Prescription Medication

Two-thirds of teens who report abuse of prescription medicine are getting them from friends, family and acquaintances.  There is a perception by the youth that since these medications are prescribed, they aren’t harmful.  That couldn’t be further from the truth.   If you are the adult in the household, you need to make sure the teens in your life don’t have access to your medicine.

“Parents are in an influential position to immediately help reduce teen access to prescription medicine because medicine is commonly found in the home. But how aware are you of the quantities that are currently in your home? Think about this: Would you know if some of your pills were missing?  If your answer is no, here’s what you can do to change that answer.

Start by taking note of how many pills are in each of your prescription bottles or pill packets, and keep track of refills. This goes for your own medicine, as well as for your teens and other members of the household. If you find you need to refill your medicine more often than expected, that could indicate a problem.

If your teen has been prescribed a medicine, be sure you control the medicine, and monitor dosages and refills. You need to be especially vigilant with medicines that are known to be addictive and commonly abused by teens, such as opioids, benzodiazepines and stimulants.

Make sure your friends, parents of your teen’s friends, neighbors and relatives — especially grandparents — are also aware of the risks. Encourage them to regularly monitor their own medicines in their own homes.”[1]

When individuals develop a tolerance for the opioid, or are no longer able to obtain that particular drug from a doctor or the family’s medicine cabinet, they many times turn to street drugs such as heroin to continue getting their “high.”  It becomes a vicious spiral downward.

More Than Teens

But it is not just teens that are having substance use disorder issues.  Senior citizens are also experiencing an increase in opioid substance-use disorders.  Prescription opioid medications like oxycodone and fentanyl can be just as addictive and harmful as street heroin and these drugs are often prescribed to treat conditions common among older adults such as lower back pain and arthritis. 

With increasing rates of prescriptions for medical conditions, senior citizens are at an increasing risk of drug abuse and overdose.  From 2006 to 2012 there was a 78% increase in the number of emergency room visits by older adults because of misuse of prescription or illegal drugs.  Of that increase, 53% were ages 65 to 74, which means that a significant number of the cases involved individuals older than 75.  Yet according to the Center for Disease Control, adults between the ages of 45 and 54 have the highest death rates from opioid drug overdoses. 

The bottom line is that these prescribed substances are affecting everyone at all ages, both sexes and every race.  Find out what you can do to help prevent this from becoming a problem in your home by reading “Prevention” on this website.

What follows is edited version from a presentation done by Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse, on May 14, 2014 to the U.S. Senate Caucus on International Narcotics Control.  In it she discusses in greater detail the issue of opioid substance–use disorders and how it is impacting every corner of the United States. [2]

America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

“Prescription opioids are one of the three main broad categories of medications that present abuse liability, the other two being stimulants and central nervous system (CNS) depressants.

Several factors are likely to have contributed to the severity of the current prescription drug abuse problem.  They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.  These factors together have helped create the broad “environmental availability” of prescription medications in general and opioid analgesics in particular

In terms of abuse and mortality, opioids account for the greatest proportion of the prescription drug abuse problem.  Deaths related to prescription opioids began rising in the early part of the 21^st century.  By 2002, death certificates listed opioid analgesic poisoning as a cause of death more commonly than heroin or cocaine.

Because prescription opioids are similar to, and act on the same brain systems affected by, heroin and morphine, they present an intrinsic abuse and addiction liability, particularly if they are used for non-medical purposes.  They are most dangerous and addictive when taken via methods that increase their euphoric effects (the “high”), such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or other drugs.  Also, some people taking them for their intended purpose risk dangerous adverse reactions by not taking them exactly as prescribed (e.g., taking more pills at once, or taking them more frequently or combining them with medications for which they are not being properly controlled); and it is possible for a small number of people to become addicted even when they take them as prescribed, but the extent to which this happens currently is not known.  It is estimated that more than 100 million people suffer from chronic pain in this country, and for some of them, opioid therapy may be appropriate. The bulk of American patients who need relief from persistent, moderate-to-severe non-cancer pain have back pain conditions (approximately 38 million) or osteoarthritis (approximately 17 million).  Even if a small percentage of this group develops substance use disorders (a subset of those already vulnerable to developing tolerance and/or clinically manageable physical dependence), a large number of people could be affected.  Scientists debate the appropriateness of chronic opioid use for these conditions in light of the fact that long-term studies demonstrating that the benefits outweigh the risks have not been conducted. In June 2012, NIH and FDA held a joint meeting on this topic, and now FDA is requiring companies who manufacture long-acting and extended-release opioid formulations to conduct post-marketing research on their safety.

Prescription opioid abuse is not only costly in economic terms (it has been estimated that the nonmedical use of opioid pain relievers costs insurance companies up to $72.5 billion annually in health-care costs) but may also be partly responsible for the steady upward trend in poisoning mortality. In 2010, there were 13,652 unintentional deaths from opioid pain reliever (82.8 percent of the 16,490 unintentional deaths from all prescription drugs), and there was a five-fold increase in treatment admissions for prescription pain relievers between 2001 and 2011 (from 35,648 to 180,708, respectively). In the same decade, there was a tripling of the prevalence of positive opioid tests among drivers who died within one hour of a crash.

A property of opioid drugs is their tendency, when used repeatedly over time, to induce tolerance. Tolerance occurs when the person no longer responds to the drug as strongly as he or she did at first, thus necessitating a higher dose to achieve the same effect.  The establishment of tolerance hinges on the ability of abused opioids (e.g., OxyContin, morphine) to desensitize the brain’s own natural opioid system, making it less responsive over time.  This tolerance contributes to the high risk of overdose during a relapse to opioid use after a period in recovery; users who do not realize they may have lost their tolerance during a period of abstinence may initially take the high dosage that they previously had used before quitting, a dosage that produces an overdose in the person who no longer has tolerance.  Another contributing factor to the risk of opioid-related morbidity and mortality is the combined use of benzodiazepines (BZDs) and/or other CNS depressants, even if these agents are used appropriately. Thus, patients with chronic pain who use opioid analgesics along with BZDs (and/or alcohol) are at higher risk for overdose. Unfortunately, there are few available practice guidelines for the combined use of CNS depressants and opioid analgesics; such cases warrant much closer scrutiny and monitoring. Finally, it must be noted in this context that, although more men die from drug overdoses than women, the percentage increase in deaths seen since 1999 is greater among women: Deaths from opioid pain relievers increased five-fold between 1999 and 2010 for women versus 3.6 times among men.

Relationship between Prescription Opioids and Heroin Abuse

The recent trend of a switch from prescription opioids to heroin seen in some communities in our country alerts us to the complex issues surrounding opioid addiction and the intrinsic difficulties in addressing it through any single measure such as enhanced diversion control. Of particular concern has been the rise in new populations of heroin users, particularly young people.

The emergence of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally, may in some instances explain the transition to abuse of heroin, which is cheaper and in some communities easier to obtain than prescription opioids.

The number of past-year heroin users in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000. Heroin abuse, like prescription opioid abuse, is dangerous both because of the drug’s addictiveness and because of the high risk for overdosing.  In the case of heroin, this danger is compounded by the lack of control over the purity of the drug injected and its possible contamination with other drugs (such as fentanyl, a very potent prescription opioid that is also abused by itself). All of these factors increase the risk for overdosing, since the user can never be sure of the amount of the active drug (or drugs) being taken. In 2010, there were 2,789 fatal heroin overdoses, approximately a 50 percent increase over the relatively constant level seen during the early 2000s.   What was once almost exclusively an urban problem is spreading to small towns and suburbs.  In addition, the abuse of an opioid like heroin, which is typically injected intravenously, is also linked to the transmission of human immunodeficiency virus (HIV), hepatitis (especially Hepatitis C), sexually-transmitted infections, and other blood-borne diseases, mostly through the sharing of contaminated drug paraphernalia but also through the risky sexual behavior that drug abuse may engender. 

Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be a difficult one to convey.  Thus, we need focused research to discover targeted communication strategies that effectively address this problem.  Reaching this goal may be significantly more complex and nuanced than developing and deploying effective programs for the prevention of abuse of illegal drugs, but good prevention messages based on scientific evidence will be difficult to ignore.

Footnotes:

[1] Secure & Dispose of Medicine Properly, Partnership for Drug-Free Kids, obtained from: https://drugfree.org/article/secure-dispose-of-medicine-properly/

[2] To read her full comments go to: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse