Is prescription-drug abuse as serious as illegal drug abuse?

Below is an excerpt from the "Overview" section of the October 9, 2009 CQ Researcher report on "Medication Abuse" by Marcia Clemmitt

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The use of legitimate prescription drugs like opioid painkillers and stimulants to treat attention deficit hyperactivity disorder (ADHD) has soared in the United States over the past two decades. But along with increased legitimate use of opioids like Vicodin and OxyContin and stimulants like Ritalin and Adderall has come extensive abuse.

In recent years, prescription drugs have outpaced illegal drugs like heroin and cocaine as the cause of overdose deaths, according to both federal statistics and data from many states. “The number of deaths … that involved prescription opioid analgesics increased from 2,900 in 1999 to at least 7,500 in 2004,” up “150 percent in just five years,” with painkiller deaths more numerous than heroin- and cocaine-related deaths put together, said the CDC's Paulozzi. [Footnote 8]

While the CDC has not analyzed data beyond 2004, the trend is likely to continue, said Paulozzi. The Substance Abuse and Mental Health Services Administration (SAMHSA), has found that “the number of emergency department visits for opioid overdoses increased steadily through 2007,” so that “the mortality statistics through 2005 probably underestimate the present magnitude of the problem.” [Footnote 9]

Considering the high rate at which Americans consume prescription drugs, there should be little surprise in such numbers, some analysts say.

Indeed, frequently abused Vicodin is the most-prescribed drug in the United States, with 117 million prescriptions written in 2008, says David S. Kloth, a Danbury, Conn., anesthesiologist and past president of the American Society of Interventional Pain Physicians (ASIPP). By comparison, another heavily used drug, the cholesterol-lowering medicine Lipitor, was prescribed 61 million times last year, Kloth says.
Marijuana and Vicodin Are Most-Abused

Ninety-nine percent of the world's hydrocodone — Vicodin's opioid component — and 80 percent of the world's supply of narcotics, generally, are consumed in the United States, he says. “The actual, indirect societal costs [of prescription-drug abuse] are so huge that the problem can no longer be ignored,” says Kloth. “We have doctors assisting patients in abuse.”

There also has been a dramatic increase in deaths from methadone — in the wafer form prescribed as a pain medication, not the liquid form used as maintenance for former heroin addicts, says Hazelden's Seppala. “The pill is a lethal drug because it's so slow going out of one's system,” he says. But unwary people “take a whole bunch because it acts so slowly that they don't realize they're getting high,” and they end up dying from the drug's toxicity, he explains.

Today there is more abuse of prescription opiates than marijuana, says Kosten of Baylor College of Medicine. “The average first-time user is 15 years old,” and, unlike with most drug epidemics, females are as likely as males to abuse prescription medications. With illegal drugs, “boys are more likely to go out to find a dealer and get them,” but boys and girls can get prescription opiates on their own, for free, from their families' medicine chests, he says.

“Illicit drugs come and go,” but abuse of prescription drugs is likely to keep on expanding because of their availability, says Western Law School's Liang. “It's a growth industry for our kids, and addicted children become addicted adults.”

Among his students, “it's a normal thing to buy on the Internet,” Liang says. “This is the health-care system for kids today. And when you hear the justifications of college students — like, ‘I'm using [Adderall] because I'm trying to get into med school,’ followed by the admission that ‘I couldn't really cope with the test because I was so buzzed from the drug’ — you understand how serious substance-abuse-related problems can quickly grow,” he says.

Furthermore, “there's a real synergy between opioids diverted to illegal use and heroin, since many people get hooked on the diverted opioids” and then shift to illegal drugs or add them to the mix, says Robert G. Carlson, director of the Center for Interventions, Treatment and Addictions Research at Wright State University's Boonshoft School of Medicine in Dayton, Ohio. Abuse of prescription drugs also likely brings sellers of illegal drugs like heroin into areas where illegal-drug pushers haven't previously operated. “Sellers follow the drugs,” Carlson says.

Nevertheless, some observers say that facts on the ground may not warrant the alarms some substance-abuse specialists are sounding. “I haven't seen any communication from anyone indicating we're near a crisis mode or things have gotten a lot worse … in the recent past,” said Ron Petrin, vice president of the Board of Pharmacy in New Hampshire, a state in which some analyses find a surging epidemic of prescription-drug addiction. [Footnote 10]

Just as with illegal drugs, the number of people who initially abuse prescription drugs is far higher than those who actually become dependent, says Kosten. For both kinds of drugs, “eight people try opiates and one becomes dependent,” he says. For that reason, “it's a good bet that a substantial proportion [of prescription-drug abusers] will outgrow” the habit. Nevertheless, Kosten adds, “a lot of damage can happen in the meantime,” including education setbacks, such as poor grades, that take years to overcome, he says.

Abuse of prescription “opioids hit a peak in 2006, and it's still staying there, not really on the rise, but not dropping either,” says Michael H. Lowenstein, co-director of the Waismann Institute, a detoxification center in Beverly Hills, Calif.

Still, an alarming story making the media rounds may be more legend than fact, says Hazelden's Seppala. Beginning in the early 2000s, some news reports described “pharm parties,” in which teenagers scrounge up all the prescription drugs they can find, get together, toss all the drugs into a bowl, and grab and consume random handfuls of the medications. The story reached the mainstream with a USA Today account on June 13, 2006.[Footnote 11] But while some “pharm parties” probably do occur, “I don't think it's a common phenomenon,” says Seppala, who has researched them.

Similarly, while prescription sleeping pills are addictive, “the vast, vast majority of people never have a problem with them,” says Leslie Lundt, a psychiatrist in Boise, Idaho, who is the author of Think Like a Psychiatrist: Understanding Psychiatric Medicines. “Nearly 100 percent of the people who have issues with the ‘sleepers’ have had another substance-abuse or gambling issue.”

Some aspects of prescription drugs may ultimately make them easier for society to control than illegal drugs. As compared to alcoholics and heroin addicts, for example, “We see opioid pill addicts a lot earlier” in their substance-abusing lives, says Seppala. For all opioids, including heroin, “the addiction starts more quickly” than with most other substances, but pill addicts often find it harder to get a daily supply of their drug than street-drug addicts, and so fall into the pain of withdrawal sooner, which brings them to treatment, he says.

Unlike with illegal drugs, if abuse becomes a problem with a legal medication, “we can just make less of it, or make it a lot harder to get” by limiting the places at which the drug can be dispensed, requiring buyers to fill out certain forms, or the like, says Kosten.

The Issues:
* Is prescription-drug abuse as serious as illegal drug abuse?
* Is enough being done to combat medication abuse?
* Are patients in pain suffering because doctors fear prosecution for medication abuse?

For more information see the CQ Researcher report on "Medication Abuse" [subscription required] or purchase the CQ Researcher PDF

Footnotes
[8] Testimony before House Judiciary Subcommittee on Crime, Terrorism and Homeland Security, July 12, 2007.

[9] Ibid.

[10] Quoted in Elaine Grant, “Pharmacy Board Stalls Drug Abuse Prevention Efforts, Advocates Say,” New Hampshire Public Radio, July 27, 2009, http://www.nhpr.org.

[11] Donna Leinwand, “Prescription Drugs Find Place in Teen Culture,” USA Today, June 13, 2006, p. 1A. David Emery, “Are Pharm Parties for Real?” David Emery's Urban Legends Blog, About.com, March 24, 2009, http://urbanlegends.about.com/b/2009/03/24/are-pharm-parties-for-real.htm.