CNE SERIES Nursing Pharmacology Drug abuse is a chronic pub lic health problem, affect ing all levels of society, with potential irreversible consequences. Drug abuse may affect a person’s relationships, employment status, educational opportunities, status in society, and general health and wellness. The initial decision to abuse a drug is often voluntary. However, as the substance’s active chemicals disrupt central nervous system processes over time, the individual’s self-control is chal lenged and he or she becomes unable to resist the urge to use the drug. This is the start of drug addic tion (National Institute of Drug Abuse [NIDA], 2012). However, drug abuse and addiction may be preventable. Systematic reviews on the effectiveness of drug abuse prevention programs delivered through multimedia channels and implemented in schools and com munities have shown a potential to reduce a person’s intention to abuse alcohol and other substances (Champion, Newton, Barrett, & Teesson, 2013; Singh et al., 2011). Prescription drug abuse/misuse is increasing. Nonmedical use of pre scription medications, especially opi oid analgesics, now is considered an epidemic in the United States (Maxwell, 2011). The National Survey on Dmg Use and Health (NSDUH, 2013) reported a significant increase in nonmedical use of pre scription psychotherapeutics (14,657 to 16,666, p=0.01) and painkillers (11,143 to 12,489, p=0.01) across age groups within a year’s time (2011- 2012). The top three abused prescrip tion medications, according to the same NSDUH survey, were variants of hydrocodone/paracetamol (9.0%), acetaminophen with codeine (7%), and alprazolam/lorazepam (5.4%). Rhea Faye D. Felicilda-Reynaldo Prescription drug abuse/misuse is increasing. Nonmedical use of prescription medications, especially opioid analgesics, now is con sidered an epidemic in the United States. Medical-surgical nurses are in a strategic position to help address substance abuse prob lems in patients. Instructions for Continuing Nursing Education Contact Hours appear on page 396. Recognizing Signs of Prescription Drug Abuse and Addiction, Part I Prescription drug abuse can lead to severe, even fatal complications depending on the type of medica tion abused. Stimulant abuse can cause sudden cardiac arrest, high body temperature levels, and sei zures. Abuse of opioids can lead to respiratory arrest and coma. Over dose of sedatives can cause respira tory suppression, which could result in death (Screening, Brief Intervention, and Referral Treat ment [SBIRT] Colorado, 2014). The Substance Abuse and Mental Health Services Administration (SAMHSA, 2013) reported more patient emer gency visits for prescription drug abuse (435/100,000 visits) than illicit drugs (378/100,000 visits) each year. Furthermore, the Centers for Disease Control and Prevention (2011) reported the majority of deaths related to drug overdose are caused by prescription drug abuse. Medical-Surgical Nurses Role in Assessing Substance Abuse Problems in Patients Government health agencies, such as NIDA (2010) and SAMSHA in collaboration with the Health Resources and Services Admini s t r a t i o n (SAMSHA-HRSA) (2014), have stressed the need to screen patients for alcohol and illicit drug use to provide early treatment and reduce risk of development of med ical and psychiatric illnesses due to substance abuse. This call has been echoed by nursing groups such as the American Psychiatric Nurses Association (2012). According to the American Nurses Association (2010), assessing patients for health risk behavior, including substance abuse, is within the scope of nursing practice. Since 1999, SAMSHA (n.d.) has encour aged a no wrong door policy, sug gesting health care providers in all settings are responsible for assess ing patients for substance abuse/ misuse and providing treatment directly or through referral. With their health promotion, communication, and patient educa tion skills, as well as the opportuni ty to build therapeutic relationships with patients in their daily practice, medical-surgical nurses are in a strategic position to identify at-risk patients and provide intervention in the early stages of substance abuse/misuse (Wilson, 2013). Vali dated screening tools are available to aid nurses in the assessment process. The SBIRT is an evidence- based tool that uses motivational Rhea Faye D. Felicilda-Reynaldo, EdD, RN, is Assistant Professor, Department of Nursing, Missouri State University, Springfield, MO; and MEDSURG Nursing Editorial Board Member. For comments and to suggest topics for the Nursing Pharmacology column, contact her at xxxxxxxx. MEDSURGisr ujj *s t isrg November-December 2014 Vol. 23/No. 6 391 CNE interviewing to identify persons with early (nondependent) sub stance abuse problems or those at risk for developing the illness (SAMSHA-HRSA, 2014; SBIRT Colorado, 2011a). The first step of SBIRT involves asking brief ques tions about patients’ alcohol and illicit drug use. W hen patients are screened as positive for substance use, further assessment is initiated using other validated assessment tools, such as the Drug Abuse Screen Test-10 (step 2). Through this step, health care providers get more information about a patient’s health risk behavior. If a patient is determined to be of moderate-to- high risk for abuse, brief interven tion is started based on use of moti vational interviewing. Alternately, the patient could be referred to substance abuse treatment (SBIRT Colorado, 2011a). The SBIRT Col orado (2011b) website provides a supplemental screening algorithm for patients at risk of prescription drug misuse/abuse. Researchers found nurse-deliv ered SBIRT programs to be effec tive. However, the SBIRT program in these studies focused only on assessing alcohol abuse behavior in patients (Broyles, Rosenberger, Hanusa, Kraemer, & Gordon, 2012; Groves et al., 2010). Further re search is needed to address the impact of screening and brief inter ventions on prescription drug
