0
0

Chapter 42. Prescription Drug Abuse

Wilson M. Compton, M.D., M.P.E.; Richard Denisco, M.D., M.P.H.
DOI: 10.1176/appi.books.9781585623440.356700

Sections

Excerpt

Pharmaceutical products have been abused throughout the ages, and the current epidemic of prescription drug abuse in the United States represents the newest wave of a long-standing problem (Compton and Volkow 2006a). The extent of the problem is staggering, with national surveys showing that in 2004, approximately 15 million Americans, age 12 years and older, used a psychotherapeutic drug for a purpose other than medical use (Colliver et al. 2006). Past-year prevalence rates among twelfth grade students documented that prescription drugs were among the most abused illicit substances: 9%–10% reported Vicodin abuse, 4%–5% reported OxyContin abuse, 8%–9% reported amphetamine abuse, 6%–8% reported sedative abuse, and 5%–7% reported Ritalin abuse in each of the past several years (Johnston et al. 2007). Thus, prescription drug abuse has reemerged recently as a major and costly public health threat (Birnbaum et al. 2006). Furthermore, prescription drug abuse presents unusual difficulties for clinicians for two reasons: first, the medical system is the origin of the substances in many cases; and second, the boundary between therapeutic use, misuse, and addiction can be quite vague. Overall, physicians are in a unique situation of having to prescribe the optimal medication dosage to minimize the symptoms of the disease, such as when treating pain with opioids, hyperactivity with stimulants, or anxiety with sedatives. Simultaneously, physicians must monitor their prescribing practices to reduce the risk of substance abuse and addiction.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 42–1. Past-year nonmedical use of prescription psychotherapeutic drugs among persons age 12 years or older, by drug type: percentages, 2002–2004.aIncludes methamphetamine.Source. Reprinted from Colliver JD, Kroutil LA, Dai L, et al: Misuse of Prescription Drugs: Data From the 2002, 2003, and 2004 National Surveys on Drug Use and Health. Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006.

FIGURE 42–2. Past-year nonmedical use of any prescription psychotherapeutic drug, by race/ethnicity: annual averages based on 2002–2004.Source. Reprinted from Colliver JD, Kroutil LA, Dai L, et al: Misuse of Prescription Drugs: Data From the 2002, 2003, and 2004 National Surveys on Drug Use and Health. Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006.

FIGURE 42–3. Percentage of high school seniors reporting nonmedical use of sedatives in past year.Source. Reprinted from Johnston LD, O'Malley PM, Bachman JG, et al: Monitoring the Future, National Survey Results on Drug Use, 1975–2006, Vol. I: Secondary School Students. Bethesda, MD, National Institute on Drug Abuse, 2007.
Table Reference Number
TABLE 42–1. Past-year prevalence of illicit use of drugs among twelfth graders in the United States, 2006
Table Reference Number
TABLE 42–2. Prescription drugs with potential for abuse
Table Reference Number

Prescription drug abuse is common.

Prescription drug abuse has a major relation to medical practice.

Nomenclature is difficult and confusing; distinguishing use from misuse from abuse from addiction is complex for both clinicians and researchers.

Treatment is based on the pharmacological class of the substance of abuse.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Ballantyne JC, Mao J: Opioid therapy for chronic pain. N Engl J Med 349:1943–1953, 2003
[PubMed]
 
Biederman J, Faraone S, Milberger S, et al: Predictors of persistence and remission of ADHD: results from a four year prospective follow-up study of ADHD children. J Am Acad Child Adolesc Psychiatry 35:343–351, 1996
[PubMed]
 
Birnbaum HG, White AG, Reynolds JL, et al: Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective. Clin J Pain 22:667–676, 2006
[PubMed]
 
Brands B, Blake J, Sproule B, et al: Prescription opioid abuse in patients presenting for methadone maintenance treatment. Drug Alcohol Depend 73:199–207, 2004
[PubMed]
 
Brunton LL, Parker KL, Buxton ILO, et al (eds): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 11th Edition, Online Edition. New York, McGraw-Hill's Access Medicine, 2006. Available at: http://www.accessmedicine.com/resourceTOC.aspx?resourceID=28. Accessed January 15, 2007.
 
Centers for Disease Control and Prevention: Unintentional poisoning deaths—United States, 1999–2004. MMWR Morb Mortal Wkly Rep 56:93–96, 2007
 
Centers for Disease Control and Prevention, National Center for Health Statistics: Health, United States, 2006: With Chartbook on Trends in the Health of Americans. Hyattsville, MD, National Center for Health Statistics, 2006. Available at: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed January 14, 2007.
 
Colliver JD, Kroutil LA, Dai L, et al: Misuse of Prescription Drugs: Data From the 2002, 2003, and 2004 National Surveys on Drug Use and Health. Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006
 
Compton WM, Volkow ND: Abuse of prescription drugs and the risk of addiction. Drug Alcohol Depend 83 (suppl 1):S4–S7, 2006a
 
Compton WM, Volkow ND: Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend 81:103–107, 2006b
 
Compton WM, Conway KP, Stinson FS, et al: Prevalence and comorbidity of DSM-IV antisocial personality syndromes and specific substance use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 66:677–685, 2005
[PubMed]
 
Compton WM, Thomas YF, Stinson FS, et al: Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 64:566–576, 2007
[PubMed]
 
Conway KP, Compton WM, Stinson FS, et al: Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 67:247–257, 2006
[PubMed]
 
Cordell WH, Keene KK, Giles BK, et al: The high prevalence of pain in emergency medical care. Am J Emerg Med 20:165–169, 2002
[PubMed]
 
De Quincy T: Confessions of an English Opium-Eater and Other Writings (Oxford World's Classics). Oxford, UK, Oxford University Press, 1996
 
Drug Enforcement Administration: 21 USC Part B—Code of Federal Regulations: Authority to Control; Standards and Schedules 01/22/02. 1970. Available at: http://www.dea.gov/pubs/csa/811.htm. Accessed January 11, 2007.
 
Drug Enforcement Administration: A Tradition of Excellence: 1973–2003. Washington, DC, Drug Enforcement Administration, 2003. Available at: http://www.usdoj.gov/dea/pubs/history/index.html. Accessed January 11, 2007
 
Drug Enforcement Administration: Office of Diversion Control Web site. 2006. Available at: http://www.deadiversion.usdoj.gov/. Accessed January 11, 2007.
 
Fiellin DA: Buprenorphine: effective treatment of opioid addiction starts in the office. Am Fam Physician 73:1513–1514, 2006
[PubMed]
 
Forman RF, Woody GE, McLellan T, et al: The availability of web sites offering to sell opioid medications without prescriptions. Am J Psychiatry 163:1233–1238, 2006
[PubMed]
 
Friedman RA: The changing face of teenage drug abuse—the trend toward prescription drugs. N Engl J Med 354:1448–1450, 2006
[PubMed]
 
Goldman LS, Genel M, Bezman RJ, et al: Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. JAMA 279:1100–1107, 1998
[PubMed]
 
Grant BF, Stinson FS, Dawson DA, et al: Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 61:807–816, 2004
[PubMed]
 
Hajak G, Muller WE, Wittchen HU, et al: Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiologic evidence. Addiction 98:1371–1378, 2003
[PubMed]
 
Herman-Stahl MA, Krebs CP, Kroutil LA, et al: Risk and protective factors for nonmedical use of prescription stimulants and methamphetamine among adolescents. J Adolesc Health 39:374–380, 2006
[PubMed]
 
Hill CS Jr: Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin. J Pain Symptom Manage 11:287–298, 1996
[PubMed]
 
Hill JC, Schoener EP: Age-dependent decline of attention deficit hyperactivity disorder. Am J Psychiatry 153:1143–1146, 1996
[PubMed]
 
Himmelsbach CK: Addiction liability of codeine. JAMA 103:1420, 1934
 
Huang BD, Dawson DA, Stinson FS, et al: Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: results of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 67:1062–1073, 2006
[PubMed]
 
Ives TJ, Chelminski PR, Hammett-Stabler CA, et al: Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv Res 6:46, 2006
[PubMed]
 
Johnston LD, O'Malley PM, Bachman JG, et al: Monitoring the Future, National Survey Results on Drug Use, 1975–2006, Vol I: Secondary School Students. Bethesda, MD, National Institute on Drug Abuse, 2007
 
Joranson DE, Ryan KA, Gilson AM, et al: Trends in medical use and abuse of opioid analgesics. JAMA 283:1710–1714, 2000
[PubMed]
 
Kroutil LA, Van Brunt DL, Herman-Stahl MA, et al: Nonmedical use of prescription stimulants in the United States. Drug Alcohol Depend 84:135–143, 2006
[PubMed]
 
McCabe SE, Teter CJ, Boyd CJ: The use, misuse and diversion of prescription stimulants among middle and high school students. Subst Use Misuse 39:1095–1116, 2004
[PubMed]
 
McCabe SE, Boyd CJ, Teter CJ: Illicit use of opioid analgesics by high school seniors. J Subst Abuse Treat 28:225–230, 2005
[PubMed]
 
McCabe SE, Cranford JA, Boyd CJ: The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: prevalence of co-occurrence in a national sample. Drug Alcohol Depend 84:281–288, 2006a
 
McCabe SE, Teter CJ, Boyd CJ: Medical use, illicit use, and diversion of abusable prescription drugs. J Am Coll Health 54:269–278, 2006b
 
McCabe SE, Cranford JA, Boyd CJ, et al: Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav 32:562–575, 2007
[PubMed]
 
McQuay H: Opioids in pain management. Lancet 353:2229–2232, 1999
[PubMed]
 
Monga N, Rehm J, Fischer B, et al: Using latent class analysis (LCA) to analyze patterns of drug use in a population of illegal opioid users. Drug Alcohol Depend 88:1–8, 2007
[PubMed]
 
Morgan AE, Lindley CM, Berry JI: Assessment of pain and patterns of analgesic use in hospice patients. Am J Hosp Palliat Care 11:13–19, 22–25, 1994
 
Musser CJ, Ahmann PA, Theye FW, et al: Stimulant use and the potential for abuse in Wisconsin as reported by school administrators and longitudinally followed children. J Dev Behav Pediatr 19:187–192, 1998
[PubMed]
 
National Institute on Drug Abuse: Selected Prescription Drugs With Potential for Abuse. 2005. Available at: http://www.nida.nih.gov/PDF/PrescriptionDrugs.pdf. Accessed February 5, 2007.
 
Paulozzi LJ, Ryan GW: Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med 31:506–511, 2006
[PubMed]
 
Phillips DM: JCAHO pain management standards are unveiled. JAMA 284:428–429, 2000
[PubMed]
 
Portenoy RK: Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage 11:203–217, 1996
[PubMed]
 
Portenoy RK, Foley KM: Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain 25:171–186, 1986
[PubMed]
 
Poulin C: Medical and nonmedical stimulant use among adolescents: from sanctioned to unsanctioned use. CMAJ 165:1039–1044, 2001
[PubMed]
 
Regier DA, Farmer ME, Rae DS, et al: Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 264:2511–2518, 1990
[PubMed]
 
Siegal HA, Carlson RG, Kenne DR, et al: Probable relationship between opioid abuse and heroin use (letter). Am Fam Physician 67:942–945, 2003
[PubMed]
 
Sigmon SC: Characterizing the emerging population of prescription opioid abusers. Am J Addict 15:208–212, 2006
[PubMed]
 
Stewart WF, Ricci JA, Chee E, et al: Lost productive time and cost due to common pain conditions in the US workforce. JAMA 290:2443–2454, 2003
[PubMed]
 
Substance Abuse and Mental Health Services Administration: Emergency Department Trends From the Drug Abuse Warning Network, Final Estimates 1995–2002. Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2003
 
Substance Abuse and Mental Health Services Administration: Mortality Data From the Drug Abuse Warning Network. Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004
 
Substance Abuse and Mental Health Services Administration: Results From the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD, Office of Applied Studies, 2006a
 
Substance Abuse and Mental Health Services Administration: Treatment Episode Data Set (TEDS): Highlights—2005. Rockville, MD, National Admissions to Substance Abuse Treatment Services, Office of Applied Studies, 2006b
 
Sullivan MD, Edlund MJ, Zhang L, et al: Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Intern Med 166:2087–2093, 2006
[PubMed]
 
Taylor E, Chadwick O, Heptinstall E, et al: Hyperactivity and conduct problems as risk factors for adolescent development. J Am Acad Child Adolesc Psychiatry 35:1213–1226, 1996
[PubMed]
 
Teter CJ, McCabe SE, LaGrange K, et al: Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Pharmacotherapy 26:1501–1510, 2006
[PubMed]
 
Volkow ND, Swanson JM: Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am J Psychiatry 160:1909–1918, 2003
[PubMed]
 
Weissman DE, Haddox DJ: Opioid pseudoaddiction—an iatrogenic syndrome. Pain 36:363–366, 1989
[PubMed]
 
Weppner RS, Wells KS, McBride DC, et al: Effects of criminal justice and medical definitions of a social problem upon the delivery of treatment: the case of drug abuse. J Health Soc Behav 17:170–177, 1976
 
White BP, Becker-Blease KA, Grace-Bishop KA: Stimulant medication use, misuse, and abuse in an undergraduate and graduate student sample. J Am Coll Health 54:261–268, 2006
[PubMed]
 
Wilford BB: Abuse of prescription drugs. West J Med 152:609–612, 1990
[PubMed]
 
Wilson JE, Pendleton JM: Oligoanalgesia in the emergency department. Am J Emerg Med 7:620–623, 1998
 
Zenz M, Sorge J: Is the therapeutic use of opioids adversely affected by prejudice and law (abstract)? Recent Results Cancer Res 121:43–50, 1991
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
According to the National Household Survey on Drug Abuse of persons in the United States in the twelfth grade, the most commonly abused prescription medication or medication class was. . .
2.
Rates of past-year prescription drug abuse are highest among which of the following ethnic groups?
3.
Prescription opioid abusers, in contrast to heroin abusers, have. . .
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Topic Collections
Psychiatric News
PubMed Articles
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation