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Prescription Drug Abuse
Prescription drugs can transform lives. For the millions of patients who take them, prescription drugs bring dramatic improvements in health and quality of life. But when abused or misused, many of these medications can have effects that disrupt rather than improve lives. Some prescription medications-particularly opioids, central nervous system (CNS) depressants, and stimulants-alter the brain's activity, and misuse or abuse of these drugs can lead to compulsive drug seeking and use, the hallmark of addiction.
Data from the National Household Survey on Drug Abuse reveal that an estimated 9 million Americans 12 years or older used prescription pain relievers, sedatives, or stimulants for nonmedical reasons in 1999; more than one-fourth of them reported that they had used prescription drugs nonmedically for the first time in the previous year.
The most dramatic increases in new nonmedical use of prescription drugs that act on the brain were among 12- to 17- and 18- to 25-year-olds. Elderly Americans-those 60 years and older-are three times more likely than the rest of the population to use prescription drugs. Research suggests that the elderly are less likely than younger patients to carefully follow instructions for taking medication, making them more vulnerable to the dangers of misuse of prescription drugs.
To help reverse these trends, NIDA is initiating several new projects. Some of these efforts are directed toward improving our understanding of the basic mechanisms involved in the action and effects of prescription drugs, as well as interactions that may occur between different medications when they are taken together. Other efforts seek to inform the general public and health care professionals of the risks of misuse of prescription drugs; a recent national survey revealed that 46.6 percent of primary care physicians find it difficult to discuss prescription drug abuse with patients for whom they prescribe the medications. For some patients, misunderstanding the risks of prescription drugs or failing to closely follow a medication regimen is what leads to misuse and addiction.
Facts about Prescription Drug Abuse
More than 6.3 Million Americans Reported Current Use of Prescription Drugs for Nonmedical Purposes in 2003
Medications can be effective when they are used properly, but some can be addictive and dangerous when misused. This chart provides a brief look at some prescribed medications that—when used in ways other than they are prescribed—have the potential for abuse and even addiction.
Fortunately, most Americans take their medications responsibly. Addiction to prescription drugs is rare. However, in 2003, approximately 15 million Americans reported using a prescription drug for no medical reasons at least once during the year.
Past Month Use of Selected Illicit Drugs Among Youths,
by Age: 2003
What types of prescription drugs are misused or abused?
Three types of drugs are misused or abused most often:
• Opioids—prescribed for pain relief
• CNS depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers)
• Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder narcolepsy, or obesity.
How can you help prevent prescription drug misuse or abuse?
• Keep your doctor informed about all medications you are taking, including over-the-counter medications.
• Take your medication(s) as prescribed.
• Read the information your pharmacist provides before starting to take medications.
• Ask your doctor or pharmacist about your medication, especially if you are unsure about its effects.
Research Report Series - Prescription Drugs: Abuse and Addiction
Trends in prescription drug abuse
Although prescription drug abuse affects many Americans, some concerning 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 nonmedically for the first time in 2002 -
• 2.5 million used pain relievers
• 1.2 million used tranquilizers
• 761,000 used stimulants
• 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.
The Drug Abuse Warning Network (DAWN), which monitors medications and illicit drugs reported in emergency departments (EDs) across the Nation, recently found that two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs). In 2002, benzodiazepines accounted for 100,784 mentions that were classified as drug abuse cases, and opioid pain relievers accounted for more than 119,000 ED mentions. From 1994 to 2002, ED mentions of hydrocodone and oxycodone increased by 170 percent and 450 percent, respectively. While ED visits attributed to drug addiction and drug-taking for psychoactive effects have been increasing, intentional overdose visits have remained stable since 1995.
Older adults
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. 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. 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. Elderly persons who take benzodiazepines are at increased risk for cognitive impairment associated with benzodiazepine use, leading to possible falls (causing hip and thigh fractures), as well as vehicle accidents. However, cognitive impairment may be reversible once the drug is discontinued.
Adolescents and young adults
Data from the 2003 NSDUH indicate that 4.0 percent of youth ages 12 to 17 reported nonmedical 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 NIDA Monitoring the Future survey of 8th-, 10th-, and 12th-graders found that the nonmedical 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, nonmedical 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) nonmedically, 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 National Household Survey on Drug Abuse (now the NSDUH), 63 percent of youth who had used prescription drugs nonmedically in the past year had also used marijuana in the past year, compared with 17 percent of youth who had not used prescription drugs nonmedically in the past year.
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