In April 2011, President Obama released a White House report entitled “Epidemic: Responding to America’s Prescription Drug Abuse Crisis” (ONDCP, 2011). This report observes that prescription drug abuse is the nation’s fastest-growing drug problem. “More than five million Americans misuse painkillers every month”, says a study conducted by the U.S. Department of Health and Human Services. Prescription pain killers are being widely used for a variety of medical conditions and have brought relief to millions of people with pain, but their use for non-medical purposes and consequent addiction and overdose has assumed epidemic proportions in the U.S. According to Columbia University’s National Center on Addiction and Substance Abuse, about 15.1 million Americans are addicted to prescription drugs, which is more than the total number of people addicted to heroin, cocaine, hallucinogen and inhalants. The number of deaths caused by drug overdose in the U.S. is higher than the number of road traffic accidents (Stobbe, 2009), murders (FBI, 2007), or suicides (Heron et al., 2009). These statistics compel one to analyze the reasons why prescription drug abuse (PDA) is on the rise, what the health risks are and what steps can be taken by individuals and the government to curb this menace.
Drug abuse refers to non-medical use with the specific intent to create a desired alteration in mental state or physical performance. Prescription drug abuse is defined as the use of a legend drug in a way not intended by an authorized prescriber of the medication. The intent of prescription drug abuse is to obtain an altered state of mood or behavior. Prescription drug abuse frequently involves circumventing the intended route of drug administration (O’Neil & Hannah, 2010).
One of the foremost reasons for growing abuse of prescription drugs is easy access to medicines, especially pain killers. People are being prescribed pain killers for a growing number of conditions, and these medicines are becoming easily accessible to other members of the family of the patient. A large number of teenagers start using prescription painkillers as they can easily reach the pills prescribed for their parents (Perry, 2011).
Curley (2010) states that another reason for PDA is the idea that prescription drugs are safe, because they have been prescribed by a doctor. This contributes to careless usage of these drugs. Healthcare providers should make an effort to educate the public that every drug has a safe dose and overdose of any drug can have lethal consequences. Also the idea that prescription drugs are not addictive makes people share medicines with friends and family without a second thought (SAPTA, 2008). There is a suspected co-relation between pharmaceutical advertisements on TV and an increased demand and misuse of prescription drugs among people. Another reason is co-occurring mental illnesses, where the patient tries to relieve psychological pain by means of self-medication (SAPTA, 2009).
Many doctors also contribute directly or indirectly to the problem of prescription drug abuse. A survey of physicians in 2004 found that 43 percent of them did not address prescription drug abuse while taking the patient’s history. One third of them did not consult with the patient’s previous physician before prescribing potentially addictive drugs. These statistics suggest that a lot of doctors are quite careless while prescribing controlled drugs (Friedman, 2006). Non-medical use of a prescription drug is thought to be more legitimate and socially acceptable than using illegal drugs, such as heroin and cocaine (Hernandez and Nelson, 2010).
Prescription drugs can also be obtained easily through illegal internet pharmacies, illegal sale and distribution by health care personnel, fake prescriptions and “doctor shopping,” approaching a number of doctors to obtain prescription for a controlled drug (Curley, 2010).
All kinds of prescription drugs can be abused in some way. But the most commonly abused ones are those that are frequently dispensed. These are opioid pain killers, central nervous system stimulants and depressants. Opioids are pain medications commercially known as Demerol, Vicodin and OxyContin. They are used for relieving pain, cough and diarrhea. These medications reduce the perception of pain by blocking pain receptors in the brain. As a side effect, they produce a feeling of euphoria or wellbeing similar to illegal drugs (Adams, 2007).
Types of abused drugs
Commonly abused stimulant drugs are the ones known as Ritalin, Straterra and Adderrall. These are used for treatment of asthma, depression, obesity, Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. These drugs produce enhanced alertness and wakefulness. They increase attention span and energy levels. These drugs are most commonly abused by school or college students during exam days, as well as by young people wanting to lose weight (Adams, 2007).
Another type of frequently abused drugs is the central nervous system depressants such as diazepam, alprazolam and pentobarbital sodium. These are available in the market as Valium, Xanax and Nembutal. When taken, they produce a calming effect and are used to treat sleep disorders, anxiety and tension (Adams, 2007).
Prescription drugs are supposed to be taken under the supervision of a physician who would take a patient’s age and body weight into consideration while deciding the dose and duration. But taken unsupervised, these drugs can have serious negative effects on health. Opioid analgesics have sedative properties and can cause relaxation and drowsiness. If overdosed, they can suppress respiratory function and even cause death. In habitual users, the body gradually develops resistance to the drug and its effects diminish. Therefore, to feel the same euphoric high, drug abusers need to take higher doses of a drug, and, therefore, risk overdose. Misuse of stimulants can raise blood pressure and heart rate, constrict blood vessels, increase blood glucose levels and accelerate respiration. Users may also experience feelings of aggression and paranoia, raised body temperature, irregular heartbeat, cardiovascular failure and seizures, which may prove to be fatal (Chambliss, 2011)
The age groups most at risk of prescription drug abuse are teenagers aged 12 to 17 years and young adults aged 18 to 25 years. In young adults, abuse of prescription drugs has increased from 14.49% in 2004 to 16.53% in 2006. This is largely due to an increased usage of opioid pain killers. Nurses and the elderly are other high-risk groups for PDA (Curley, 2010).
DuPont (2010) suggested several strategies for checking non-medical use of prescription drugs. He suggests developing and implementing certain policies to improve public health. A national public education campaign about the problem of prescription drug abuse to educate the general public can go a long way in raising concern about this dangerous trend. Patients receiving prescribed controlled medicines must be aware that they are responsible for ensuring that the medicine does not fall into wrong hands. Such medicines should be kept in locked cabinets. A brilliant new strategy to reduce PDA is the development of abuse-resistant delivery systems of prescribed controlled drugs. These systems control the rate at which the drug enters the body, maintaining a steady release into the bloodstream rather than a rapid one-time release, which produces a feeling of being‘high’. This achieves the treatment goal, while eliminating the euphoric feeling associated with the drug.
Prescription Drug Monitoring Programs
A very effective strategy to reduce non-medical use of controlled drugs is the development of Prescription Drug Monitoring Programs (PDMP). PDMPs can keep track of prescriptions and identify physicians who are prescribing controlled drugs in excessive quantities. They can also track patients collecting prescriptions from multiple sources for misuse. Pharmacists can play a major role in monitoring, recognizing and preventing this kind of drug abuse. They can be alert to any suspicious behavior and watch out for forged prescriptions, thus being the first line of defense (Hanson, 2010). PDMPs of various states need to cooperate and work as a single network to be fully effective, as offenders can cross state borders to escape monitoring programs.
Efforts should be enhanced to detect drugged driving and prosecute offenders. If a person is driving after being impaired by medication, he should be found guilty of driving under influence (DUI), irrespective of whether the medicine was prescribed or not. A case of illegal drug use should be handled the same way as a case of alcohol abuse while driving, as such a person poses danger to everyone on the road. A project called 24/7 Sobriety Project has been started in South Dakota. Under this project, convicted DUI offenders are monitored for use of impairing drugs or alcohol as a condition of community release. It has shown good results during random testing of subjects (DuPont & Caulkins, 2010).
Prescription drug abuse is a steadily growing problem, not only in the U.S. but throughout the world. Young adults and adolescents are the most affected age group, as they use these drugs for the purpose of recreation or performance enhancement and can obtain the drugs easily from a wide variety of sources. Using prescription drugs without proper medical supervision can have adverse effects on health, even causing death in many cases. Educating the public is the first step to control the increasing illegal use of prescription drugs. Other methods include development of abuse-resistant drug delivery systems, developing and improving PDMP program network, training pharmacists to monitor prescriptions that are filled too frequently, from multiple sources or on fake prescriptions, strict drugged driving regulations to improve highway safety and improved drug abuse treatment programs.