Prescription Opioid Drug Misuse: Promoting Treatment in Drug Court, 0917 COBJ, Vol. 46, No. 8 Pg. 28
| Author | JAMI VIGIL, J. |
August, 2017
PROBLEM SOLVING COURTS
JAMI VIGIL, J.
Tis is the third in a series of articles dedicated to exploring current best practices and common issues facing problem solving courts locally and nationally. As described in the prior two installments, problem solving courts are developing throughout the United States to promote rehabilitation and reduced recidivism through collaborative and therapeutically guided court programs addressing complex problems such as substance abuse, domestic and family violence, mental health issues, and truancy.
Concern over prescription drug misuse seems to be everywhere these days, and the alarm is warranted. Prescription drug misuse and dependence are on the rise, along with deaths related to prescription drug overdose. By some estimates, as much as 63% of drug overdose deaths in the United States involve an opioid—either a prescription opioid like codeine or an illicit opioid like heroin.1 National data shows a steady increase in prescription overdose deaths since 1999.2 In Colorado, in 2015 alone, there were a reported 472 opioid-related overdose deaths.[3]
Although there are many prescription drugs that can be misused, this article focuses on prescription opioids, chronic pain treatment, and recommended drug court best practices. Many prescription drugs that frequently appear in court-ordered drug testing are potentially addictive. For example, drugs commonly prescribed to relieve anxiety and depression, including lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium), are potentially addictive.4 However, this article focuses on prescription opioids because they are the most misused and have significant adverse consequences for drug court participants.
Medication assisted treatment, though helpful and often recommended for opioid misuse and abuse, is not addressed in this article, as that was the subject of the second article in the series.5 Also beyond the scope of this article are the numerous local, state, tribal, and national efforts to address this public health epidemic. There are countless projects underway in the United States that aim to educate both patients and prescribers on the severity of this crisis; ensure responsible prescribing of prescription drugs; and encourage patients with prescription opioid dependence and addiction to seek assistance and treatment.
Prescription Opioids and Opioid Use Disorder
“Opioid” refers to a specific class of chemically related drugs that includes illegal substances such as heroin; synthetic drugs like fentanyl; and many common prescription pain relievers legally available, including oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others.6 All opioids function similarly in that they interact with receptors on nerve cells to dull the perception of pain and create feelings of euphoria.
Opioids have been, and are generally still, considered safe for short-term pain management and post-operative care in the United States.7 Standard medical practice in the United States recognizes a limited medical use for prescription opioids. For instance, patients may experience pain following an invasive medical procedure or surgery. Many medical and dental professionals believe that a prescription opioid, when administered for a limited amount of time at a controlled dose, may help the patient rest and recover. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) states that when those same prescription drugs are taken in any other way than as medically recommended, this use should be considered prescription drug misuse. 8
Although prescription opioids...
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