During National Drug Facts Week, the FDA reminded health care professionals that prescription medication misuse is a growing problem that they can help prevent by talking about it with teen and young adult patients. Teens and young adults often are not aware of the dangers of taking too much medication, or how mixing those with other medicines, illicit drugs, or alcohol can be deadly. Health care professionals can inform young patients about the safe and effective use of prescriptions, including pain relievers, and how to avoid a risky mistake.
The FDA has developed “The Buzz Takes Your Breath Away…Permanently,” a document targeted to young patients that explains how misusing prescription drugs can have serious consequences. “The Buzz” makes it clear, “when abused alone, or taken with other drugs, prescription pain medications can kill you. And the death toll from misuse and abuse is rising steadily. Prescription pain relievers, when used correctly and under a doctor's supervision, are safe and effective. But abuse them, or mix them with illegal drugs or alcohol, and you could wind up in the morgue. Even using prescription pain relievers with other prescription drugs (such as antidepressants) or over-the-counter medications (like cough syrups and antihistamines), can lead to life-threatening respiratory failure. . . . With some prescription pain relievers, all it takes is one pill.
When a person takes a legal prescription medication for a purpose other than the reason it was prescribed, or when that person takes a drug not prescribed to him or her, that is misuse of a drug. Misuse can include taking a drug in a manner or at a dose that was not recommended by a health care professional. It can also happen when the person wants to “get high,” which is an example of prescription drug abuse. The difference between misuse and abuse mostly has to do with the individual’s intentions or motivations. For example, let’s say that a person knows that he or she will get a pleasant or euphoric feeling by taking the drug, especially at higher doses than prescribed. That is an example of drug abuse because the person is specifically looking for that euphoric response.
In contrast, if a person isn’t able to fall asleep after taking a single sleeping pill, they may take another pill an hour later, thinking, “That will do the job.” Or, a person may offer a headache medication to a friend who is in pain. Those are examples of drug misuse because these people did not follow the medication instructions, and even though they were not looking to “get high” from the drugs. They were treating themselves, but not according to the directions of their health care providers.
Both misuse and abuse of prescription drugs can be harmful and even life-threatening to the individual. This is because taking a drug other than the way it is prescribed can lead to dangerous outcomes that the person may not anticipate. It’s important to note that all drugs can produce side effects, but the risks associated with prescription drugs are managed by a health care professional. Thus, the benefits outweigh the risks when the drug is taken as directed. However, when a person misuses or abuses a prescription drug, there is no medical oversight of the risks. A person can die from respiratory depression from misusing or abusing prescription painkillers; for example, opioids. Prescription sedatives like benzodiazepines can cause withdrawal seizures. Prescription stimulants such as medications for attention deficit hyperactivity disorder (ADHD) can lead to dangerous increases in blood pressure. The risks from these drugs are worse when they are combined with other drugs, or alcohol.
Additionally, when a person misuses a prescription drug, even on a single occasion, that individual might enjoy the experience so much that they begin to seek out the drug more often. Thus, drug abuse and drug dependence are serious risks of misusing prescription drugs. Prescription drugs are often readily accessible in the home, so it’s easy to take more of them than recommended for a therapeutic reason, or to sneak a few from someone else’s bottle to see if you can “get high.”
One feature of prescription drug abuse is when a person continues to take the drug after it’s no longer medically needed. This is usually because the drug produces euphoric responses. Prescription drugs are often preferred for abuse because of the mistaken belief that the drugs provide a “safe high.” But, as was mentioned before, all drugs carry risks, and if these risks are not being managed by a health care professional, people can get into serious trouble.
The prevalence of misuse and abuse of prescription medications is concerning. The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal health agency, reports that in 2008, 52 million persons in the United States age 12 or older had used prescription drugs nonmedically at least once in their lifetime, and 6.2 million had used them in the past month. SAMHSA also reported that between 1998 and 2008, there was a 400 percent increase in substance abuse treatment admissions for opioid prescription pain relievers.
A recent CDC survey found that one in five high school students had taken a prescription drug without a doctor’s prescription. According to SAMHSA, the majority of these teenagers are obtaining the drugs from friends or relatives for free. Most concerning, the perception of risk of prescription drug abuse declined 20 percent from 1992 to 2008, based on data from a National Institute on Drug Abuse survey.
SAMHSA reports that in 2008, nonmedical use of psychotherapeutic prescription drugs fell into four major classes: pain relievers, tranquilizers, stimulants, and sedatives. Nearly 35 million Americans reported that they had nonmedical use of prescription pain relievers—including opioid-containing drugs such as hydrocodone (Vicodin), oxycodone (OxyContin, Percodan, Percocet), and fentanyl (Duragesic)—at least once during their lifetime. Approximately 21.5 million Americans have used prescription tranquilizers for nonmedical purposes at least once. These include drugs prescribed for anxiety or insomnia, such as benzodiazepines—including diazepam (Valium), alprazolam (Xanax) and clonazepam (Klonapin)—and non-benzodiazepines such as zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta).
Similarly, about 21.2 million Americans have used prescription stimulants nonmedically at least once. These include drugs prescribed for ADHD such as amphetamine (Adderall), methylphenidate (Ritalin, Concerta, and Daytrana), and methamphetamine. Notably, almost 13 million people reported they had used prescription methamphetamine at least once during their lifetime. Finally, nearly 9 million Americans have used prescription sedatives nonmedically at least once. These sedatives include barbiturates such as amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal).
Prescription drugs are being misused and abused by a wide variety of people. According to SAMHSA, about 26 million Americans between the ages of 26 and 50 report they have used prescription drugs non-medically at some point in their life. Other age groups have lower lifetime incidents: 13 million who are age 50 or older, 9 million who are age 18 to 25, and 3 million who are 12 to 17 years of age. There also appears to be regional differences across the U.S. For example, SAMHSA reports that the highest past-year rates of nonmedical use of prescription pain relievers occur in Arkansas, Kentucky, Nevada, Oklahoma, Oregon, Tennessee, and Wisconsin.
Health care professionals should talk to patients about all of the warnings and precautions listed on the drug label for the medication being prescribed. In addition, if a medication guide is available, it should explain the risks of the drug in plain language. The pharmacy should provide the medication guide when a person picks up the prescription.
Health care professionals should encourage patients to be aware of early signs of drug abuse, which can include using the prescription more frequently or at higher doses, but without medical direction to do so. Using the drug compulsively or not being able to carry out normal daily activities because of drug misuse are also signs of abuse.
Finally, health care professionals and pharmacists have a responsibility to remind patients not to share their medications with friends or family. Not only is this a dangerous practice health-wise, it is also illegal.
Be informed about the effects of prescription drugs and be vigilant. Know what medications your loved ones are taking and watch for signs of changes in behavior. For instance, have you noticed negative changes in your child's behavior or grades? Is your spouse evasive about how much medication he or she is taking? Do you have friends that you suspect might be pilfering prescription drugs from your medicine cabinet?
If you are taking medications that have abuse potential, use the drugs only as directed. Don’t share them, and store them in a safe, secure place. Count the pills regularly to make sure no one else is using them. If you are having a house party or an open house, make sure the medications are properly secured.
Finally, all drugs should be disposed of properly after they are no longer needed. If no specific disposal directions are given with the medication, discard the drugs by mixing with undesirable substances, sealing them in a container, and placing them in the trash.
See the FDA Resources on Misuse of Prescription Pain Relievers
See also the FDA’s “The Buzz Takes Your Breath Away . . . Permanently”
See also the National Institute on Drug Abuse Announcement
See also the National Drug Facts Week site
See also Medical Law Perspectives, January 2014 Report: Prescription Painkillers: Risks for Patients, Pharmacists, and Physicians
See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication