Q&A: Poly-substance Misuse Treatment with Dr. Melinda Campopiano

This is a reprint of a great question and answer on the Substance Abuse and Mental Health Services Administration (SAMSHA) its more geared for doctors but it does illustrate the issues around prescription drug abuse


SAMHSA Medical Officer Melinda Campopiano addresses concerns about provider care and prescription drugs raised by a recent TEDS Report  on benzodiazepene and narcotic pain reliever treatment admissions.

What needs to be considered by providers when they’re prescribing drugs that can lead to misuse or addiction?
Judgment is crucial, but having accurate information upon which to base one’s judgment is a necessary first step.

How does a provider fulfill this “necessary first step” and obtain accurate information?
The APA guidelines recommend all patients be screened for substance use disorders prior to being prescribed psychiatric medications of any kind, not just benzodiazepines.

Why should all people be screened if some people just need pain management medication and have no history of psychiatric conditions?
Screening all patients is a sound recommendation with regard to the population at risk for fatalities from accidental overdose. It is also sound advice from the point of view of assuring the best possible psychiatric recovery for the individual under the psychiatrist’s care. This “universal” approach does not permit those persons who are dependent on opioids for pain management and who have never abused them to be exposed to the added risk of concomitant benzodiazepene use without a full discussion and consent simply because they do not presently have a substance use disorder.

For providers utilizing these drugs in treatment, what are resources to help them prevent drug misuse?
The field of addiction medicine has been observing the rise of misuse of benzodiazepines in conjunction with opioids for a long time. Consequently, while not all patients prescribed both of these substances necessarily have a substance use disorder, the field has useful experience and guidance to offer health care providers in other disciplines. I believe TIP 40 and TIP 43 remain accurate and easily accessible resources on this subject.

Are there any other resources you can recommend?
The webinar offered by PCSS-O would be a good introduction for health care providers not ready to recognize what the specialty of Addiction Medicine has to offer as relevant to their patient populations.

Melinda Campopiano, M.D., is a Medical Officer in the Division of Pharmacologic Therapies in SAMHSA’s Center for Substance Abuse Treatment.

Resources mentioned:

  • TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
  •  TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs
  •  The Prescribers’ Clinical Support System for Opioid Therapies (PCSS-O) is a national training and mentoring program. It addresses the safe use of opioid medications and treatment of opioid dependence. As part of those efforts, a webinar on January 8th with the subject of ‘Managing Poly-Substance Abuse – A Case Discussion’ will be held. You can register here for the webinar.
  • A just-issued TEDS Report gives a picture of patients who enter treatment for combined benzodiazepine and narcotic pain reliever abuse. These admissions show distinct demographic differences from other treatment admissions and the information can be used to tailor therapies to individuals.

Related in the news:
Los Angeles Times article “Dying for Relief” investigates reckless prescription of drugs and its consequences.