Abuse Trends

The United States had experienced an unprecedented rise in prescription drug abuse since 1990s. While some reports indicate that the abuse of illicit substances may have leveled off or even slightly declined among certain demographic groups, the abuse of prescription drugs is skyrocketing and so are the socioeconomic consequences associated with this largely hidden problem.

Source – CDC 2014

In 2010, about 7 million Americans reported non-medical use of prescription medications

Abuse of prescription drugs occurs when used:

  • without a legitimate prescription,

  • in a manner other than prescribed,

  • or to induce certain experience or feeling.

According to CDC and DEA estimates, the US consumes >75% of world’s prescription drugs and >90% of world’s production of Hydrocodone, one of the most frequently abused and diverted opioids. Prescription opioids are the fastest-growing cause of death among Americans, exceeding deaths caused by firearms and motor vehicle accidents. Drug overdose death rates more than tripled since 1990.

How did we get here?

While there are many factors contributing to the current status quo, one factor worth mentioning is the paradigm shift in pain management from under-treatment to over-prescribing that occurred over the past two decades. The Veterans Health Administration’s “Pain as the 5th Vital Sign” initiative of 1999 may have precipitated this shift. When Congress declared the year 2001 as the beginning of the Decade of Pain Control and Research (HR 3244, Oct. 2000), the floodgates of opioid prescriptions were open as the use of pharmacological treatment of pain was disproportionately emphasized and non-pharmacological treatment modalities were underutilized. As a result, many communities have experienced proliferation of so-called “pill mills” which engaged in unscrupulous prescribing and dispensing of controlled substances, essentially amounting to deliberate diversion of controlled substances for the purpose of generating profit. Similarly, direct-to-consumer advertising arguably played significant role in the dramatic increase in consumption of prescription drugs.

However, prescription drug abuse is not limited to opiods. Stimulants and anxiolytics are also frequently abused, with stimulants gaining popularity among teens and young adults and the number of prescriptions dispensed in this category is rising in a similar manner that was observed for opioids. Of concern are also cocktails, such as “Holy Trinity” (Oxycodone, Carisoprodol, and Alprazolam), etc., frequently sought by abusers.

Why are prescription drugs so popular?

The popularity of prescription drugs can be attributed to several factors:

  • Perception of safety – prescription drugs are FDA approved and thus may be considered a safe alternative to street drugs.
  • Relatively low initial cost – many abusers can obtain prescription drugs, at least initially, at little or no cost through their health insurance.
  • Easy access – large percentage of abusers, particularly teens and young adults, obtained drugs free from friends or relatives (see graph below).

Who is most vulnerable?

According to the data published by CDC, teens and young adults are particularly vulnerable to peer-pressure to engage in drug abuse. Women appear to be at higher risk of death from overdose than men.

Growing rates of drug-related deaths among women (Source – CDC)