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research
update:
prescription drug abuse
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background briefing
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download the complete files as a pdf document (with the
exception of the Friedman article)
The prescription drug problem is unique in that
there are four distinct behaviors that cause harm, each with
their own set of motivations and potential prevention
strategies.
1) Individuals
misuse their own prescription. For example, an extra dose
of Vicodin might be taken to try to manage the pain for which it
was originally prescribed.
2) Individuals
abuse their own prescription, hoping to get an outcome
other than the intended purpose of the prescription. For
example, Adderall might be crushed and snorted to get a bigger
buzz while drinking alcohol. This clearly is not the intended
purpose of Adderall.
3) Individuals
misuse another person’s prescription. For example, an
individual may use their family member’s prescription to try to
alleviate their own symptoms.
4) Individuals
abuse another person’s prescription. For example, a
family member’s prescription may be used to get high.
There are distinct motivations and access
channels associated with each of these behaviors. Prevention
practitioners must be savvy in understanding which of the
behaviors we are trying to curb, so that our strategies are an
appropriate match.
Research is mounting to understand the
characteristics that place individuals at risk for each of these
four behaviors. There is one characteristic that applies
regardless of demographics: having a family history that
genetically predisposes an individual to addiction. This may be
a red flag that an individual requires more support and
monitoring while being treated with prescription medications or
that they should consider alternative therapies.
Risk characteristics for adolescents who
abuse either their own or others’ prescription drugs include
psychiatric illness, cigarette smoking, alcohol use,
marijuana use, other illicit drug use, and other problem
behaviors.
When surveyed, adolescents report that they feel prescription
drugs are safer than street drugs and that they perceive less
disapproval for their use. These two factors – feeling a drug is
safe and that there is little disapproval for its use – are
strongly related to adolescents’ use of any drug. Therefore, key
to prevention of prescription drug abuse is correcting the
misperception that there is safety in the non-medical use of
prescription drugs (NMUPD) and that friends and family think
it’s okay.
For
college students who engage in NMUPD, there are also risk
factors:
low grade point average (GPA); polydrug use;
residents of
fraternity and sorority houses; attendance at colleges in the
Northeast, schools with more competitive admission standards,
and noncommuter schools; higher rates of substance use and other
risky behaviors. Students who abused prescription stimulants
reported higher levels of cigarette smoking; heavy drinking;
risky driving; and abuse of marijuana, MDMA (Ecstasy), and
cocaine. Compared with other survey respondents, for example,
they were 20 times as likely to report past-year cocaine abuse
and 5 times as likely to report driving after heavy drinking.
Students who obtained medications from peers were more likely to
smoke and drink heavily and to have abused other
substances—including marijuana, cocaine, and other illegal
drugs—than those who obtained them from family members.
There are prevention strategies that can be
tailored toward this demographic as well. It is important that
students
and their parents
receive an orientation
stating the school’s policies on NMUPD; the campus health clinic
conducts mental health assessments; medications and prescription
pads are kept under lock and key; the campus engages in a social
norms campaign; tutoring, time management and academic support
are offered; and anonymous reporting is available.
Studies on adults
28-40 years old have found that those who are most likely to
engage in NMUPD have a history of amphetamine use and/or use
medical opioids for the treatment of pain (legal access to
opioids through a physician’s prescription). It is rarer for
older individuals to initiate an addiction to prescription
medications (or other substances, including alcohol).
Elderly individuals,
however, are particularly vulnerable to prescription drug
misuse. While individuals 65 years old and older
represent approximately 13% of the population in the United
States, they 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.
Those with a risk profile include individuals
with a history of substance abuse, including alcohol. Physicians
and family members should watch for requests for early refills,
self medicating, and demands for more or stronger medications.
Prevention efforts should include assistance in transitions with
aging and retirement and informing patients and their families
about multiple drug interactions and warning signs for problems.
Regardless of demographics, there are some
universal prevention measures that could have a widespread
benefit. Anyone with a prescription for medication should be
trained on how to secure, count and properly dispose of unused
medication. College students should be provided with lock boxes
to reduce access to personal medications by other students.
Doctors and pharmacists should be trained on
“doctor shopping” and
other forms of fraud (doctor training should include asking
about prescription drug abuse when taking the patient’s history
and contacting their previous doctor). Additionally, it is
believed that part of the prescription drug epidemic is driven
by the wave of direct-to-consumer prescription drug advertising
that has taken place in recent years. Counter campaigns that
utilize contemporary forms of outreach (including MySpace,
Facebook, and blogs) may serve to balance the message that
consumers are receiving. Any well-rounded effort will address
the factors that drive all substance abuse: dose, route of
administration, co-administration with other drugs, context of
use, and expectations.
Twenty-one states have some version of a
prescription monitoring program, and several others have
programs in the pipeline. As with most of the proposed
prevention strategies in this arena, the efficacy of these
efforts has not yet been determined. Our understanding of what
works in prescription drug abuse prevention is still emerging.
The only known model program to have a prescription drug abuse
module is Project Alert. Legislation and other policy
initiatives to limit access should be approached in such a way
that those who need pain medication are not penalized. There is
a critical balance to be struck between hindering those who seek
illicit use of these powerful drugs and empowering those who
seek legitimate use.
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