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The Prescription Drug Abuse Epidemic: Incidence, Treatment, Prevention, and Policy
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10 The Prescription Drug Abuse Epidemic hazardous property that can develop after only one dose of opioids (Kornet- sky & Bain, 1968). Euphoria, commonly called a drug high, is the activation of reward pathways in the brain that underlines misuse and addiction. These concepts help describe the need for higher treatment doses, but they should not be confused with addiction or physical or psychological dependence. Addiction is a primary chronic disorder of an individual pathologically pursuing reward or relief through substance use and other behaviors (Amer- ican Society of Addiction Medicine, 2011). Addiction is the end result of neu- rochemical changes to the brain that create compulsive drug-seeking and drug-use behavior. The reasons why some people develop addiction to these inherently addictive medications while others do not are not clear. Addiction and overdose can occur in individuals with prescriptions for opioids to relieve pain and those who nonmedically use (i.e., those using medications that were not prescribed for them or were taken only for the experience or feeling that they cause). Almost 75 percent of all opioid misuse starts with people taking a medication that was not prescribed for them (Center for Behavioral Health Statistics and Quality, 2015). A study involving 136,000 opioid overdose patients treated in the emergency department in 2010 found that only 13 percent of those patients had a chronic pain diagnosis (Yokell et al., 2014). Predictors of overdose have been identified in the literature that can assist health care providers with targeting interventions for those at risk (Cochran et al., 2017 Rice et al., 2012 Sullivan & Fiellin, 2008). Medical Uses Virtually everyone experiences moderate or severe pain at some point in their lifetime. More than 30 percent of Americans have some form of chronic pain (Johannes, Le, Zhou, Johnston, & Dworkin, 2010), so it is unsurprising that opioids are the third most commonly prescribed class of medications in the United States, following antimicrobials and antidepressants (Zhong et al., 2013). According to the Centers for Disease Control and Prevention (CDC), 70.6 opioid prescriptions per every 100 persons were issued annually from 2012 to 2015 (Guy et al., 2017). This is approximately three times the num- ber of prescriptions written in 1999. The average morphine milligram equiv- alent (MME) for each prescription is about 640 MME per person annually. Americans consume over 80 percent of the world’s opioid supply, over 99 percent of all manufactured hydrocodone, and two-thirds of the world’s ille- gal drugs (American Society of Interventional Pain Physicians, n.d.). It is esti- mated that 2 million people in the United States have a problematic pattern of opioid use that has led to clinically significant impairment, or opioid use disorder (OUD American Psychiatric Association, 2013). Opioids can be used for various types of pain, including pain caused by cancer and chronic noncancer pain (CNCP). Use of opioids for CNCP is