Vol. 17, No. 1
March 2012

Child Welfare and Prescription Drug Abuse
Answers to Common Questions

1. If a client has a valid prescription, how can I verify misuse?
Only a physician or substance abuse professional can formally diagnose or identify abuse or misuse of prescribed medications. However, as a child welfare professional, you are in an excellent position to screen for the signs of substance abuse/misuse. To do this, look for indications the client’s use of prescription drugs is problematic: Does she seem in control of her use of the medicine? Is the quality of her life expanding with the treatment, or constricting? Does she continue to increase her use of the drug in spite of adverse consequences or problems? Does she use the medicine as prescribed? (Scholl & Finch, 1994). Or, use a brief screening tool such as the CAGE or UNCOPE.

If there are signs of a problem, seek the client’s written permission to communicate with the prescribing physician, and/or refer the client for an evaluation by a substance abuse professional. Also, the problem may be that the person has pain that is not being adequately addressed; a physician will be able to assess this possibility, and will know how to support the person with appropriate pain management strategies if need be.

2. Is there a way to determine the level of a drug in someone’s system? It is prescribed to be taken “as needed” for chronic pain.
Even if you could determine the amount of the drug in the client’s bloodstream, the information would probably be meaningless—the client is under a doctor’s care and apparently taking the medication as prescribed. It is more useful to look for signs of a problem as described in question 1 above.

3. Is it common for family physicians to prescribe mental health medications?
Yes, many family doctors now prescribe medications to treat mental problems; it is very common in some communities due to a shortage of psychiatrists.

4. Do hospitals and medical offices have a way to flag people who may be abusing drugs?
North Carolina has something called the Controlled Substance Reporting System (CSRS). Established by State law, the CSRS is a prescription monitoring system that allows registered dispensers (pharmacists) and medical practitioners to review a patient’s controlled substances prescription history on the web. It is intended to help practitioners monitor, identify, and refer patients for specialized substance abuse treatment or specialized pain management.

All prescriptions for controlled substances (schedule II through V) dispensed in North Carolina are reported into the CSRS database. Pharmacies transmit the data weekly. Prescribers and pharmacists register and are then granted a password to access the system online to look up a patient’s controlled substances prescription history. Information in the system dates back to July 2007. Prescribers may legally query the system for their patients only. Participation in the system is voluntary. Currently about 20% of physicians in the state participate in this system, but enrollment is growing.

Ask doctors and hospitals if they participate in the CSRS. In the next few years, expect to see more doctors connected with Medicaid and CCNC (Community Care Network of NC, http://www.communitycarenc.com) using this reporting system. To learn more, visit:

• http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_90/Article_5.html
• http://www.ncga.state.nc.us/gascripts/statutes/statutelookup.pl?statute=90-113.74

5. Can I access people’s prescription profiles on the CSRS if I have a HIPPA release?
No. The only people who can access CSRS are prescribers, special agents, and other specific parties. If DSS is working with law enforcement and this is pertinent information in protecting a child, DSS can work with law enforcement to share information as needed from the CSRS.

6. Are doctors who overwrite scripts ever prosecuted?
Doctors are subject to criminal prosecution if they break the law. Although prosecutions and convictions of this kind are uncommon, they do happen. However, in the vast majority of cases “overwriting” prescriptions is unintentional and due to difficulty communicating with other doctors and a variety of other factors.

7. What is the success rate of Suboxone clinics?
Suboxone is a prescription narcotic drug used to treat opioid dependence. General success rates for Suboxone (or other drug treatment modalities) are not particularly meaningful because each person is different—each person’s vulnerability to addiction is variable. Addiction severity varies. Furthermore, treatment success depends on treatment of other co-occurring conditions (e.g, depression) and environmental factors; stress is a primary relapse predictor.

8. If methadone is used as prescribed, does it affect the caregiver’s ability to parent?
Used as prescribed, methadone does not cause euphoria or intoxication. Instead, it allows people to work and parent, live productive lives, and improve their health (Joseph, 2000; Brady, 2007). For more about methadone and medication assisted drug treatment (MADT), click here and here.

References for this and other articles in this issue

Read the February 2012 issue of Training Matters to learn more about child welfare practice with families struggling with substance abuse.