Opiate addiction and prescription drug abuse: a pragmatic approach.

In the United States, the abuse of prescription medications, and especially opiates, has significantly impacted escalating health-care costs, increased patient hospitalizations, and has led to a growing number of untimely deaths. Approximately 14% of American adults are using pain medications for nonmedical purposes; therefore, the recreational use of opioids is steadily on the rise. Contributing to the problem is a small number of physicians who indiscriminately prescribe opiates without proper assessment and a lack of use of nonaddictive adjunctive medications. The result has created a culture of iatrogenic drug addiction, and the offending providers are described as being “legalized drug pushers.” There are several pragmatic changes to physician practices that are proposed that address this ever-growing problem. This includes limiting narcotic prescriptions for noncancer pain management. In addition, physicians must monitor the dosage, quantity, and treatment duration of narcotic usage. In the treatment of opioid dependence, physicians must properly control the use of agonist replacement treatments as these have developed a street value. Without adequate support measures and follow-up, the prescribing of narcotics will have addictive consequences. Additionally, certain treatment guidelines are recommended. These include restricting the patient to one pharmacy of his or her choice, expecting the patient to attend regular treatment support groups, requiring the patient to pay copayments in advance and other measures. These, along with changes in public policy and educational programs, will limit the growing trend of prescription drug abuse in the United States.