Prescription Drug Abuse

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What is prescription drug abuse?

The National Survey on Drug Use and Health (NSDUH) defines prescription drug misuse as use of the drug in any way that does not comply with the doctor’s directives. This includes using the drug without a prescription; using it longer than the prescribed period; using the drug in greater amounts than the prescribed dosage; or using in any other way that does not adhere to the doctor’s instructions. In other words, prescription drug abuse means use of drugs without a prescription or use for reasons outside of intended purposes.

Prescription Drugs for Non-medical Purposes
“Non-medical use of prescription drugs” is another way of describing problematic drug-taking behaviors, ranging from noncompliance to recreational use to abuse (Simoni-Wastila & Strickler, 2004). The significant increase in nonmedical use of prescription opioids among youth and young adults can be attributed to its availability over illicit drugs (Martins & Ghandour, 2017). HealthDay News Reporter Dennis Thompson adds a contemporary meaning to the term “non-medical use.” In his article published in U.S. News & World Report, Thompson cites a study that most emergency room (ER) visits related to prescription misuse are attributed to patients’ mixing different substances such as alcohol and other drugs. The study, which appears in the American Journal of Preventive Medicine, reveals that when prescription medications such as opioids and benzodiazepines are mixed with non-pharmaceutical substances or psychoactive drugs, the result can be dangerous or fatal.

Risks of Prescription Drug Misuse

Consequences for prescription drug misuse have short- and long-term range effects, which are contingent upon the type of drug, the method of use, the dosage, the patient’s health and other variables. The individual may experience short-term changes in appetite, blood pressure, alertness, heart rate, mood stability, stroke, psychosis and some cardiac event such as a heart attack. The symptoms can occur soon after just one use and may result in an emergency department (ED) visit for prescription drug use disorder.

Long-term consequences may include chronic diseases such as cardiovascular, gastrointestinal, and respiratory diseases and other health effects, including damage to the vital organs, brain damage and substance abuse addiction.

Most Commonly Abused Prescription Drugs

The most common types of prescription misuse can be classified into three categories: opioids, central nervous system (CNS) depressants, and stimulants, according to the National Institute on Drug Abuse (NIDA).

Opioids
• Treatment for pain relief and chronic pain; also used to treat cough and diarrhea
• Side effects: Even if used as prescribed, opioids can lead to the development of an opioid use disorder. One single large dose can significantly slow down or stop breathing. Taken with alcohol or other sedatives, opioids increase the risk for respiratory depression.
• Consequences of opioid misuse: Regular or prolonged use of opioids may lead to opioid dependence. Addiction withdrawal symptoms may include bone pain, restlessness, nausea and vomiting, cold flashes, involuntary leg movements, insomnia and diarrhea. Cessation of opioid use may lead to heroin use to avoid withdrawal symptoms.
• Brand names:
– hydrocodone (e.g., Vicodin®),
– oxycodone (e.g., OxyContin®, Percocet®),
– oxymorphone (e.g., Opana®),
– morphine (e.g., Kadian®, Avinza®),
– codeine,
– fentanyl
– codeine and diphenoxylate (Lomotil®) (also used for cough and diarrhea relief)

Central nervous system (CNS) depressants
• Treatment for anxiety, sleep disorders, acute stress, panic attacks, etc.
• Side effects: drowsiness and lack of coordination in the first few days
• Consequences of CNS depressant misuse may result possible physiological dependence with prolonged use. Addiction withdrawal symptoms may include rebound effects such as seizures. Benzodiazepine withdrawal symptoms are not as severe as barbiturate withdrawal symptoms, which could be life-threatening.
• Brand names
– Benzodiazepines (e.g., diazepam (Valium®), clonazepam (Klonopin®), and alprazolam (Xanax®), triazolam (Halcion®) and estazolam (Prosom®)
– Non-benzodiazepine sleep medications (e.g., zolpidem (Ambien®), eszopiclone (Lunesta®), and zaleplon (Sonata®)
– Barbiturates (e.g., mephobarbital (Mebaral®), phenobarbital (Luminal®), and pentobarbital sodium (Nembutal®)

Stimulants
• Treatment for attention-deficit hyperactivity disorder (ADHD), narcolepsy (a sleep disorder characterized by sleep paralysis, excessive sleepiness, hallucinations, etc.), and other depressive disorders
• Side effects: energy and alertness; increased blood pressure, heart rate and breathing
• Consequences of stimulant misuse may result in cardiac arrhythmia, high body temperature, feelings of hostility and/or paranoia, psychosis and increased risk of cardiovascular failure or seizures. Addiction withdrawal symptoms may include fatigue, sleep disturbance and depression
• Brand names:
– dextroamphetamine (Dexedrine®, Adderall®)
– methylphenidate (Ritalin®, Concerta®)

How did prescription drug abuse begin?

The escalation of prescription drug abuse began in the late 1990s when pharmaceutical companies falsely reassured medical professionals that opioid pain relievers were not addictive, so prescriptions for opioids increased. Opioid manufacturers failed to adequately warn physicians about the addiction risks on drug packaging and promotional material, according to an article published in The New England Journal of Medicine. This led to a widespread misuse when prescriptions for opioids increased significantly for adults, in pediatric emergency departments and in ambulatory settings such as hospital outpatient departments and private clinics (McHugh, Nielsen & Weiss, 2014). Among college students, prescriptions for stimulants increased as prescriptions for opioids decreased from 2003 to 2013 (McCabe, West, Teter & Boyd, 2014).

While pharmaceutical companies and physicians have been largely blamed for the emerging opioid crisis, there are deeper root causes for the opioid epidemic, which are namely limited drug treatment, evolving approaches to pain treatment and an eroding economic opportunity (Dasgupta, Beletsky & Ciccarone, 2018). Drug supply is recognized as a key factor in the opioid epidemic, but the epidemic is fundamentally fueled by economic and social upheaval, with opioid abuse serving as a refuge from physical and psychological trauma (Dasgupta et al., 2018).

Prescription Drug Abuse Facts and Statistics

• Prescription drug misuse ranks as the second most common type of illicit drug abuse next to marijuana use, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
• About 46 people die every day from prescription opioid overdoses (CDC, 2018)
• The Centers for Disease Control and Prevention (CDC) reports that roughly 218,000 people died from prescription opioid overdoses from 1999 to 2017, and overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.
• In 2012, approximately more than 16.7 million people age 12 and older abused prescription drugs, and an estimated 2.1 million people met the criteria for a prescription drug-related substance use disorder (SAMHSA, 2013)
• Prescription opioid misuse costs the nation $26 billion in health care and $78.5 billion overall (National Institute on Drug Abuse, 2017)
• Prescription opioids and heroin overdoses are related to most of the world’s drug-related deaths (Martins & Ghandour, 2017)
• The U.S. Health and Human Services Department created a chart to illustrate the Opioid Epidemic

Motives for Prescription Drug Misuse

Why do people misuse prescription drugs? The reasons are cited in the 2015 NSDUH Survey that collected information from 51,200 survey respondents aged 18 and older about their misuse of pain relievers, tranquilizers, stimulants and sedatives. Relief for physical pain was reported to be the most common reason (63.4%) above the others, which include tension relief, insomnia, experimentation, mood enhancement, psychological cravings, increase/decrease effects of other drugs or other reasons.

For teens and college students, easy access to and false perceptions about prescription drugs rank as the top reasons why they abuse these drugs over illicit drugs. Prescription medications are easily accessible at home; young adults may find their parents’ or grandparents’ drugs in the medicine cabinet and decide to experiment, since there is less stigma attached to it than other substances. They may falsely perceive that prescription drugs are safer than street drugs because they are approved by the Food and Drug Administration (FDA).

Is It Illegal to Share Prescription Drugs?

A common phenomenon, prescription drug-sharing among friends and family can be attributed to high costs of medication. According to a review of medical and health policy literature from 2005 to 2016, per capita spending on prescription drugs was much higher in the United States than in other countries. For example, in 2013, per capita spending in the United States was $858 compared to $400 in 19 other industrialized countries. Prescription drug spending also comprise an estimated 17% of overall costs of personal health care services, according to the report.

The types of drugs shared depend on the age group. Older adults are likely to share prescription drugs for diabetes, hypertension and cardiovascular disease, whereas younger age groups tend to misuse prescription drugs to get high or to help them study better in school. Without fully understanding the risks of prescription drug-sharing, those who misuse or abuse these drugs are prone to health risks, drug addiction and possibly fatal consequences.

Not only is sharing prescription drugs unsafe, it’s also illegal. Sharing prescription drugs or giving them away is usually discussed in the context of drug abuse, but sometimes, people innocently want to borrow a friend’s prescribed meds because they are using the same one, and perhaps the borrower forgot the meds at home. Whether shared innocuously or with the intent to abuse, giving one’s prescription medication to another person can result in legal trouble. Though laws vary by state, the abuse, distribution and unauthorized use of prescription drug use are subject to fines and criminal convictions. The Public Health Law Program of the Centers for Disease Control and Prevention provides resources regarding State Laws on Prescription Drug Misuse and Abuse as well as other resources for health practitioners.

Prescription Drug Misuse vs. Other Substance Abuse

Prescription drug misuse is different from illicit drug use in terms of access and perceptions of risk (McHugh, Nielsen & Weiss, 2014). Some of the differences are illustrated as follows:

• Meaningful differences between prescription and illicit drugs of the same class (e.g., Oxycontin, a prescription opioid vs. heroin, an illicit opioid)
• Cue-induced cravings in opioid-dependent individuals are less robust than those in heroin dependent individuals. (Cue-induced cravings are intense psychological and physiological reactions to the presence of drug-related stimuli. For example, for alcohol-dependent individuals, the sight of a bar would be a drug-related stimulus; walking by a bar would be a cue that instigates strong psychological cravings for alcohol.)
• Teens and young adults have greater access to prescription drugs than illicit drugs through friends and family, although many of them take the prescribed meds from their loved ones without their consent.
• Patients who transition from medical use to abuse do so because they are trying to manage symptoms of pain, anxiety, sleep disturbance and other health conditions that are receiving inadequate medical attention or treatment. Patients with prescription drug use disorders are more likely to report pain than heroin-dependent individuals

References

1 Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American journal of public health, 108(2), 182-186.

2 Martins, S. S., & Ghandour, L. A. (2017). Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon. World psychiatry: official journal of the World Psychiatric Association (WPA), 16(1), 102-104.

3 McCabe SE, West BT, Teter CJ, & Boyd CJ. (2014). Trends in medical use, diversion, and non-medical use of prescription medications among college students from 2003 to 2013: Connecting the dots. Addictive Behaviors. 2014;39:1176–1182. doi: 10.1016/j.addbeh.2014.03.008

4 McHugh RK, Nielsen S & Weiss RD. (2014). Prescription drug abuse: from epidemiology to public policy. Journal of substance abuse treatment, 48(1), 1-7.

5 Simoni-Wastila, L., & Strickler, G. (2004). Risk factors associated with problem use of prescription drugs. American journal of public health, 94(2), 266-8.

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