Prescription Drug Abuse. Walter Ling MD Integrated Substance Abuse Programs Semel Institute for Neuroscience and Human Behavior UCLA Western Conference on Addiction Universal City, California Sunday November 13, 2005 firstname.lastname@example.org www.uclaisap.org.
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Walter Ling MD
Integrated Substance Abuse Programs
Semel Institute for Neuroscience and Human Behavior UCLA
Western Conference on Addiction
Universal City, California
Sunday November 13, 2005
Any non-prescribed use of a drug (NIDA, 2002 & DEA, 1970)
Non-medical use of a substance for psychic effect, dependence, or suicide attempt or gesture (SAMHSA, 2002)
Any harmful use, irrespective of whether the behavior constitutes a “disorder” in the DSM-IVdiagnostic nomenclature (IOM, 1996)
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by one or more behaviorally-based criteria (APA, 1994)
Hydrocodone Lortab, Vicodin
2002 National Survey on Drug Use and Health (NSDUH), SAMHSA, Sept 5, 2003
No prescription required!
Easy Access: Role of the Internet?
“Delivered in the Privacy of your Home”
Source: NESARC Study
Is pain associated with opioid disorders?
Opioid Disorders According to Different Levels of
Past 4 Week Interference Due to Pain
Nearly Linear Relationship of Pain and Opioid Use Disorder
Number of Prescriptions (in 1000s)
Source: IMS Health for Prescriptions and SAMHSA (DAWN) for Emergency Department MentionsAs Prescriptions Increase, Emergency Room Reports Have Increased at the Same or Faster rate
“Among the remedies which it has pleased Almighty God to give to man to relieve his suffering, none is so universal and so efficacious as opium.” - Thomas Syndenham, 1680
Opiate—an unlocked door in the prison of identity. It leads into the jail yard. - Ambrose Bierce, The Devil’s Dictionary
The junk merchant does not sell his product to the consumer, he sells the consumer to the product. He does not improve and simplify his merchandise, he degrades and simplifies the client.
It is always subjective. Each individual learns the application of the word through experiences related to injury in early life.—IASP
Sufferers of chronic pain suffer for nothing
Feeling (sensory experience) : Pain
Meaning (emotional & cognitive): Suffering
Action– Expression of the “word”: Behavior
Chronic pain is not having lots of pain; its having
pain and behaving like a chronic pain patient
Fishbain, 1986, 1992; Kouyanou et al., 1997
*Adams et al., 2001; Brown, 1996;
Same predictors as in non-pain patients
Drug-seeking or increased requests for pain medication
pathology/pain of new source
Detailed pain work-up
No new pain pathology
Absence of toxicity
Presence of toxicity
M. Soledad Cepeda et al.
Proc 10th world Cong on Pain vol 24; pp 601-609