Prescription Drug Abuse Trends Surveillance and Future Implications Dena M Fisher Case Western Reserve University Master of Public Health I Prescription Drug Abuse A What is it B What types of drugs are being abused 1 Opioids central nervous system depressants sedatives and tranquilizers C Epidemiology of prescription drug abuse Who is abusing D Poisoning and death from prescription drug abuse II Sources of Abused Prescription Drugs A Why prescription drugs 1 How are they obtained III Prescribing Trends A Over prescribing B Under prescribing V Future Implications A Screening by physicians B National and state prevention programs 1 What works VI Surveillance and Monitoring Annotated bibliography with corresponding websites Appendix A Treatment and Recovery Resources What is abuse Advancements in pharmacotherapy have enabled many people to be relieved of persistent and chronic pain and many Americans today benefit from appropriate use of prescription painkillers ONDCP 2008 However when these drugs are used for nonmedical purposes they can alter brain activity and lead to dependence NIDA 2007 1 Drug abuse is defined as the use of illicit drugs NIH 2007 Illicit drugs are classified as marijuana phencyclidine PCP hallucinogens stimulants amphetamines inhalants and narcotics While most illicit drugs are purchased from the street including crack cocaine or heroin some of the deadliest illicit drugs are available in one s medicine cabinet Many are prescribed narcotics to relieve chronic and acute pain however prescription drug abuse is on the rise in the United States and appears to be contributing to a growing public health problem riddled with abuse and addiction NSDUH 2007 Prescription drug abuse and dependence is slightly more complex than illicit drug or alcohol abuse in that often times a person is prescribed the drug of abuse for initial therapy to a pain issue It can be said that no one is prescribed cocaine marijuana or alcohol Medline Plus states that prescription or over the counter drugs may be abused if you take more than the normal or recommended amount of the medicine or if you use them for illegal purposes MedlinePlus 2008 In a report to The Addiction Technology Transfer Center Network Jane Carlisle Maxwell defines non medical use of prescription drugs as the use of prescription type drugs that are not prescribed for the individual by a physician or the drugs are used only for the experience or feeling they cause Maxwell 2006 The National Household Survey on Drug Abuse NHSDA has developed criteria to better define prescription drug abuse According to NHSDA heavy use is considered to be daily nonmedical use of one or more prescription drugs for at least two weeks in the past year Wastila Strickler 2004 Additionally NHSDA considers one to be abusing when two of the following five criteria are met 1 inability to cut down 2 getting less work done 3 using substance in past month and being depressed 2 argumentative anxious or upset feeling isolated and or having health problems and or difficulty thinking clearly 4 needing larger amounts or 5 experiencing withdrawal symptoms Epstein 1995 DSM III 1987 Addiction is a multi stage process that involves the initiation of drug use progression to intermittent and then regular use followed by dependence or addiction and frequently relapses following withdrawal or slowing of drug use Kreek et al 2005 Patients who deviate from their prescribed pain reliever program can be categorized as patients with problematic opioid use Ballantyne LaForge 2007 The terms abuse misuse and dependence are debatable however the consequences of all three are quite real What drugs are being abused Prescription medications are increasingly being abused or used for nonmedical purposes and while the practice is illegal it can also be lethal in some cases Commonly abused classes of prescription drugs include painkillers sedatives and stimulants www drugabuse gov Prescription psychotherapeutic drugs include pain relievers tranquilizers stimulants and sedatives Maxwell 2006 Commonly abused classes of prescription drugs include opioids often prescribed to treat pain central nervous system depressants prescribed to treat anxiety and sleep disorders and stimulants used to treat narcolepsy attention deficit hyperactivity disorder and obesity NIDA 2007 Derived from opium poppies opiates include morphine and codeine Opioids have the same effect of morphine and codeine but are synthetically produced MedlinePlus 2008 Included in this class of drugs are oxycodone heroin hydromorphone meperidine propoxyphene and methadone Prescribed as pain killers these drugs promote sedation decrease anxiety and block pain receptors in the brain in order to alleviate acute and 3 chronic pain MedlinePlus 2008 Commercially these drugs are called OxyContin Darvon Vicodin Dilaudid Demerol and Lomotil NIDA 2007 On the street however the commercial names are broken down further into slang such as OC s Perc s OxyCoffin s Hillbilly Heroin Killer s and Oxy s SAMHSA 2007 Common central nervous system depressants include barbiturates such as Nembutol and benzodiazepines such as Valium and Xanax NIDA 2007 Painkillers such as Vicodin and OxyContin are very powerful medications against pain however they need to be monitored and taken only under close supervision by a prescribing physician When these controlled medications are taken inappropriately they can trigger addiction as they act on the same places in the brain as heroin Long term use of opioids or central nervous system depressants can lead to physical dependence Taken in high doses stimulants can lead to compulsive use paranoia dangerously high body temperatures and irregular heartbeat NIDA 2007 Typically time released opioids such as OxyContin are chewed or crushed and inhaled to negate the time release effect there is also evidence that some abusers inject the drug intravenously SAMHSA 2007 The following table from the Office of Applied Studies Substance Abuse and Mental Health Services Administration SAMHSA illustrates the breakdown of nonmedical prescription drug use in 2003 4 Opioid abuse exceeds stimulants sedatives and tranquilizers over sixty percent and this trend has shown a continual incline since 2004 NSDUH 2004 Epidemiology of Prescription Drug Abuse Who is abusing The National Survey on Drug Use and Health NSDUH surveys persons aged 12 or older nonmedical use is defined as use of prescription type drugs not prescribed for the