Prescription Drug Abuse

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By Manonmani Antony, MD.

Prescription Drug Abuse:

The Silent Epidemic and How To Prevent

Prescription drugs are the second-most abused category of drugs in the United States, following marijuana. It is not a new problem, but one that deserves renewed attention. For although prescription drugs can be powerful allies, they also pose serious health risks related to their abuse.

Definition

Prescription drug abuse is the intentional use of a medication without a prescription; use of a medication in a way other than as prescribed (crushed and injected or snorted); use of a medication for the experience or feeling it causes;  for a nonmedical purpose such as altering one’s state of consciousness (e.g. getting high).

Prescription drug abuse remains a significant problem in the United States.

In 2010, approximately 7.0 million persons were current users of psychotherapeutic drugs taken non-medically (2.7 percent of the U.S. population), an estimate similar to that in 2009. The medications most commonly abused are:

Pain killers (opioids) – 5.1 million

Tranquilizers – 2.2 million,

Sedatives – 0.4 million

Stimulants – 1.1 million

Among adolescents, prescription and over-the-counter medications account for most of the commonly abused drugs by high school seniors.

Among those who abuse prescription drugs, high rates of other risky behaviors, including abuse of other drugs and alcohol, have also been reported. (NIDA, 2011)

Risks of commonly abused prescription drugs

Painkillers (Opioids): refers to opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin, Oxycodone, Opana (oxymorphone), morphine, codeine and methadone.

Addiction. Prescription opioids act on the same receptors as heroin and can be highly addictive. People who abuse them sometimes alter the route of administration (e.g. snorting or injecting) to intensify the effect; some even report moving from prescription opioids to heroin.

Overdose. Abuse of opioids, alone or with alcohol or other drugs, can depress respiration and eventually lead to death. Prescription painkiller overdoses are a public health epidemic. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999 and now outnumber those from heroin and cocaine combined. Nearly half a million emergency department visits in 2009 were due to people misusing or abusing prescription painkillers.

Heightened HIV risk. Injecting opioids increases the risk of HIV and other infectious diseases through use of unsterile or shared equipment. Non-injection drug use can also increase these risks through drug-altered judgment and decision making.

Tranquilizers and Sedatives: refers to medications used to treat anxiety and sleep problems, including drugs such as Valium, Ativan, Xanax and Ambien (zolpidem).

Addiction and dangerous withdrawal symptoms. These drugs are addictive and, in chronic users or abusers, discontinuing them absent a physician’s guidance can bring about severe withdrawal symptoms, including seizures that can be life-threatening.

Overdose. High doses can cause severe respiratory depression. This risk increases when CNS depressants are combined with other medications or alcohol.

Stimulants: refers to medications used to treat ADHD and narcolepsy, including drugs such as Adderall and Ritalin

Addiction and other health consequences. These include psychosis, seizures, and cardiovascular complications.

What is driving this high prevalence?

Multiple factors are likely at work:

Misperceptions about their safety. Because these medications are prescribed by doctors, many assume that they are safe to take under any circumstances. This is not the case. Prescription drugs act directly or indirectly on the same brain systems affected by illicit drugs. Using a medication other than as prescribed can potentially lead to a variety of adverse health effects, including overdose and addiction.

Increasing environmental availability. The supply of prescription painkillers is larger than ever. The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was 4 times larger in 2010 than in 1999. Many states report problems with “pill mills” where non-pain doctors prescribe large quantities of painkillers to people who don’t need them medically. Some people also obtain prescriptions from multiple prescribers by “doctor shopping.” Online pharmacies make it easy to get prescription drugs without a prescription, even for youngsters.

Varied motivations for their abuse. Underlying reasons include: to get high; to counter anxiety, pain, or sleep problems; or to enhance cognition. Whatever the motivation, prescription drug abuse comes with serious risks.

Treatments for Prescription Drug Abuse

Available options for effectively treating addiction to prescription drugs depend on the medication being abused. Approaches to treating pain reliever addiction are drawn from research on treating heroin addiction, and include medications Suboxone (buprenorphine + naloxone), combined with behavioral counseling.  Another promising approach includes long-acting formulations of medications, such as Vivitrol, a depot formulation of the opioid receptor blocker naltrexone, recently approved by the FDA to treat opioid addiction

Although no medications yet exist to treat addiction to Tranquilizers and Sedatives or to prescription stimulants, behavioral therapies proven effective in treating other drug addictions may be used.

What Can Be Done To Prevent Prescription Drug Abuse

Patients can…

Use prescription painkillers only as directed by a health care provider.

Make sure they are the only one to use their prescription painkillers. Not selling or sharing them with others helps prevent misuse and abuse.

Store prescription painkillers in a secure place and dispose of them properly.

Get help for substance abuse problems if needed from your doctor or call 1-800-662-HELP.

Physicians can…

Follow guidelines for responsible prescribing, including the new regulation on the use of controlled substances for the treatment of pain released by Delaware Board of Medical Licensure and Discipline, effective February 11, 2012.

Screening and monitoring for substance abuse and mental health problems.

Prescribing painkillers only when other treatments have not been effective for pain.

Prescribing only the quantity of painkillers needed based on the expected length of pain.

Using patient-provider agreements combined with urine drug tests for people using prescription painkillers long term.

Talking with patients about safely using, storing and disposing of prescription painkillers.

State medical Board can…

Start prescription drug monitoring programs (PDMPs), which are electronic databases that track all prescriptions for painkillers in the state.

Pass, enforce and evaluate pill mill, doctor shopping and other laws to reduce prescription painkiller abuse.

Increase access to substance abuse treatment.

(NIDA 2011, CDC, 2011)

Dr. Manonmani Antony is a pain fellowship trained, board certified anesthesiologist who focuses on comprehensive pain management. Dr. Antony believes that the problem with prescription drug abuse cannot be overstated. “It’s an enormous problem that is consuming medicine and policy makers,” she says. “Our goal is to help make sure prescription drug abuse is addressed, while access to appropriate care for people suffering in pain is not unduly hindered. The drugs that treat pain are essential for society and we don’t want to lose that valuable arsenal. We strongly advocate for safety and effectiveness of all pain treatments.”

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