Prescription and OTC Medication Abuse Increases Over Last Decade

You may be seeing these headlines more frequently in the future.  Increasingly, public policy and prevention organizations are highlighting concerns about the growing abuse of both prescription and over-the-counter drugs.

This article will address the non-medical use and misuse of prescription drugs and over-the-counter medications across the population.  Non-medical use can be understood as misuse, and the terms can be used interchangeably.  It is usually defined as using prescription medications for oneself without a legitimate prescription or using any medications for an emotional experience or pleasure.  The abuse of prescription drugs for non-medical reasons is becoming more and more concerning, particularly for adolescents.  The National Survey on Drug Use and Health (NSDUH) is an annual survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).  The latest findings available are from the 2006 survey and will be used for this article.

For adults, the abuse of any prescription-type psychotherapeutic drug for past month use is estimated at 2.5 percent, and at 6.1 percent for past year use.  Total life misuse of prescription-type medication is reported to be 48 million people or 20.0 percent of the population!  Pain relievers continue to be the most frequently misused of the prescription medications, with 4.9 percent of adults.  Of these, opiates, excluding heroin, are the most popular.  In decreasing order of abuse are tranquilizers (2.1 percent), stimulants (1.4 percent), methamphetamine (.7 percent), and sedatives (.4 percent).  The abuse of prescription medications is higher than that of cocaine, heroin, inhalants and hallucinogens combined.  When asked where they obtained prescription medications that they misused, 55.7 percent stated that they obtained the drugs from friends or relatives for free.

For adolescents age 12 to 17 years, the misuse of prescription-type psychotherapeutic drugs is similar to that of adults.  The lifetime misuse of the opiate OxyContin, however, has been increasing for this age group.

Another national survey conducted on adolescents by the National Institute on Drug Abuse (NIDA) is called Monitoring the Future. Their 2004 survey findings revealed that 9.3 percent of twelth graders reported using Vicodin without a prescription, and 5.0 percent reported using OxyContin without a prescription.  Misuse of tranquilizers for twelth graders was 7.3 percent, misuse of sedatives/barbituates was 6.5 percent and misuse of amphetamines was 12 percent.  Adolescents are more likely to abuse prescription medications if they abuse other drugs.  The NSDUH indicates that 63 percent of adolescents who misused prescription medications in the past year also used marijuana in the past year.

For adults aged 65 and older, there is particular concern about the misuse and abuse of prescription medications.  Although they make up only 13 percent of the population, they account for over 30 percent of all prescribed medications (SAMHSA, 2006).  Many of the prescriptions written for older adults are for psychoactive medications, which have a high potential for abuse and addiction.  Because of slowed metabolism and the high level of co-morbid illnesses in the elderly, they can experience more adverse consequences from their medications.

Most people are not aware that many over-the-counter medications (OTC) that are kept in their medicine cabinets can be abused and that they are most often abused by adolescents.  Certain cough suppressants (including dextromethorphan or DXM), sleep aids (such as doxylamine, found in Unisom), antihistamines (including diphenhydramine, found in benadryl), and dimenhydrinates (which are found in Dramamine) can be misused and abused for their psychoactive effects.  Cough medicines and suppressants are particularly abused because when taken in large amounts, DXM can cause dissociative or “out-of-body” experiences similar to some hallucinations.  Parents particularly need to be aware of the potential danger of OTC medications in their homes and either destroy them in a safe manner or lock them up.

In 2006, 5.3 percent of the population surveyed had used over-the-counter cough and cold medication at least once to get high, and 1.7 percent of them had done so in the past year.  The age group with the highest rates of misuse of OTC cough medications is the group between the ages of 12 and 25 years (NSDUH, 2006).  Most of those who misuse OTC medications get them from the medicine cabinets of friends or relatives, often without the friends or relatives’ knowledge.

Although use and abuse are not included in the criteria for dependency or addiction, use and abuse can also alter the brain chemistry and generally do precede more severe dependency symptoms.  Use and abuse certainly can lead to the development of tolerance, withdrawal symptoms, preoccupation, loss of control, the compulsion to use, and continued use despite harmful consequences.  The presence of any three of these symptoms is indicative of an addiction problem.  General risk factors for the development of addiction include:  family history of substance abuse/addiction, poor parental discipline or direction, family history of antisocial behavior or criminality, positive family/peer attitudes toward use and use before the age of 15 years (SAMSHA, 1998). 

Nurses and other health care providers are also vulnerable to encountering these problems.  Additional risk factors for health care professionals include lack of education about substance abuse, positive attitudes towards drugs/medication, a sense of being invulnerable to illness, permissive attitudes toward self-diagnosing and self prescribing, and the stress of work and daily living (Trinkoff, et al, 2000). 

It is clear that the misuse and abuse of prescription and OTC medications is widespread and impacts people from every walk of life.  Becoming aware of the problems that can be encountered from these medications will help everyone be more prepared to avoid and/or address these problems in the future.  It is clear that all of us need to be cautious.  We can learn to monitor the security and safety of our own OTC medications and ensure that any prescription medications are destroyed safely (and not flushed down the toilet).  The Board of Pharmacy has recommendations for the safe disposal of prescription medication and OTC medications on their Web site at www.rld.state.nm.us/pharmacy, under the term “drug disposal.” •

Story contributed by: Nancy Darbro, Ph.D., RN, DP Coordinator

References:

Fleming, et al. 2007, Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy. The Journal of Pain, 8(7), 573-582.

National Institute on Drug Abuse (NIDA):  Monitoring the Future. 2004 Findings www.drugabuse.gov.

Substance Abuse and Mental Health Services Administration (SAMHSA).  National Survey on Drug Use and Health (NSDUH) 2006 Findings.  http://oas.samhsa.gov.

Substance Abuse and Mental Health Services Administration (SAMHSA). 1998. National Household Survey on Drug Abuse. Rockville, MD: Department of Health and Human Services.

Trinkoff, A.M., Shou, Q., Storr, C.L., and Soeken, K.L. (2000). Workplace access, negative proscriptions, job strain and substance abuse in registered nurses. Nursing Research, 49(2), 83-89.