ between acute and chronic alcohol use and be influenced by race, gender, or environmental or genetic factors. This review focuses on the mechanisms underlying pharmacokinetic and pharmacodynamic interactions between alcohol and medications and provides examples for such interactions from replicated research studies. In conclusion, further translational research is needed to address several gaps in our current knowledge of alcohol-medication interactions, including those under various pathologic conditions., (© 2014 Elsevier B.V. All rights reserved.)