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Trends In Prescription Drug Abuse

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Autor:  anton  07 December 2010
Tags:  Trends,  Prescription
Words: 3708   |   Pages: 15
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Prescription drug abuse is on the rise in the United States. According to the 1999 National Household Survey on Drug Abuse, in 1998, an estimated 1.6 million Americans used prescription pain relievers non-medically for the first time. This represents a significant increase since the 1980s, when there were generally fewer than 500,000 first-time users per year. From 1990 to 1998, the number of new users of pain relievers increased by 181 percent; the number of individuals who initiated tranquilizer use increased by 132 percent; the number of new sedative users increased by 90 percent; and the number of people initiating stimulant use increased by 165 percent. In total, in 1999, an estimated 4 million people - almost 2 percent of the population aged 12 and older - were using certain prescription drugs non-medically: pain relievers (2.6 million users), sedatives and tranquilizers (1.3 million users), and stimulants (0.9 million users).

Data from the 2003 National Survey on Drug Use and Health (NSDUH) indicate that 4.0 percent of youth ages 12 to 17 reported non-medical use of prescription medications in the past month. Rates of abuse were highest among the 18-25 age group (6.0 percent). Among the youngest group surveyed, ages 12-13, a higher percentage reported using psychotherapeutics (1.8 percent) than marijuana (1.0 percent).

The National Institute on Drug Abuse Monitoring the Future survey of 8th, 10th, and 12th graders found that the non-medical use of opioids, tranquilizers, sedatives/barbiturates, and amphetamines was unchanged between 2003 and 2004. Specifically, the survey found that 5.0 percent of 12th graders reported using OxyContin without a prescription in the past year, and 9.3 percent reported using Vicodin, making Vicodin one of the most commonly abused licit drugs in this population. Past year, non-medical use of tranquilizers (e.g., Valium, Xanax) in 2004 was 2.5 percent for 8th graders, 5.1 percent for 10th graders, and 7.3 percent for 12th graders. Also within the past year, 6.5 percent of 12th graders used sedatives/ barbiturates (e.g., Amytal, Nembutal) non-medically, and 10.0 percent used amphetamines (e.g., Ritalin, Benzedrine).

Youth who use other drugs are more likely to abuse prescription medications. According to the 2001 NSDUH, 63 percent of youth who had used prescription drugs non-medically in the past year had also used marijuana in the past year, compared with 17 percent of youth who had not used prescription drugs non-medically in the past year.

It's no secret that drug abuse can be harmful and dangerous. Most people think serious problems are only caused by club drugs like ecstasy and GHB, and by street drugs like heroin and cocaine. What a lot of people don't know is that prescription drug abuse (using medications for non-medical purposes) can be just as harmful and just as dangerous. Just because they're available at your local pharmacy, doesn't make them safe if they are misused or abused.

Prescription drugs are medications regulated by the U.S. government. These medications are helpful in treating a variety of health conditions and are only available when prescribed by a doctor or other healthcare professional. "The government restricts these medications because they may be harmful if they are not taken properly or if they are combined with other medications" (Firshein, 2005). Doctors and other healthcare professionals are highly trained and experienced at selecting the best medication to use for a certain condition. The type of medication and the dosage prescribed is carefully determined. "It's very important that the doctor's directions are followed exactly to help treat the condition for which it was prescribed and to make sure the medication doesn't cause unwanted effects" (Kalb, 2001).

"In 1970, the U.S. government set up a system to control the use (and the abuse) of certain drugs and other substances used to produce drugs. The Controlled Substances Act divides drugs into five classes: narcotics, CNS depressants, stimulants, hallucinogens and anabolic steroids" (Kennedy & Leslie, 1996). Each class is made up of drugs that have similar effects when they're taken. В‘The reasons these drugs were placed under control is because they have a potential to be taken for non-medical reasons (or abused), may be harmful to use, or may cause physical dependence or addiction when not used under the direct supervision of a doctor or other healthcare professional (Rosenberg, 2001).

Abusing prescription drugs can affect your relationship with your family. It can create problems at school and with your future education. You may end up losing some longtime friendships or be forced to give up some of your favorite activities. And you could get into some serious problems with the law.

There are so many reasons to not abuse prescription drugs. According to Kalb using medications improperly may cause changes in your breathing and heart rates, making them dangerously high or dangerously slow. Your body temperature may get way too high; comas and seizures are possible. It's also possible to die from an overdose (2001).

"Prescription medications can be helpful В— even life saving В— when used for treating injury and illness" (Scanlon, 2005). They are to be used only when prescribed to you by a doctor or other healthcare professional. But when misused or abused, they can have devastating effects. "Even when prescription drugs are unintentionally misused В— for example, if you accidentally take more of your own prescription than you were directed to by your doctor В— the effects can be very different from what you expected (Deans, 2005). Kohn notes that some of the effects of misusing or abusing prescription drugs include: excessive sweating, urination or thirst; nausea and vomiting; uncontrollable diarrhea; spastic shaking; drowsiness, dizziness and insomnia; loss of consciousness; addiction; hospitalization; and death (1998). Besides the physical effects, prescription drug abuse can affect other parts of your life that you may not even think of, some prescription medications can cause a loss of coordination or judgment that may make you do things you normally would not. You may do something embarrassing in front of your friends or other kids at school. Or, you may do something dangerous that hurts you or someone else.

The risks for addiction to prescription drugs increase when the drugs are used in ways other than for those prescribed. "Healthcare providers, primary care physicians, and pharmacists, as well as patients themselves, all can play a role in identifying and preventing prescription drug abuse" (Kalb, 2001).

While most people still think of a doctor when considering medical care or medication advice, a doctor is just one part of a broad healthcare community. Healthcare professionals include physicians (doctors), pharmacists, nurses, physician assistants, etc. Each is highly trained in their areas of expertise, and they are valuable resources of information on your disease states and medications. Some healthcare professionals can prescribe medications while others cannot.

According to 2005 National Clearinghouse for Alcohol and Drug Information, generally speaking, physicians and dentists can prescribe medications if they have a valid medical license from their state and a DEA license. Under certain circumstances and depending on the state that they are practicing in nurse practitioners, physician assistants, and pharmacist also can prescribe medications. Chiropractors and nurses are not able to prescribe medications (NCADI, 2005).

Doctors and other healthcare professionals who prescribe medications play an important role in the selection of the right prescription medications for their patients.

Doctors and other healthcare professionals have years of training, in addition to years of schooling, to understand and to know, not only how the human body works, but how certain medications react in the body.

The best way to avoid misuse or abuse of prescription medications is to stop it before it starts. This is one reason why a complete and honest discussion of a patient's medical history is important at the beginning of treatment. A doctor can learn about past reactions to certain medications, any family history of abuse, or if a particular patient has misused or abused medications in the past.

With accurate information, the doctor can help the patient avoid the problems caused by misuse or abuse. Some steps the doctor will take against misuse or abuse are:

educating the patient about the medication, its effects, dosage and the importance of following the prescription exactly; making sure that there is not a substitute medication that will treat the condition but will be less likely for the patient to misuse; requesting that the patient return regularly during treatment to check on the medication's success at treating the condition and checking for signs of misuse or abuse; not prescribing large quantities of a medication at one time; making sure the patient, or the patient's family, reports any side effects or changes in the drug's effectiveness; and making sure that the patient reports any medications prescribed by other doctors or health care professionals (Deans, 2005).

Years of research have shown us that addiction to any drug (illicit or prescribed) is a brain disease that, like other chronic diseases, can be treated effectively. No single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. Successful treatment may need to incorporate several components, including detoxification, counseling, and in some cases, the use of pharmacological therapies. Multiple courses of treatment may be needed for the patient to make a full recovery.

Although prescription drug abuse affects many Americans, the most serious trends can be seen among older adults, adolescents, and women. Several indicators suggest that prescription drug abuse is on the rise in the United States. According to the 2003 National Survey on Drug Use and Health (NSDUH), an estimated 4.7 million Americans used prescription drugs non-medically for the first time in 2002: 2.5 million used pain relievers; 1.2 million used tranquilizers; 761,000 used stimulants; and 225,000 used sedatives. Pain reliever incidence increased-from 573,000 initiates in 1990 to 2.5 million initiates in 2000-and has remained stable through 2003. In 2002, more than half (55 percent) of the new users were females, and more than half (56 percent) were ages 18 or older.

Studies suggest that women are 55 percent more likely than men to be prescribed a drug that can easily be abused, particularly narcotics and anti-anxiety drugs in some cases (Kohn, 1998). Overall, men and women have roughly similar rates of non-medical use of prescription drugs. An exception is found among 12- to 17-year-olds. Kennedy and Sacco state that in this age group, young women are more likely than young men to use psychotherapeutic drugs non-medically. In addition, research has shown that women are at increased risk for non-medical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines) (1996).

Persons 65 years of age and above comprise only 13 percent of the population, yet account for approximately one-third of all medications prescribed in the United States (NCADI, 2005). Older patients are more likely to be prescribed long term and multiple prescriptions, which could lead to unintentional misuse.

The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. "In addition to prescription medications, a large percentage of older adults also use OTC medicines and dietary supplements" (Kalb, 2001). "Because of their high rates of comorbid illnesses, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse and misuse can have more adverse health consequences among the elderly than are likely to be seen in a younger population" (Deans, 2005).

Some drugstore chains have already tightened controls over cold and cough remedies abused by teenagers by putting them behind counters or selling them only to adults. "The study suggests broader remedies, including improving monitoring of sales and distribution by enforcement agents, having doctors routinely ask patients about prescription drug use as they do tobacco use, and improving training to detect abuse" (Kalb, 2001). Pharmacists should ask about all controlled drugs a patient may be taking and become more aggressive about validating prescriptions.

The Pharmaceutical Research and Manufacturers of America, whose members include major drug firms, "strongly supports efforts that help prevent the dangerous and illegal practice of diverting prescription drugs from their intended use," PhRMA Senior Vice President Ken Johnson said in a written statement. "Medicines cannot help patients if they are compromised by misuse or by breakdowns in the distribution system" (Scanlon, 2005).

"The DEA has been trying for so long to prevent robberies, thefts and doctors from prescribing medications illegally, but the actions they have been taking are not enough" (NCADI, 2005). Despite their efforts there are still many ways and illegal techniques used to obtain OxyContin. Abusers have been getting their hands on these drugs via pharmacists, physicians, doctor shopping, thefts and robberies, the internet, organizations, and foreign distribution. Physicians and pharmacists will use their ability to prescribe the medications to either use it themselves or distribute illegally to someone else. Doctor shopping has become increasingly popular among users because it does not involve much work. "The network formed between abusers has become incredible (Rosenburg, 2001). Abusers will go around from doctor to doctor looking for someone to prescribe them what they are looking for and they will not stop until they find one who will. "They then report back to this network on who would and would not prescribe the medications" (Rosenburg, 2001). Foreign distribution has also become a huge problem. Because foreign companies operate outside United States laws there are not many ways that the DEA or the Government in general can do to prevent it. "The disturbing part is how much the number of dosage units sent to foreign countries has increased. In 1998 an approximate 5,000 grams were sent from Purdue Pharma L.P. Laboratories in Totowa, New Jersey to Mexico and Canada, but the number jumped to 89,000 grams in 2000" (Firshein, 2005).

If the DEA were to create a system to better regulate prescription narcotics who would be the person to judge another's pain, and what qualifies someone to do so? This perplexing question arises when realizing that there needs to be a better system for tracking drug distribution. To answer this question, it is not particularly necessary to someone or another person to judge another's pain, to do so without proper understanding of a person's condition or approval would be immoral. However, what if we could create some sort of a timed device that would dispense a pill or a form of the medication as they do with morphine in the hospitals, limiting how much morphine can be implemented to a patient.

To think that the problem of abusing any kind of drug would just disappear with one solution is naive and absurdly optimistic. However, to think that all the DEA is doing right now to prevent harmfully addictive and destructive medications is enough is plain ignorant. The DEA has made substantial progress toward making OxyContin and other prescribed narcotics less available for abusers. But first hand accounts and shocking statistics prove that these measures are clearly not enough. It is true and will always be true that free will is a legitimate part of this equation. The abuse of any kind of drug is almost guaranteed to be present at all times no matter how hard the government tries to keep a firm lock on the situation. If a person wants it they will have it. The fact also remains that people with addictions cannot control themselves or their addictions, that's why it is called an addiction. Therefore making it the partial obligation of the DEA and the government to not only recognize this desperate need for restrictions but do something more about it.

Drug abuse is a pressing problem in today's world. The more prevalent

it becomes the more expensive it becomes. Government money is being distributed among all ways of recovery and only time will tell if the distribution of funds was successful. Drug addiction is also very costly. "Debt continues to build from personal, governmental, societal, and statistical aspects of the nation" (Scanlon, 2005). Perhaps the greatest cost of all however is the loss of a once happy and independent brother, sister, mother, father, friend or spouse to the vices of an addiction that has spun out of control.

I believe the foundation of an effective prevention strategy lies in education, first and foremost. The government needs to get the word out about the physical and psychological dangers of improperly using these powerful analgesics, since most people view them as being safe. A forceful media campaign like the old ones they did for crack and cocaine would do much for raising public awareness. Incorporating information about these substances into the DARE program which, at the time I was involved in it 9 or 10 years ago barely gave opioids a nod, would also be tremendously helpful. The DARE program is the first formal education children receive on substance abuse, and we need to properly educate them on all of the potential drugs out there.

Physicians should also play an active role in any prevention strategy; they are literally the first line of defense against those who would abuse the system to support their habit. Modernizing the system for prescribing narcotics would be an excellent step in this area. "Utilizing new technology to make the prescription process a more secure transaction would have a large impact on the supply side of the issue since almost all opioids found on the street have in all likelihood been fraudulently redirected from legitimate sources" (Kalb, 2001). According to Deans, if you close those loopholes that allow this redirection (forgers, social-engineering pharmacists) the supply would be drastically reduced. They should not in any way, however, be dissuaded from prescribing medication to a patient in genuine need (2005). Pain is not something that can be measured, and no patient should suffer because a specific segment of the population cannot handle it responsibly. The key word here is vigilance on the part of the doctor, not radical departure from quality care. The pharmaceutical companies themselves need to play a large role in this strategy to alleviate the pressure on doctors caught in the conflict between good medicines and supporting a drug habit. "They should continue to devote research and development dollars to the study and synthesis of compounds that are comparative to the opioids in analgesic action but lack the euphoria and addiction potential of the morphine-derived medication currently available" (Scanlon, 2005). I'll be the first one to admit this is easier said than done, being that scientists have been working on this since at least the turn of the century when they developed heroin in an effort to curtail morphine addiction. The truth of the matter is morphine and its relatives are simply the best treatment we have for pain management until science comes up with something better.

Until that happens, however, pharmaceutical companies should be obligated to modify their existing product to prevent the misuse we are seeing today. This would be particularly useful for the time released version of oxycodone, OxyContin. "Abusers looking for the heroin-like rush of euphoria either suck the coating off the pills or grind them up and eat or snort" (Wade, 1999). Safeguards could easily be implemented to make this type of entry into the body uncomfortable or unfeasible. They could take lessons from the manufacturers of ephedrine-containing products such as Sudafed which for years were routinely tampered with by "clandestine chemists" manufacturing methamphetamine (Wade, 1999). Today, it is considerably more difficult to extract the ephedrine from the pill due to countermeasures developed by the manufacturer, such as including micro cellulose fibers in the tablet to gunk up the equipment used in the extraction. The idea could easily be applied to OxyContin tablets that would render them resistant to tampering.

Additives could also be introduced that would give the tablet a horribly unpleasant flavor if ingested without the special coating, or would cause debilitating discomfort to the nasal passage if inhaled. These are but a handful of cheap and relatively simple ways to address the issue of abuse until science gives us an equivalent, non-addicting alternative.

The criminal justice system would have to play a more pro-active role in my anti-drug strategy. First and foremost, I would make significant changes to or eliminate the Federal Controlled Substance Schedule, which is essentially a ranking system for illegal drugs that the government uses as a guideline when sentencing drug offenders. At the top are Schedule I substances, which are the most rigorously controlled. LSD, heroin and ecstasy all reside at the top of this rather ridiculous hierarchy. Most prescription opioids fall under Schedule II, along with cocaine and amphetamine. Steroids, marijuana, and Valium are all listed at Schedule III or below, and have a lower priority to the criminal justice system.

An easy solution to the problem of drug abuse of all types will continue to elude us, probably indefinitely. Indeed, the problem can seem so overwhelming that people simply give up on a real cure and satisfy themselves with treating some of the symptoms, like banning certain medicines or locking up repeat users to keep them from indulging their habit. The truth of the matter is no one change or modification to existing policies will have much effect if any, on the current state of affairs. It isn't enough to ban drugs, we must work to understand their allure and the intricate mechanisms in our brains and in our psychology that make some of us too weak to resist the temptation. Only with this sort of concentrated effort will we see any progress.

References

Deans, David A. (2005). "Drug Addiction". CSU at Northridge. 1997. California State University.

Firshein, Moyers. (2005). "Our Current Policy" PBS Home. PBS.

Kalb, Claudia. (2001). "Playing With Painkillers." Newsweek. 45-47

Kohn, Cynthia. (1998). Buzzed. New York: W.W. Norton and Co.

Rosenburg, Debra. (2001). "How One Town Got Hokked." Newsweek. 48-51

Sacco, Vincent F. & Kennedy, Leslie W. (1996). The Criminal Event. New York: Wadsworth.

Scanlon, Anna. (2005) "State Spending on Substance Abuse and Treatment." Dec. 2002. National Conference of State Legislatures.

US Dept. of Health and Human Services. National Clearinghouse for Alcohol and Drug Information. (2005). "Drug War Facts."

Wade, L.G. Jr. (1999). Organic Chemistry. New Jersey; Prentice Hall. 846-847.



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