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National Institute on Drug Abuse -  NIDA NOTES
Research News
Volume 16, Number 3 (August, 2001)

NIDA Scientific Panel Reports on Prescription Drug Misuse and Abuse

By Patrick Zickler, NIDA NOTES Staff Writer

Photo of NIDA Postcard Showing Dangers of Prescription Drugs

As part of its initiative on prescription drug misuse and addiction, NIDA is distributing 400,000 postcards with messages about the dangers of prescription drugs. The cards are available in restaurants, book stores, clubs, record stores, coffee shops, gyms, and other locations in several major cities.

NIDA launched a new initiative on prescription drug abuse, misuse, and addiction at a press conference in Washington, D.C., in April. NIDA developed the initiative in response to reports of increased abuse of prescription pain relievers and concern over abuse of other prescription drugs. A scientific program following the press conference provided an overview of current research into issues associated with prescription opioid drugs used in pain relief, central nervous system depressants prescribed for anxiety and sleep disorders, and stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) and obesity. Dr. Alice Young, a NIDA-supported researcher at Wayne State University in Detroit, presented a discussion of the neurobiology of addiction. In subsequent presentations, researchers focused on investigations into specific aspects of prescription drug abuse.

Dr. Howard Chilcoat of the Johns Hopkins University School of Public Health and Hygiene in Baltimore discussed research into the epidemiology of prescription drug abuse. Overall, he said, the number of people who abuse prescription drugs each year roughly equals the number who abuse cocaine-about 2 to 4 percent of the population. Whites are more likely than other racial or ethnic groups to abuse prescription drugs, and many people who abuse these drugs also have psychiatric disorders. Persons age 18 to 25 are more likely than persons in other age groups to begin abusing prescription drugs. Between the ages of 12 and 17, girls are more likely than boys to begin prescription drug abuse and are more likely to abuse stimulants and sedatives than other prescription drugs.

Dr. Kenneth Schmader of Duke University in Durham, North Carolina, said that the elderly (persons age 65 or older) represent about 13 percent of the U.S. population but consume one-third of all prescription drugs. These patients are generally less healthy than younger persons and often suffer from multiple diseases for which they take multiple drugs, Dr. Schmader said, and are therefore more vulnerable than are younger patients to unintentionally misusing and becoming habituated to prescription medications. In one study of more than 1,500 elderly patients, 50 patients, roughly 3 percent, were abusing prescription drugs. In a study of consecutive admissions to a treatment program, 70 of 100 elderly patients admitted for prescription drug abuse were women. Eighty were dependent (that is, they experienced withdrawl symptoms if they tried to stop taking the drugs) on sedatives, 49 on opioids, and 3 on stimulants. Thirty-six were dependent on 2 drugs and 8 were dependent on 3.

Dr. Timothy Wilens of Massachusetts General Hospital in Boston discussed prospective studies designed to determine whether children treated for ADHD with the stimulant methylphenidate (Ritalin) are at risk for abuse of other stimulant drugs. The research involved two groups of patients diagnosed with ADHD of similar severity: one group was treated with methylphenidate and the other received treatment that did not include stimulants. Dr. Wilens reported that those who were treated with methylphenidate were less likely to abuse drugs, including prescribed or unprescribed stimulants, during treatment and throughout youth and adolescence.

Graph Showing Pain Reliever Use Trends

In 1998 roughly 1.6 million people used prescription pain relievers nonmedically for the first time-four times as many as in 1980.

Dr. Richard Brown of the University of Wisconsin Medical School in Madison said that physicians' misunderstanding of the risks associated with prescription drugs can lead to inadequate treatment of some illnesses. Dr. Brown based his statement on research in which he and his colleagues asked physicians how they would treat a set of hypothetical patients who suffered anxiety disorders, pain associated with cancer, or back pain. The researchers gave the clinicians detailed profiles of the hypothetical patients that included a treatment history and characteristics, such as use of alcohol and history of substance abuse, related to possible misuse of prescription medication. The researchers compared the physicians' treatment plans with a plan developed by a panel of experts. Compared to the experts, the 2,000 physicians who participated in the study were more reluctant to provide opioids and less cautious about prescribing sedatives. For example, 5 percent of the respondents would not prescribe opioids for severe cancer pain and nearly 80 percent would avoid opioids for severe, chronic back pain that had not responded to other treatments. About 25 percent of the physicians would prescribe benzodiazepines (sedatives such as Valium or Xanax) for a hypothetical patient with an adjustment disorder (anxiety or sadness associated with a particular situation), even though they showed several signs and symptoms of a current alcohol use disorder.

Dr. Steven Passik of Community Cancer Care, Inc., in Indianapolis, Indiana, discussed a study designed to evaluate the risks of misuse or abuse of drugs prescribed for management of chronic pain and to compare the risks with the drugs' benefits. The research involved 264 patients being treated with opioids for chronic pain not associated with cancer. On average, patients reported that the drugs relieved nearly 60 percent of their pain, and more than 90 percent said the pain relief made a significant improvement in their quality of life. Nearly 80 percent reported improvement in overall aspects of daily life such as mood, physical functioning, relationships, and sleep patterns. More than 60 percent of patients reported some adverse side effects from their medication, but only 1.2 percent described the side effects as intolerable. Overall, roughly 6 percent of patients (or their physicians) reported abuse or misuse of prescribed drugs. Drug abuse issues in pain management are complex, Dr. Passik said, but his study results suggest that the risk of opioid abuse is low compared with the benefits of the drugs in chronic pain management.

NIDA NOTES - Volume 16, Number 3

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