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background
briefing paper:
prescription drug abuse
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exception of the Friedman article)
During the past
fifty years the use of prescription drugs to treat medical
disorders has risen substantially in the United States. From
1960 to 2002 the amount spent on prescription drugs has risen
from $2.7 billion to $162 billion. During this time the misuse
of prescription drugs has been a growing concern for many
communities. A series of reports, surveys, and studies, have
suggested that the emerging problem of prescription drug abuse
is one that warrants our full attention.
Our understanding
of the misuse of prescription drugs has grown substantially over
the years as our measurement tools have been revised to reflect
this growing concern. In 2002, the Monitoring the Future survey,
which tracks illicit drug use and attitudes towards drugs by
8th, 10th, and 12th grades, added items to specifically track
the use of pain relievers OxyContin (a controlled-release form
of oxycodone that can cause severe health consequences if
crushed and ingested), Vicodin (hydrocodone), and Percocet. In
addition, the 2005-2006 California Student Survey, the 11th
biennial statewide assessment of alcohol and other drug use
among California secondary school students, included a new item
to assess the illicit use of prescription painkillers such as
OxyContin, Vicodin, and Percodan.
Furthermore, it should be noted that the National Institute on
Drug Abuse refers to prescription drug abuse as the “non-medical
use of prescription medications.” NIDA points out that this
definition of abuse does not correspond to the definition of
abuse/dependence listed in the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV). (Research Report Series,
Prescription Drugs, National Institute on Drug Abuse).
Prescription Medications Commonly Abused
Opiates. In addition to being very effective analgesics (pain
relievers) and the primary reason they are prescribed by
physicians, opiates create an intense sense of euphoria. The
most commonly known prescription opiates are Vicodin and
OxyContin.
This class of drugs also includes such medication as: morphine (Kadian,
Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet),
hydrocodone (Lortab, Lorcet, Vicodin), propoxyphene (Darvon),
fentanyl (Duragesic), and hydromorphone (Dilaudid). Although
produced in laboratories, these medications share the same
potential for addiction and medical consequences as heroin.
Central Nervous System (CNS) Depressants. Often referred to as
sedatives, CNS depressants are substances that slow down normal
brain functioning. There are two types of CNS depressants –
barbiturates and benzodiazepines – which are primarily used to
treat anxiety and sleep disorders. The most commonly known CNS
depressants are Valium (diazepam), Librium (chlordiazepoxide HCI),
and Xanax (alprazolam). Additional CNS depressants include such
barbiturates as mephobarbital (Mebaral), pentobarbital sodium
(Nembutal), butalbital (Fioricet) and benzodiazapines such as
triazolam (Halcion).
Stimulants. These medications traditionally prescribed to treat
asthma, obesity, narcolepsy and most notably ADHD, increase
alertness, attention, and energy as well as elevate blood
pressure, heart rate, and respiration. The most commonly known
stimulants are Adderall and Dexedrine (dextroamphetamine) and
Ritalin and Concerta (methylphenidate).
Prevalence of Use
Nationally
-
According to
the 2006 Monitoring the Future Study, the nonmedical use of
narcotic drugs is the second most prevalent drug used among
US high school seniors.
- Nearly One in Ten 12th graders reported using Vicodin without a
doctor’s order during the past year. In addition, 4.3% used
OxyContin, 5% used amphetamines or stimulants, 6.6% used
tranquilizers and 6.6% used sedatives.
-
The
Partnership for a Drug-Free America reported that nearly One
in Five teens (19% or 4.5 million) report using prescription
medication that was not prescribed to them.
-
The 2005
National Survey on Drug Use and Health (NSDUH) reported
7,872,000 currently use prescription or over the counter
drugs for nonmedical purposes. Based on this survey there
were 2,200,000 new users of prescription pain relievers and
1,286,000 new users of tranquilizers (depressants).
- Between 2002 and 2005 the lifetime nonmedical use of pain
relievers has increased by three million.
- Prescription drugs are the number two illicit substance used in
the United States.
-
The NSDUH
found that between 2002-2004 6.2% or respondents engaged in
nonmedical use of psychotherapeutic drugs (pain relievers,
tranquilizers, stimulants, and sedatives)
- Of concern, 14.5% of 18-25 year olds and 9.1% of 12-17 year old
reported misusing psychotherapeutics whereas only 4.4% of
those 26 and older misused these substances.
- One third of new abusers of prescription drugs in 2005 were
between the ages of 12-17 years old.
- Prescription drugs are the most commonly abused drug among 12-13
year olds.
-
In 2004,
nearly half a million emergency department visits involved
the non-medical use of pharmaceuticals, of which 33% were
opiates and 23% benzodiazepines, as reported by the Drug
Abuse Warning Network (DAWN)
California
-
Similar to
the results of the Monitoring the Future study, the
2005-2006 California Student Survey found that 15% of 11th
graders used prescription pain killers during the past year,
second only to the use of marijuana.
The
California-specific data from the 2002-2004 National Survey on
Drug Use and Health (NSDUH) mirrors the trends seen in the
national data (see Table 1.) The prevalence of prescription drug
abuse among Californians is slightly higher than those in the
national sample. Young adults ages 18-25 have the highest rates
of use as compared to other age groups. Interestingly, however,
this is the one age group whose prevalence of use in California
falls below the national average.
|
|
12-17 yrs old |
18-25 yrs old |
26 or Older |
|
|
CA |
US |
CA |
US |
CA |
US |
|
Overall Psychotherapeutics |
9.1 |
8.8 |
12.5 |
14.8 |
5.8 |
4.2 |
|
Pain Relievers |
7.8 |
7.4 |
9.9 |
11.9 |
3.9 |
3.0 |
|
Tranquilizers |
2.1 |
2.1 |
3.1 |
5.2 |
1.5 |
1.6 |
|
Stimulants |
1.9 |
2.0 |
3.4 |
3.7 |
1.2 |
0.7 |
|
Sedatives |
0.5 |
0.5 |
0.3 |
1.6 |
0.3 |
0.4 |
At-Risk
Populations
Older Adults
Individuals 65 years old and older represent approximately 13%
of the population in the United States, yet account for one
third of all medications prescribed. This population is more
likely to be prescribed several different medications at once
and for a prolonged duration of time. This population is at-risk
for abuse of prescription medications because it is likely to
misunderstand recommended doses and/or consume over the counter
medications and dietary supplements while on prescription
medications. This can lead to more negative health consequences
than expected in a younger population.
Adolescents and Young Adults
Local and national surveys on the nonmedical use of medications
demonstrate that adolescents and young adults represent the
majority of individuals who are abusing prescriptions drugs. In
addition, this population represents the fastest growing segment
of the population abusing such drugs as Vicodin, OxyContin, and
stimulants.
Pain relievers
are the most abused type of prescription drugs – especially
Vicodin.and OxyContin. Although Vicodin is the most popular drug
of the two, according to the Monitoring the Future study, the
use of OxyContin among 8th graders increased 100% over the past
four years.
Of most concern
among this population are their attitudes toward the misuse of
prescription drugs. According to the Partnership Attitude
Tracking Study (PATS) conducted by the Partnership for a
Drug-Free America, four out of ten teens feel that the use of
prescription drugs are safer than using illegal drugs and
one-third believe that there is “nothing wrong” with using
prescription drugs without a prescription once in a while. This
report revealed that teens are more likely to obtain
prescription drugs from their parents’ medicine cabinet (62%)
and other people’s prescriptions (50%) than purchasing over the
Internet (32%). Furthermore, 29% or 6.8 million teens are under
the impression that prescription pain relievers are not
addictive, 32% believe they have fewer side effects than street
drugs, and 25% think prescription pain relievers can be used as
study aids. The Partnership for a Drug-Free America report also
indicated that the misuse of prescription drugs is higher among
Hispanics than other ethnic groups. Despite the fact that
Hispanics use fewer illicit drugs overall, it is believed that
one in five Hispanics abused prescription drugs.
It should also be
noted that those who use prescription drugs without a
prescription are more likely to abuse alcohol and other drugs.
Based on the 2001 NSDUH, 63% of youth who had used prescription
drugs illegally in the past year also used marijuana.
Women
In general, men and women engage in the nonmedical use of
prescription drugs at the same rate. However, based on the 2004
NSDUH, young women between the ages of 12-17 used every class of
psychotherapeutic more often than men: pain relievers (8.1% vs.
7.0%), tranquilizers (2.6% vs. 1.9%), stimulants (2.6% vs. 1.9%)
and sedatives (0.6% vs. 0.4%). Furthermore, women are
approximately 55% more likely to be prescribed an abusable
prescription drug such as a narcotic pain reliever or
antianxiety medication than men.
Availability of Prescription Drugs
Between 1992 and 2002 there was an over 154% increase in the
number of prescriptions written for controlled substances. This
contrasts with the 56% increase in prescriptions written for
non-controlled medications.
There appear to be five main routes through which prescription
drugs become diverted to nonmedical uses: (1) prescription
fraud, (2) “doctor shopping”, (3) theft, (4) the Internet, and
(5) parents and friends.
(1) Prescription Fraud. This spans the gambit from
forging or altering prescriptions, to impersonating physicians
over the phone, to producing counterfeit prescriptions. Although
rare, this category also includes those physicians and
pharmacists who write or dispense fraudulent prescriptions for
personal use or in exchange for a fee.
(2) “Doctor Shopping.” This occurs when individuals visit
several different doctors in an attempt to obtain multiple
prescriptions for a drug. The individual then has these
prescriptions filled at different pharmacies to avoid suspicion
of illegal activity. According to the 2005 NSDUH, 13.6% of young
adults received prescription pain relievers from a doctor and
2.3% received medications from more than one physician.
(3) Theft. In addition to fraud and doctor shopping, many
prescription medications become available through theft. Each
year millions of dosages of prescription medications are stolen
from pharmacies, manufacturers, distributors, and people with
legitimate prescriptions. While 12.5% of young adults bought
prescription pain relievers from a drug dealer or stranger, the
theft of prescription drugs is on the rise. Between 2002 and
2003 the DEA reported 2,494 thefts of OxyContin, resulting in
over 1.3 million dosages potentially ending up on the street.
(4) The Internet. Due to pop-up ads and spam emails, the
source of prescription medications that has been gaining the
most attention is the Internet. Although this is quickly
becoming a major source of illegal prescription medications, the
2005 NSDUH report indicated that just 1.3% of young adults
obtained prescription medications via the Internet. Internet
pharmacies often dispense medication without a prescription,
doctors, consultation, or even verifying the individual’s age.
The number of Internet sites offering prescription medications
has risen from zero in the mid-1990s to over one thousand in
2003.
(5) Parents and Friends. The data suggest that the main
source of prescription medication, especially for young adults,
comes from family and friends. This is not to say that family
and friends are intentionally providing medications for misuse.
However, the NSDUH reports indicated that 37.5% of young adults
obtained prescription medication from a friend or family member
for free. One in five young adults bought their pain relievers
from a friend or relative and 6.3% stole from a friend or family
member to obtain pain relievers. These results are in line with
the findings of the PATS that found that 47% received
prescription medication for free from family and friends.
Furthermore, the PATS found that 62% of teens found it easy to
get prescription medication from their parents’ medicine
cabinets and 50% of teens indicated that it is easy to obtain
medications from other people.
Recommendations
The use of prescription medications for nonmedical uses is
increasing at a startling rate. In particularly, the use of such
substances as Vicodin and OxyContin by young adults is very
troubling. Two of the most concerning aspects of the
proliferation of use by young adults is the ease at which they
obtain these substances and the perception that since these
substances were made in a laboratory, they are “safer” than
drugs such as cocaine and heroin and carry less addictive
potential. There are several steps that can be taken to curb the
misuse of prescription medications.
Education
The attitudes toward the misuse of prescription drugs suggest
that educating the public, especially young adults and parents,
could have a positive impact. At the very least, young adults
could be informed about the negative consequences associated
with prescription drugs as well as how some of the medications
are just as or more addictive than street drugs. Furthermore,
parents can be educated about the prevalence of prescription
drug abuse and the means by which many young adults obtain these
substances so that they can appropriately secure and dispose of
their medications. Parents can take extra steps to safeguard
their medications by communicating with their pharmacist and
physician to determine if any of the medications prescribed for
members of their family have a potential for abuse. If there are
medications with abuse potential in the home, it is important
for parents to take an inventory of these medications and keeps
tabs on their quantity.
In addition,
individuals who are prescribed prescription medications,
especially older adults, would benefit from education regarding
the proper usage of these medications and potential drugs
interactions with other prescription and over the counter
medications. Informing individuals about the importance of
taking their medications as prescribed, to never stop or change
a dosing regimen without first discussing it with their
healthcare provider, and never use another person's prescription
could prove to be invaluable. This could easily be done when
their doctors initially prescribe these medications and/or when
pharmacists dispense these drugs.
Early intervention
Due to the fact that over 191 million Americans see a doctor
every two years, physicians are in a unique position to identify
those individuals who may be at risk or are already using
prescription medications improperly. Doctors should be educated
as to how screening for prescription drug abuse can be
incorporated into routine doctor visits. Furthermore, doctors
should be taught how to avoid “doctor shopping” as well as how
to be mindful of rapid increases in the amount of medication
needed, or frequent, unscheduled refill requests.
Monitoring
Pharmacist can play a key role in reducing prescription fraud by
monitoring prescriptions for falsification or alterations as
well as being aware of potential "doctor shopping." Some
pharmacies have developed hotlines to alert other pharmacies in
the region when a fraudulent prescription is detected.
Summary
1) There are three classes of prescription medication that are
commonly abused:
(A) Opiates (e.g., Vicodin & OxyContin)
(B) Stimulants (e.g., Ritalin & Adderall)
(C) CNS depressants, which includes sedatives or tranquilizers
(e.g., Valium & Xanax)
2) Nationally, prescription drugs are the number two illicit
substance used in the United States.
• Nearly one in ten 12th graders reported using Vicodin without
a doctor’s order during the past year.
• The nonmedical use of narcotic drugs is the second most
prevalent drug used among US high school seniors.
• Prescription drugs are the most commonly abused drug among
12-13 year olds.
• The use of OxyContin among 8th graders increased 100% over the
past four years
• One third of new abusers of prescription drugs in 2005 were
between the ages of 12-17 years old.
3) California youth are following national trends. California
11th graders’ use of prescription pain killers during the past
year is second only to their use of marijuana.
4) Pain relievers are the most abused type of prescription
drugs, in particular Vicodin.and OxyContin.
5) The attitudes young adults have toward prescription drugs is
of concern. Young adults believe that prescription drugs are
“safer” than drugs such as heroin and cocaine.
6) Several reports revealed that teens are most likely to obtain
prescription drugs from their parents’ medicine cabinet and from
other people they know.
7) Despite the dramatic proliferation of Internet sites selling
prescription medications, the 2005 NSDUH report indicated that
only 1.3% of young adults obtained prescription medications via
the Internet.
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