Module 4: Therapeutics

Lesson 1

Learning outcome

Make informed decisions regarding when to prescribe CDS.

Introduction

The driving factors behind the need for judicious CDS prescribing are considered in this lesson. It emphasizes the need for both short-term and long-term assessment of indications for the use of CDS, the availability of well-tolerated alternatives, and the risk of misuse.

Abuse and misuse of CDS

In discussing the prescription of CDS, Lader (2011) highlights “the difficulty of preventing short term use from drifting into long term use where efficacy is largely unestablished and the range of unwanted effects including dependence remains a major public concern” (p. 2102).

Dr. Jackson, who trained in anesthesiology at the University of North Carolina and completed a fellowship in chronic pain management at Stanford University, makes the point that “pain is in the brain”. She explains why a pill won’t make it go away and explores how clinicians and patients are getting pain management wrong, and how pain management can be made right (TedX Talks, 2016).

Dr. Volkow, Director of the National Institute on Drug Abuse at the NIH, also identifies addiction as a brain disease. A world leader in the neurobiology of diseases of reward and self-control such as addiction and obesity, Dr. Volkow was born in Mexico City where she lived until completing medical school. While training as a psychiatrist in New York City, she began studying the effects of drugs on the human brain using brain imagining technologies. Her research has been instrumental in demonstrating that addiction undermines the function of circuits underlying reward, motivation, and self-control, and in identifying overlapping circuitry disruptions in (TEDMED, 2015).