RX & OTC MEDICATIONS

FTA Drug and Alcohol Regulation Updates
Issue 33, page 5

     According to the 2004 National Survey on Drug Use and Health, the number of Americans reporting abuse of prescription medication was higher than the combined total of those reporting abuse of cocaine, hallucinogens, inhalants, and heroin. The National Survey on Drug Use and Health defines prescription drug abuse as using "any prescription (pain reliever, sedative, stimulant, tranquilizer) that was not prescribed for you or that you took only for the experience or feeling it caused."
     The abuse of prescription medications can have an adverse impact on health including overdose, toxic reactions, hypertension, seizures, cardiovascular collapse, and death. Many prescriptions have high potential for misuse, abuse, dependence, and addiction even in the context of good medical care. Drug classes that have contributed to prescription misuse, abuse, dependence and addiction include opioid analgesics used for management of acute or chronic pain, sedative-hypnotics (Benzodiazepines) for anxiety, panic disorders and acute stress reactions, sedative-hypnotics (Barbiturates) for insomnia, anxiety and seizure control, and stimulants used for attention deficit disorder (ADD) and attention deficit/hyperactivity disorder (AD/HD), narcolepsy, weight loss, and depression.
     Inappropriate use of medications can be categorized as non-medical use, misuse, abuse, physiological dependence, and psychological dependence. Non-medical use is when use of the medication is not prescribed by a medical professional and is used for the experience or feeling it causes. Misuse is the incorrect use of a medication by not following prescribed dosage levels, frequency of use, or use for a purpose other than for which it was prescribed. Abuse is when the pattern of use leads to clinically significant impairment or distress that manifests itself in the individual's behavior. Physiological dependence is when the individual experiences increasing tolerance for a drug and experiences withdrawal when the medication is discontinued. Psychological dependence or addiction is when the individual experiences an overall loss of control, seeks medication compulsively, and continues use of the medication in spite of negative consequences.
     According to the Substance Abuse Treatment Advisory published by the SAMHSA's Center for Substance Abuse Treatment, prescription medication use "may quickly escalate to unintended and initially unanticipated levels beyond the initial intended use, alarming both the patient and treatment provider." Some individuals may have predisposing factors that lead to psychological dependence on a substance, while, physiological dependence is an expected side-effect of some medical treatments for pain. Others may self-medicate using previously prescribed medication to treat new or under-treated illnesses or disorders. Treatment of individuals with certain conditions, especially those associated with chronic pain, is very complicated and can result in various psychological and physiological disorders that lead to misuse, abuse, and dependence. Individuals may also abuse alcohol or illicit drugs further complicating treatment. Treatment for prescription medication misuse, abuse, and dependency is the same as for illicit substance abuse.
     Given the prevalence of prescription medication misuse in American society, employers, especially those that employee safety-sensitive individuals, should proactively address this problem as part of their fitness for duty programs. The Substance Abuse Treatment Advisory recommends that individuals with addictions or dependence to prescription medications have access to the following resources or professionals.

• Appropriate dose-tapering or other detoxification services,
• Medical practitioners with expertise in pain management and/or pain clinics,
• Psychiatrists with expertise in addiction treatment and psychotropic medication management, and
• Addiction counselors, social workers, and/or psychiatric nurses with experience and training in providing cognitive-behavioral therapy and other approaches for treating anxiety and panic disorders, post-traumatic stress disorder, ADD, AD/HD, and eating disorders.

Employee educational programs should provide employees with information on how to discuss treatment options with medical practitioners when pain or other psychoactive prescription medications are needed. 　

The information presented on this page should be used to update Chapter 5 of the revised Implementation Guidelines.