Prescription drug abuse on rise

With a death rate higher than all deaths for cocaine and heroin combined, abuse of prescription drugs and painkillers is gaining more attention.

Auglaize County Medical Director Dr. Juan Torres said the increased misuse and abuse of prescription drugs has led to a public health problem.

“People tend to think that because the doctor gave them to them they must be good,” Torres said. “Pain killers are thought of as a type of medicine that they need more of once they run out.”

The National Institute on Drug Abuse defines prescription drug abuse as the use of a medication without a prescription, in a way other than as prescribed, or for the experience of feelings elicited.

Prescription drugs are the second most commonly abused category of drugs, behind marijuana and ahead of cocaine, heroin, methamphetamine and other drugs, according to the National Institute of Health, which estimates that approximately 20 percent of people in the United States have used prescription drugs for non-medical reasons.

According to several national surveys, prescription medications, such as those used to treat pain, attention deficit disorders and anxiety, are being abused at a rate second only to marijuana among illicit drug users. The consequences of this abuse have steadily worsened, as reflected in increased treatment admissions, emergency room visits and overdose deaths.

The Drug Abuse Warning Network, which monitors emergency department visits in selected areas across the country, reported that approximately 1 million emergency department visits in 2009 could be attributed to prescription drug abuse.

Approximately 343,000 involved prescription pain relievers — a rate more than double the previous five years. More than half of the emergency department visits for prescription drug abuse involved multiple drugs.

Prescription drug abuse’s increase is partly due to its easy availability, among other factors, including the perception, especially among younger people that prescription drugs are safer than illegal street drugs. Most people fail to lock up or secure their prescription medications, nor do they discard them when they are no longer needed, making them vulnerable to theft or misuse and more easily obtained.

A 2010 National Survey on Drug Use and Health estimated 2.4 million Americans used prescription drugs non-medically for the first time within the past year. More than half were females and a third were between the ages of 12 to 17.

Abuse of prescription drugs is highest among young adults ages 18 to 25 with almost 6 percent reporting non-medical use in the past month, according to the 2010 national survey. Among youth ages 12 to 17, 3 percent reported past month non-medical use of prescription medications.

Torres said one of every 12 adolescents have used Vicodin and one in every 20 have used Oxycotin.

The National Institute on Drug Abuse (NIDA) reports that prescription and over-the-counter drugs are among the most commonly abused drugs by high school seniors, after alcohol, marijuana and tobacco. While in past year non-medical use of sedatives and tranquilizers decreased among this same age group —during the past five years, this is not the case for the non-medical use of amphetamines or opioid pain relievers.

When asked how prescription drugs were obtained by students, more than half said they were given the drugs or bought them from a friend of relative.

Youth who abuse prescription medications also are more likely to report use of other drugs with multiple studies revealing associations between prescription drug abuse and higher rates of cigarette smoking, heavy episodic drinking, and marijuana, cocaine and other illicit drug use among adolescents, young adults and college students in the U.S.

Those aged 65 and older comprise approximately 13 percent of the population but account for more than one-third of total outpatient spending on prescription medications in the U.S. Older patients are more likely to be prescribed long-term and multiple prescriptions, and may experience some cognitive decline, which may lead to them improperly using medications, according to the NIDA.

“The high rates of co-morbid illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions may make any of these practices more dangerous than in younger populations,” according to a report from NIDA.  “Further, a large percentage of older adults also use over-the-counter medicines and dietary supplements, which in addition to alcohol, could compound any adverse health consequences resulting from prescription drug abuse.”

To ensure proper medical care, patients should discuss any and all drug use — including prescription and over-the-counter medications — with their physicians. The risks for addition to prescription drugs increase when they are used in ways other than as prescribed. Physicians, patients and pharmacists all play a role in identifying and preventing prescription drug abuse.

With more than 80 percent of Americans having contact with a healthcare professional during the past year, physicians not only can prescribe medications, but also identify abuse of prescription drugs and prevent escalation to addiction. Physicians also need to be alert to the possibility that patients addicted to prescription drugs may engage in doctor shopping, moving from provider to provider in an effort to obtain multiple prescriptions for the drugs they abuse.

Patients should make sure they are using prescription medications appropriately — always following prescribed directions and being aware of potential interactions with other drugs.

Pharmacists dispense medications and can help patients understand instructions for taking them. By being watchful for prescription falsifications or alterations, pharmacists serve as the first line of defense in recognizing prescription drug abuse.

Prescription Drug Monitoring Programs, which require physicians and pharmacists to log each filled prescription into a state database, assist medical professionals in identifying patients who are getting prescriptions from multiple sources and allows physicians and pharmacists to track prescriptions.

Changes are under way to limit who can prescribe certain medications, with the Ohio Department of Health requiring special certification for physicians to prescribe pain medications.

In 1991, there were 5 million prescriptions issued in the United States compared to 45 million prescriptions in 2010, Torres said.

“Enough pain killers have been prescribed for every adult American to be medicated around the clock,” Torres said.

He said in Ohio, 8 kilograms of pain medications are prescribed per 10,000 residents.

Combatting the problem requires community involvement, as well as the support of government and private agencies, churches and schools, Torres said.

He said while Auglaize County does have unauthorized use of narcotics, most people using drugs here use marijuana, cocaine or prescription painkillers. Synthetic marijuana, marketed as herbal incense, also has made an appearance.

In all cases, the body becomes dependent, Torres said.

“The brain actually changes to start looking for those drugs,” Auglaize County Health Commissioner Charlotte Parsons said.

Reasons for using the drugs vary from person to person.

“Drug addiction is a biological, pathological process that alters how the brain fuctions,” according to NIDA. “Prolonged drug use changes the brain in fundamental and long-lasting ways. These long-lasting changes are a major component of the addiction itself. It is as though there is a figurative switch in the brain that flips at some point during an individual’s drug use. The point at which this flip occurs varies from individual to individual, but the effect of this change is the transformation of a drug abuser to a drug addict.”