By NIDA Director Nora D. Volkow, M.D.
The misuse and abuse of prescription medications is a growing public health concern. The National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimates that in 2003, 6.3 million Americans aged 12 and older abused prescription drugs (that is, took medications not prescribed for them or took medications solely for pleasure or entertainment) in the month preceding the survey. Most abused pain relievers (4.7 million); others abused tranquilizers (1.8 million), stimulants (1.2 million), and sedatives (0.3 million).
The abuse of prescription medications has increased in all segments of the population, and in recent years the increase in abuse of prescription painkillers has been particularly sharp and worrisome. In 2002, the NIDA-supported Monitoring the Future survey initiated questions about the prescription pain medications oxycodone (OxyContin) and hydrocodone (Vicodin). In that year and in 2003, about 4 percent and 4.5 percent, respectively, of high school seniors reported nonmedical use of oxycodone in the 12 months preceding the survey. Roughly 10 percent of seniors reported nonmedical use of hydrocodone, making it the third most widely abused illicit substance (after marijuana and amphetamine) in this age group.
The abuse of prescription pain medications is increasing among adult Americans as well. Among young adults aged 18 to 25, the rate increased from 22.1 percent in 2002 to 23.7 percent in 2003, NSDUH data show. Abuse of oxycodone increased among all age groups from 2002 to 2003: by more than 10 percent among Americans aged 12 to 17, by nearly 40 percent among 18- to 25-year-olds, and by 60 percent for Americans aged 26 or older.
NIDA is responding to the increase in prescription drug abuse on several fronts. In September, a Consultant Workgroup meeting brought together researchers and physicians with expertise in pain management and the epidemiology, prevention, and treatment of opiate abuse. This panel developed an outline for a large-scale clinical study of treatment for prescription opiate abuse that will be designed and conducted by NIDA's Clinical Trials Network. NIDA research also is expanding our understanding of the risks posed by prescription medications in different populations—women, adolescents, racial and ethnic groups, health professionals, those with comorbid substance abuse and mental health disorders, and those with HIV/AIDS and other infectious diseases. One group that may be especially at risk is the elderly. Age-related changes may influence the way in which their bodies metabolize and respond to prescription drugs. Older adults are more likely to have undiagnosed psychiatric and medical illness. They also are more likely to be taking several medications in complex drug regimens, increasing the risk of drug interactions or errors in dosing. Any of these circumstances may contribute to development of unwanted dependence or even addiction to prescribed medications.
Patients with chronic pain need medications; the potential for abuse should not deter physicians from prescribing appropriate medications in adequate dosages. To help primary care providers confidently select the most appropriate medication for the situation, NIDA is working to develop screening and diagnostic tools that primary care physicians can use to assess the potential for misuse, abuse, and dependence on prescription drugs in their patients.
NIDA Updates Prescription Drug Abuse
Program Announcement Number: PA-04-110
Expiration Date: January 3, 2008, unless reissued.
In revising and reissuing this Program Announcement, NIDA
encourages applications across a broad range of experimental
approaches, including basic, clinical, epidemiological, prevention,
and treatment studies. Full details of the PA, including contact
information for questions concerning scientific, technical,
or grant management issues, are available on the Web at:
Developing new medications free of potential for abuse or diversion to illegal markets is another NIDA priority. We are evaluating potential new medications such as cannabinoids that relieve certain types of pain but have reduced risk for addiction and abuse (see "Novel Cannabinoid Appears Promising for Treatment of Chronic Pain").
We also are working to understand more fully the role of environmental and social factors in misuse or abuse of prescription medications. For example, how great a threat is posed by Internet sites offering controlled substances for sale? Do some health professionals contribute to abuse of prescription drugs through inappropriate prescribing? Do others provide inadequate treatment because they fear their patients will become addicted? If these risks are significant, what educational efforts will most effectively guide physicians in prescribing appropriate medications for patients who need them?
NIDA's expanded commitment will help ensure the availability of safe and effective treatment with lessened risk of dependence or addiction.
Volume 19, Number 5 (January 2005)