Sunday, 20 January 2013

Prescription Drug Misuse Declining Or Not?

Today's post from (see link below) follows on from yesterday's post in that it looks at the results of prescription drug availability and abuse. It seems, according to the report, that non-medical drug abuse has and is falling in the USA while prescription drug abuse is clearly rising. The report highlights medical drug abuse as being a big problem for now and the future but as Dr Leavitt's commentary below suggests, it may not be as cut and dried as it seems. Either way, as neuropathy patients who are on opioid and opium family drugs well know, the potential for addiction is always there and patients need to be carefully and regularly monitored by their doctors, to try to minimize the risk.

Rx Pain Reliever Misuse Declining?
Posted by SB. Leavitt, MA, PhD: Thursday, January 10, 2013

A new United States government report shows that prescription drug misuse decreased in 10 states between 2009 and 2011, and did not increase in any other states during that time. Yet, the government seems unimpressed by these results, and there could be biases in the reporting that are distorting the evidence to make the problems loom larger than reality as well as overlooking underlying causes.

The report issued by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) on January 8, 2013 [available here] notes that 22 million people used prescription pain-relieving drugs for “nonmedical purposes” since 2002. And, such Rx-drug misuse is just behind marijuana as the country’s most widespread drug problem, according to SAMHSA.

At the same time, however, the report states that comparisons of combined 2009-2010 data with combined 2010-2011 data show that past year nonmedical use of prescription pain relievers among persons aged 12 or older decreased in 10 states (Kentucky, Louisiana, Massachusetts, Mississippi, New Hampshire, New York, Ohio, Oklahoma, Rhode Island, and West Virginia), and leveled-off during that timeframe in all other states on average.

Iowa had the lowest rate of nonmedical prescription drug use, at 3.6%, while Oregon had the highest rate — 6.4%. Seven of the 10 states with the highest levels of prescription analgesic misuse were in the West: ie, Washington, Oregon, Nevada, New Mexico, Idaho, Colorado, and Arizona. Two other high ranking states were in the South (Arkansas and Delaware), and one was in the Midwest (Indiana).

The national rate for the overall U.S. population declined between 2009-2010 and 2010-2011 — from 4.9% to 4.6%. The rates also decreased nationally during those time periods among persons aged 12 to 25, but remained unchanged overall among persons aged 26 or older. This older group already had analgesic misuse rates significantly lower than teenagers and young adults, but even among older persons there were declines in many states.

Data for the report were from the National Survey on Drug Use and Health (NSDUH), which asks persons aged 12 or older questions related to their nonmedical use of prescription pain relievers during the past year. Such “nonmedical use” is defined as (a) use of the analgesics without a prescription, or (b) use that occurred simply for the experience or feeling the drug caused; over-the-counter (OTC) drug use and legitimate use of prescription analgesics are not included.

In a news release [here], Pamela S. Hyde, SAMHSA Administrator, stated…

“Addressing prescription drug misuse remains a top public health priority, as we’ve seen inconsistent progress in addressing the issue across the states. Data from this report helps us better understand geographic variations in use, and should help with the development of more targeted and effective prevention and treatment programs. The key is educating the public on the serious health risks involved, and ensuring that we are providing the necessary treatment to those who need it.”

COMMENTARY: This report is significant news, since nonmedical use has declined even as the rate of analgesic prescribing overall has been increasing. Yet, the government often appears to emphasize the negative side of such data in continuing to portray an “epidemic” of prescription drug misuse, rather than lauding the remarkable progress that has been made.

Importantly, definition of the problem may be contributing to misperceptions that inflate the data. “Nonmedical use” of prescription analgesics is conflated with abuse, and includes using the drugs either for recreational purposes to get “high”OR using the drugs as intended for pain, but without appropriate authorization — a form of “medical misuse.”

In other words, someone who once “borrowed” a prescription pain reliever from a relative or friend for a toothache, and answered honestly on the NSDUH survey, would be categorized as a nonmedical user (abuser). This is the same category as someone who stole prescription pain pills from their parents’ medicine cabinet to get high at a party. Yet, the motivations are strikingly different, even though both uses could be quite hazardous, and solutions to the respective problems also would be very different.

For example, some time ago in an UPDATE article [here] we reported on a large survey of high school seniors that found 12.3% of them used opioid analgesics for “nonmedical” reasons at some time. Yet, on closer inspection, 45% of the “misusers” actually took the drugs for self-medicating physical pain. This was similar to other studies finding that roughly half of so-called “nonmedical use” among students was to relieve pain; albeit, such use was unauthorized due to the person not having a prescription of their own.

As we noted in that earlier UPDATE, an important public health question might be, “Why are so many young persons suffering from untreated (or mistreated) physical pain, causing them to seek remedies on their own?” Perhaps, it is more convenient for them to borrow a few pills from a friend than go to a healthcare provider. Or, are there access-to-care and undertreatment of pain problems among these youngsters that need to be addressed?

It is interesting to observe in the latest SAMHSA data that the group with the highest rates of analgesic misuse are young adults 18-to-25 years old. Surely, this is an active time of life that may be filled with sports injuries and acute physical aches/pains of various types, as well as a period of experimentation with many life experiences — including drugs. Although the data do show some significant declines in drug misuse in this age group, as in the other groups, these young persons might represent a special target for prevention and education efforts.

Meanwhile, in older persons, with the lowest rates of “nonmedical” analgesic use in the SAMHSA data, one might speculate that such misuse more often than not is for the unauthorized self-treatment of pain. Furthermore, the use of marijuana among older age groups could be more often for pain than purely recreational use. We need better ways of capturing and categorizing such data, and then addressing the true underlying problems; although, the government has not shown any interest in doing this in the past. What do readers think?

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