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Prescription drug abuse

INTRODUCTION

Prescription drug abuse involves the use of a medication, usually by self-administration, in a manner that deviates from medical, legal and social standards [1]. Prescriptions for opioid medications have increased annually since 1990, at least in part because of evolving attitudes toward the use of opioids to treat chronic pain, and the increasing prevalence of chronic pain with the aging of the population. The prevalence of prescription drug abuse is increasing at a pace even faster than the increase in medical use of prescription drugs.

Although trends in the United States (US) show a decline in the use of some illicit drugs, the abuse of prescription drugs is increasing, both in the US [2] and worldwide [3]. Many factors contribute to this rise, including the misperception of pharmaceutical drugs as safe even when used outside of medical practice, their relatively low cost, and their wide availability [4].

The street value of diverted controlled drugs, as estimated by the US Drug Enforcement Administration, rivals the annual street value of cocaine and regularly surpasses the street value of both heroin and marijuana. Demand for prescription medications has led to increased production of counterfeit drugs [3]. Additionally, the ability to access prescription medications over the Internet has created a global market, with over 300 opioid "no prescription web sites" identified in one search [5].

This topic will address the identification and management of the prescription drug abuser and offer suggestions to reduce prescription drug abuse. An overview of drug abuse, and recognition of drug abusers is discussed separately. (See "Overview of the recognition and management of the drug abuser".) Management of specific drug dependencies are also presented separately. (See "Heroin and other opioids: Management of chronic use" and "Sedatives and hypnotics: Clinical use and abuse".)

EPIDEMIOLOGY

The number of persons in the US who used prescription medication for nonmedical purposes doubled between 1992 to 2003 (7.8 to 15.1 million) [6]. Nearly 7 million Americans used prescription drugs nonmedically in 2006, which is more than the number who used cocaine, heroin, hallucinogens, ecstasy and inhalants combined. Prescription medications are second only to cannabis in frequency of illicit use [6]. A 2003 US national survey found the following lifetime incidence of nonmedical use of prescription medications among adults: pain relievers (13 percent), tranquilizers (9 percent), and sedatives (4 percent) [7].
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