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In 2016, more than 65,000 people died of drug overdoses in America. About two-thirds of these were linked to opioids and, without intervention, the death rate will rise. A recent study predicted that as many as 650,000 people could die over the next 10 years from opioid overdoses.
It is important that prescribers not throw up their hands and stop utilizing opioids for pain as an attempt to limit diversion or the development of addiction, but rather sharpen their skills in recognizing patients who are at greater risk for developing a substance use disorder.
General Risk Factors
People of any age, sex or economic status can become addicted to opioids, however the following factors increase risk:
- Family history (50% of your risk)
- Mental health diagnosis (38%-69%)
- Substance use at an early age
- Inability to cope with stress
- History of abuse, neglect or past trauma (25%-75%)
- Drug of choice and route of administration
Warning Signs and Red Flags
While general risk factors are important, be aware that sometimes individuals develop substance use disorder without any risk factors present. Below are a breakdown of aberrant behaviors and symptoms commonly seen in the hospital or office setting that are often overlooked.
- Slurred speech
- Pinpoint pupils
- Nodding off
- Loss of alertness
- Slowed breathing
- Presence of withdrawal symptoms (nausea, diarrhea, fatigue, muscle aches, hot/cold sweats)
Psychological and Behavioral Symptoms
- Worsening depression
- Worsening anxiety
- Excessive mood swings
- Erratic behavior
- Loss of interests, activities and friends (isolation)
- Angry or defensive if substance use is brought up
- Problems at work
- History of trauma
- Financial problems
- Legal problems
- Chronic relationship problems
Office Visit Behaviors
There are several warning signs that may be present in how a patient interacts with office staff and office policies that staff may find challenging and actually point to a larger problem.
- Frequent, missed appointments
- Having multiple medical allergies to non-narcotic medications (NSAIDS, Neurontin, Lyrica)
- Unwilling to sign a release for previous doctors
- Bargaining for specific medications
- Requesting higher dosages of medications
- Reluctance to decrease or stop medications
- Abnormal findings on physical exam (needle tracks)
- Kicked out of previous offices or pain clinics
- Family dysfunction or family history of addiction
- Unwilling to sign ROI for significant other or family members
- Being on multiple controlled substances
- Multiple prescribers on MAPS (Michigan Automated Prescription System)
- Different pharmacies on MAPS
- Requesting early refills or losing prescriptions
- Pain out of proportion to physical exam
- As dose goes up quality of life goes down
Treatment for Substance Use Disorders
If you suspect increasing dependence or addiction, do not be afraid to refer to an addiction specialist for a second opinion. Also, remember to utilize community resources that offer HIV testing, syringe access and overdose prevention kits (Naloxone). Despite the magnitude of the current opioid epidemic, astute professionals can help their patients by identifying, adjusting treatments as needed and working with addiction specialists to reduce opioid addiction.
For help determining appropriate level of care or details about any addiction service in the Pine Rest Christian Mental Health Services continuum, please call 866.852.4001.
- Residential Detoxification
- Short-Term Residential
- Inpatient for Dual Diagnosis
- Partial Hospitalization
- Intensive Outpatient
- Traditional Outpatient
- Relapse Prevention
Pine Rest’s John Budnick, PA-C is well rounded and experienced in the continuum of care for patients who suffer with the disease of addiction. He has provided executive leadership and managing skills to help run and operate two separate sub-acute detox centers in Grand Rapids. Budnick is also a faculty member of the Addiction Psychiatry Fellowship starting at Pine Rest in 2018.
Substance Use Disorders: Identification and Treatment
Pine Rest Addiction Services’s John Budnick, PA-C and Bruce Springer, MD presented on the topic “Substance Use Disorders: Identification and Treatment” during our 2016-2017 Pearls for Primary Care lecture series. A recording is available. To request access, please contact the referral relations team at email@example.com.
The presentation provides information about the disease model of addiction; the neurophysiology, risk factors and behaviors; and treatment options including psychosocial treatment options as well as medication assisted treatment of both alcohol and opiates.