Drug Facts - Prescription Drugs

Overview

The non-medical use or abuse of prescription drugs remains a serious public health concern. According to the National Institute on Drug Abuse's (NIDA) research report Prescription Drugs: Abuse and Addiction, there are three classes of prescription drugs that are most commonly abused:
  • opioids, which are most often prescribed to treat pain—examples include: codeine, oxycodone (OxyContin and Percocet), and morphine (Kadian and Avinza);
  • central nervous system (CNS) depressants, which are used to treat anxiety and sleep disorders—examples include: barbiturates (Mebaral and Nembutal) and benzodiazepines (Valium and Xanax);
  • stimulants, which are prescribed to treat the sleep disorder narcolepsy, attention-deficit hyperactivity disorder (ADHD), and obesity—examples include: dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta).
Many Americans benefit from the appropriate use of prescription pain killers, but, when abused, they can be as addictive and dangerous as illegal drugs. Prescription drugs should only be taken exactly as directed by a medical professional.

The Synthetic Drug Control Strategy addresses the extent of and problems associated with prescription drug abuse. Prescription drugs account for the second most commonly abused category of drugs, behind marijuana and ahead of cocaine, heroin, methamphetamine, and other drugs. Prescription drug abuse poses a unique challenge because of the need to balance prevention, education, and enforcement, with the need for legitimate access to controlled substance prescription drugs.

Extent of Use

Data from the National Drug Intelligence Center's 2006 National Drug Threat Survey (NDTS) reveal that 78.8% of state and local law enforcement agencies reported either high or moderate availability of illegally diverted pharmaceuticals.

According to the 2008 National Survey on Drug Use and Health (NSDUH), approximately 52 million Americans aged 12 or older reported non-medical use of any psychotherapeutic at some point in their lifetimes, representing 20.8% of the population aged 12 or older. Approximately 6.2 million Americans aged 12 or older reported current (past month) use of psychotherapeutic drugs for non-medical purposes, representing 2.5% of the population. In this report, psychotherapeutics include any prescription-type pain reliever, tranquilizer, stimulant, or sedative but do not include over-the-counter drugs.

Additional data from the 2008 NSDUH show that there were 2.5 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages out to around 7,000 initiates per day. This annual estimate of the initiates of psychotherapeutics was significantly lower than the 2004 estimate (2.8 million).

Each year, the Monitoring the Future (MTF) study asks drug use and related questions of 8th, 10th, and 12th graders nationwide. MTF provides usage estimates for alcohol, tobacco, illegal drugs, and substances that are only legally available by prescription. The study includes data for the non-medical use of amphetamines, stimulants including Ritalin, and sedatives (barbiturates) including: methaqualone, tranquilizers, the narcotic pain relievers Vicodin and OxyContin, as well as GHB, Ketamine, and Rohypnol, which is not legal for prescription in the United States. Survey respondents were asked to exclude from their responses any use of prescription drugs that occurred under medical supervision.

MTF data for 2008 show that lifetime prevalence rates for amphetamine use without a doctor's orders were 6.8% for 8th graders, 9.0% for 10th graders, and 10.5% for 12th graders.

Approximately 9.7% of 12th graders surveyed in 2008 reported annual (past year) use of Vicodin without a doctor's orders.

According to data from the Bureau of Justice Statistics, approximately 21.3% of State prisoners and 16.9% of Federal prisoners surveyed in 2004 indicated that they abused depressants at some point in their lives. For this report, depressants were defined to include barbiturates, tranquilizers and Quaalude.

Health Effects

The health risks associated with prescription drug abuse vary depending on the drug. For example, abuse of opioids, narcotics and pain relievers can slow or stop breathing. The abuse of depressants, including benzodiazepines and other tranquilizers, barbiturates and other sedatives, can result in seizure, respiratory depression and decreased heart rate. Stimulant abuse can lead to high body temperature, irregular heart rate, cardiovascular system failure and seizure.9 Inappropriate use of prescription drugs, including use without a prescription or medical supervision, or using in a manner other than exactly as prescribed, can lead to addiction in some cases.

The Drug Abuse Warning Network (DAWN) receives reports of emergency department (ED) episodes involving the non-medical use of legal drugs. These can involve the deliberate abuse of prescribed or legally obtained over-the-counter (OTC) medications or of pharmaceuticals diverted for abuse. Accidental overdoses or adverse reactions to OTC or prescription drugs taken as directed are not reportable to DAWN unless they are present in combination with an illicit drug.

During 2006, there were an estimated 741,425 ED visits that involved non-medical use of prescription or OTC pharmaceuticals or dietary supplements. CNS agents were involved in an estimated 373,138 ED visits and psychotherapeutic agents were involved in an estimated 323,999 visits.

Treatment

There is no single type of treatment which is appropriate for individuals addicted to prescription drugs. Treatment options must take into account the specific type of drug used along with the needs of the individual.

Several options are available for effectively treating addiction to prescription opioids and are drawn from research regarding the treatment of heroin addiction. Options include medications, such as naltrexone, methadone, and buprenorphine, as well as behavioral counseling.

Patients addicted to barbiturates or benzodiazepines should not attempt to stop taking the drugs on their own, as withdrawal from these drugs can be problematic, and in the case of certain CNS depressants, potentially life-threatening. Patients addicted to these medications should undergo medically supervised detoxification because the treatment dose must be gradually tapered. Inpatient or outpatient counseling can help the individual during this process. Cognitive-behavioral therapy has also successfully been used to help individuals adapt to the removal from benzodiazepines.

Treatment of addiction to prescription stimulants is often based on behavioral therapies that have proven effective in treating cocaine or methamphetamine addiction. Depending on the patient's situation, the first steps in treating prescription stimulant addiction may be tapering off the drug's dose and attempting to treat withdrawal symptoms. The detoxification process could then be followed by one of many behavioral therapies.

According to the Treatment Episode Data Set (TEDS), opiates other than heroin (“other opiates/synthetics”) accounted for 5% of the total TEDS admissions in 2007 (90,516 admissions). These drugs include codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

Arrests & Sentencing

There are a variety of responses to prescription fraud that can be used by police, pharmacists, and others to try to prevent and address this crime:
  • improve pharmacists' screening of prescriptions and patients
  • employ security measures (for example, use tamper-resistant prescription pads)
  • prescribe drugs electronically
  • create a database of customers
  • use police crackdowns to target specific doctors/pharmacies
Some states have developed prescription monitoring programs, which can help prevent and detect the diversion and abuse of pharmaceutical controlled substances.18 Through the Bureau of Justice Assistance's Harold Rogers Prescription Drug Monitoring Program, funds are available to develop and enhance such programs.

The illegal sale of pharmaceutical drugs using the Internet or e-mails advertising the sale of drugs can be reported to the following agencies:
The DEA has also launched a toll-free international hotline (1-877-RxAbuse) to report the illegal sale and abuse of pharmaceutical drugs. Using the hotline, anonymous tips can be provided about the diversion of prescription drugs into the illegal market by individuals and suspicious Internet pharmacies.

During FY 2004, there were 5,556 Federal drug arrests for "other" drugs. This category of drugs includes barbiturates, hallucinogens, opiates other than heroin, and synthetic drugs.

According to the Drug Enforcement Administration (DEA), there were 237 Federal arrests involving Oxycodone during 2006. During 2005, there were 236 such arrests.

The Arrestee Drug Abuse Monitoring (ADAM) II program is designed to gather information on drug use and related matters from adult male offenders within 48 hours of arrest. ADAM II serves as a critical source of data for estimating trends in drug use in local areas, understanding the relationship between drugs and crime, and describing drug market activity in the adult male arrestee population in 10 U.S. sites during 2008. Approximately 10% of adult arrestees reported the use of opiate painkillers in four ADAM data collection sites (Indianapolis, IN; Minneapolis, MN; Portland, OR; and Sacramento, CA).

Production & Trafficking

Individuals illegally obtain prescription drugs through a variety of means, such as:
  • Doctor shopping or other prescription fraud
  • Illegal online pharmacies
  • Theft and burglary (from residences, pharmacies, etc.)
  • Receiving/purchasing from friends or family
  • Overprescribing (negligent or occasionally even intentional overprescribing by physicians or other prescribers)
A research study was conducted in 2007 on behalf of the National Center on Addiction and Substance Abuse (CASA) at Columbia University. A total of 210 hours was devoted to documenting the number of Internet sites dispensing selected prescription drugs. Using Internet search engines and e-mail advertisements, researchers discovered that of the 187 Internet sites found to be selling controlled prescription drugs during this period, 157 (84%) did not require any prescription. Of these sites, 52 (33%) clearly stated that no prescription was needed, 83 (53%) offered an “online consultation” and 22 (14%) made no mention of a prescription.

Only 30 of the 187 Internet sites found during the 2007 study required a prescription. Of these, 17 (57%) only required patients to fax a prescription, 4 (13%) required that a patient mail the prescription and 9 (30%) indicated that a doctor would be contacted prior to dispensing the drug.

Street Terms

Term Definition
80 OxyContin pill
Doctor Shopping Going from doctor to doctor to fraudulently obtain prescriptions
Murder 8 Fentanyl
Pharming Consuming a mixture of prescription substances
Ritz and Ts Comination of Ritalin and Talwin injected

Taken from the Office of National Drug Control Policy Website.