One of the greatest contributors to the current substance abuse crisis in the US is the misuse of prescription medications. Misuse of various prescription medications can lead to substance abuse, addiction, overdose, and illicit drug use. This has led to what is being described as a drug overdose epidemic by the US Centers for Disease Control and Prevention(CDC), as well as increasing rates of substance abuse and addiction.
A number of tools can help in the struggle against this increase in prescription drug overdose and addiction. Both as a form of prevention and as a way to support recovery from addiction, medication therapy management is emerging as one way to help individuals take control of their medication use and recover from addiction.
What Is Medication Therapy Management?
Medication therapy management is a series of services provided by pharmacists to help people get the most out of their prescription medications. According to the American Pharmacists Association, these services include:
- Medication therapy reviews to resolve any issues with the individual’s medications
- Pharmacotherapy consults for pharmacist expertise on complex treatments and outcomes
- Disease management coaching to provide ideas on drug and non-drug treatment support
- Pharmacogenomics to account for the individual’s specific physical attributes
- Anticoagulant management to monitor risk for individuals on such medications
- Medication safety surveillance to avoid dangerous drug and supplement combinations and other risky medication issues
- Other needed clinical services, including immunizations
Medicare explains that, through these services, pharmacists can help other treatment professionals avoid medication conflicts, help the individuals in treatment understand how to take medications and incorporate other treatment modalities for optimized treatment outcomes, and match the medications to the individual based on physical and mental health needs.
Medication Therapy Management in Addiction Treatment
Medication therapy management can contribute to addiction prevention, treatment, and recovery in multiple ways, based on the following facts regarding addiction and addiction treatment:
- Addiction sometimes develops from misuse of medications by people whose treatment is not closely managed by the treating physician or because individuals taking the medications don’t understand or are taking advantage of the addictive potential of the medication.
- Addiction treatment and recovery sometimes depend on medications to support detox and help maintain abstinence from the drug of abuse; sometimes addiction can be transferred to these drugs if their use is not closely managed.
- Individuals undergoing addiction treatment may need medications to treat other health conditions, making it difficult to gain control over addiction because of the need to keep taking potentially addictive drugs.
Involving the pharmacist in treatment from the beginning can provide expertise that manages these situations while providing treatment to the individual that maximizes positive treatment outcomes. A study from the Journal of the American Pharmacists Association also indicates that regular medication review through medication therapy management can help bring substance abuse issues to the pharmacist’s attention for intervention, referral, and treatment, if needed.
The uses of medication therapy management in each of these situations is detailed further below.
Medication Misuse and Substance Abuse
One of the most prevalent sources of substance abuse problems is misuse of medication. An example is a study from the Journal of American College Health, which discusses the misuse and abuse of stimulant medications like Ritalin and Adderall – normally prescribed to treat attention deficit hyperactivity disorder – to improve study habits. This abuse often becomes addiction as the individual begins to use the drug more and more often, and the body becomes unable to function without the drug.
Similar issues occur with opioid-based pain control medications and anti-anxiety medications like benzodiazepines and barbiturates. The National Survey on Drug Use and Health for 2015 indicates that nearly 19 million people misused prescription drugs, and that number appears to be rising. As this misuse of prescription medications increases, so does overall substance abuse; this, in turn, takes a heavy toll on families and communities and creates a high financial cost for the country, as explained in Pain Medicine.
Taking advantage of medication therapy management not only enables a medical professional – the pharmacist – to observe the individual’s misuse of medications, but can potentially prevent deceptive or improper prescribing practices like obtaining duplicate prescriptions from multiple pharmacies for off-label or illicit use. This can prevent substance abuse or addiction from developing. It can be useful for the individual in addiction recovery who may be at risk for relapse, and in turn can decrease the cost of substance abuse by decreasing the issues related to it.
Addiction Treatment Medications
Another area in addiction treatment where medication therapy management can provide a benefit is through the medicines that are sometimes used to manage addiction recovery. Many of the drugs used to help people get through detox or withdrawal – like gabapentin, baclofen, and methadone – have themselves demonstrated addiction potential and have sometimes been misused by treated individuals.
An example of this is a case study from the Indian Journal of Psychological Medicine in which baclofen, which is considered to have low addiction potential, became a subject of abuse by an individual being treated for nicotine abuse. The individual also experienced common withdrawal symptoms when baclofen use was stopped, indicating that the person was potentially addicted.
In cases like this, medication therapy management can be extremely important to determine whether medication support is going to help or worsen an individual’s chances of achieving recovery. In cases where medication is required, the medication therapy management can provide oversight of the medication’s use. Otherwise, it can suggest alternative therapies, such as Cognitive Behavioral Therapy and other psychological treatments, that are more likely to provide positive results.
Medications for Other Conditions
Sometimes, clients who are in treatment for substance abuse have become addicted to a medication that is legitimately necessary to treat a chronic medical condition. This can be true for painkillers, anti-anxiety medications, or medicines used to treat other mental or physical conditions. If this is the case, it can be difficult to manage the co-occurring disorder while providing substance abuse treatment.
In this case, medication therapy management can be highly useful in proposing alternative treatments. For example, an article from The Primary Care Companion to the Journal of Clinical Psychiatry demonstrates that, while it may be tempting to provide pain medications with lower addiction potential to people in addiction treatment, providing inadequate pain relief can make the individual seek out other forms of pain relief outside of the prescribed medication, including illicit drugs or other forms of substance abuse.
Medication therapy management can help by selecting medications that provide adequate treatment for the chronic condition, while at the same time monitoring and controlling use. The pharmacist can also provide information on non-drug therapies that can help manage the co-occurring disorder and help the individual to balance these out with any required medications. This can help the individual to stay in control and maintain recovery without relapsing to misuse and abuse of treatment medications.
Accessing Medication Therapy Management
For the individual in addiction recovery, there is always a risk of relapse. Having a wide range of tools available to minimize this risk gives the individual the best chance at moving forward and maintaining abstinence. However, the individual may not know what all of these tools are, let alone how to access them.
Consulting with a professional addiction treatment center can be the first step in finding the tools that will help the individual come to terms with, detox from, and recover from substance abuse or addiction. When seeking an appropriate treatment center, it is valuable to ask about therapy options and what might be available. If the above conditions apply to the individual, asking about medication therapy management can help to determine whether the treatment facility is right for the individual.
A research-based, certified, and experienced treatment facility is likely to provide medication therapy management as part of a customized treatment plan. With this type of plan, the individual can look forward to a greater chance of achieving recovery and staying sober into the future.