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K.C. is a 54-year-old employee at an automotive assembly plant. Three weeks ago on the assembly line, he was rotating and bending when he felt a sudden pain in the left side of his low back. He was immediately taken to the emergency department, given a diagnosis of musculoskeletal strain, and provided Tylenol with codeine #3 (codeine and acetaminophen) with instructions to take on an as-needed basis for pain relief. K.C. was scheduled for evaluation and enrollment in a work-hardening program prior to return to full-time employment at the plant. Last week, K.C. was evaluated at the rehabilitation clinic. Relevant history during the initial assessment included intermittent exertional angina and an approximate 15 pack-year smoking history (half pack of cigarettes per day for 30 years). In addition to a daily baby aspirin, K.C. has been taking Tylenol #3 every day since his injury. For his first work-hardening therapy session, K.C. arrived for an early morning appointment. He admitted that he rushed to the clinic having only eaten a breakfast of “coffee and a couple of cigarettes” with Tylenol #3 about an hour ago. The clinic’s work-hardening program includes a set of progressive aerobic activities designed to mimic the employees’ activities at the plant in order to improve biomechanical function and reduce the incidence of workplace injuries. Within about 10 minutes of starting the session, K.C. complains of shortness of breath and pain along his left arm. The physical therapist instructs him to rest and measures his blood pressure and heart rate at 155/92 mm Hg and 99 bpm (with regular rhythm), respectively. The therapist continues monitoring the patient’s vital signs and symptoms. Over the next 20 minutes, K.C.’s angina and dyspnea dissipate and blood pressure and heart rate decrease to 131/84 mm Hg and 83 bpm, respectively.


As generally understood, drug abuse indicates the use of an illicit (illegal) drug or the excessive or nonmedical use of a licit drug. Often, drugs are abused for altering consciousness, but some are taken for other reasons such as enhancing muscle mass in bodybuilding. Drug abuse also includes the deliberate use of chemicals that are generally not considered drugs by the lay public (eg, inhalants), but may be harmful to the user. The motivation for the misuse or abuse of centrally acting drugs is usually the strong feelings of pleasure or altered perception that the drug induces. With chronic use, dependence occurs with most drugs of abuse. Thus, preventing a withdrawal syndrome reinforces continued drug abuse.

The term drug abuse connotes social disapproval and may have different meanings to different people. Some may also distinguish drug abuse from drug misuse. To misuse a drug might be to take it for the wrong indication, in the wrong dosage, or for too long a period. In the context of drug abuse, the drug itself is of less importance than ...

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