Prescription drug abuse
ills. It seems everywhere we go, we’re surrounded by people selling them, buying them, or consuming them. Modern America is awash in pills. Schoolchildren line up outside the nurses office at lunchtime to get their “meds.” At parties and in libraries, people nonchalantly share pills to help them party hearty or study longer. In homes, children watch their parents, siblings, or grandparents take their daily pills with their morning orange juice. Mothers at shopping malls rummage through their purses until they find the prescription bottle. In restaurants over lunch, harried businesspeople casually pop a prescription medication, barely missing a beat in the conversation. Advances in medical science seek to improve the quality of life, prevent and arrest disease, and reduce suffering, which precipitates more medications, supplements, and vitamins than ever. In pursuit of a healthier, pain-free life, more and more people are using prescription
What health care professionals need to know By Carol Falkowski medications not as medically directed, but recreationally, for their psychoactive effects. This is now a problem of epidemic proportion, nationally and in Minnesota. Those of us in the addiction field have long known that drug abusers and addicts will use whatever substances they can get their hands on. Today prescription medications are part of that mix. In 2010, roughly 7 million people age 12 and older—2.7 percent of the U.S. population— were current users (past 30-day use) of psychotherapeutic drugs taken nonmedically (National Survey on Drug Use and Health, 2010). The medications most commonly abused were:
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MINNESOTA PHYSICIAN OCTOBER 2012
• pain relievers—5.1 million users • tranquilizers—2.2 million users • stimulants—1.1 million users • sedatives—0.4 million users According to the same survey, abuse of prescription drugs was highest among young adults 18 to 25 years of age, with 5.9 percent reporting use in the past month. Each year since 2002 has seen another 2 million or more users of new nonmedical pain relievers, including over 500,000 who initiated use without ever having used an illicit drug. Eight percent of high school seniors reported nonmedical use of Vicodin in the past year; 6.5 percent reported Adderall abuse; and 4.9 percent reported OxyContin abuse. Of note, 70 percent of the high school seniors who used prescription medications reported acquiring them from friends or relatives for free. Contrary to popular belief, online purchases were negligible (2011 Monitoring the Future Survey). Risks and consequences
Prescription opiates have high abuse potential, high addictive potential, and high overdose potential. Depressants used for anxiety and sleep disorders can produce seizure-inducing withdrawal if tapered too rapidly. Both opiates and depressants can cause severe, sometimes fatal, respiratory depression, especially when used in combination with other medications or alcohol. Effects of stimulant abuse include psychosis, seizures, addiction, and cardiovascular complications. Many people who initially abuse prescription narcotics eventually cross over and start using heroin. Why? Because heroin produces the same effects and is cheaper. In the Twin
Cities, heroin has never been so cheap, pure, and readily available. Diverted prescription narcotics typically sell for $1 per milligram, whereas heroin sells for less—in Minneapolis, for as little as 25 cents per pure milligram. According to the Heroin Domestic Monitor Program of the U.S. Drug Enforcement Administration, in 2007, 2008, and 2009, Minneapolis had the highest purity heroin sold at the lowest cost of all 19 U.S. cities with Mexican heroin. From 2001 to 2010, prescription opiate dependence rose from 936,000 to 1.4 million people. In 2010, most of these people were 26 or older (56.6 percent), but about one-third (463,000) were between 18 and 25 years of age (2010 National Survey on Drug Use and Health). From 2002 to 2010, the number of people receiving addiction treatment services for prescription opiate dependence more than doubled, from 199,000 to 406,000. In 2010, 65.7 percent were 26 or older, and 25.9 percent were 18 to 25 years old. Prescription opiate overdoses resulted in nearly 15,000 deaths in the U.S. in 2008. This is more than three times the number of deaths in 1999, and more than the number of deaths from heroin and cocaine combined. In 2011, the U.S. Centers for Disease Prevention and Control (CDC) reported that nonmedical use of prescription opiates costs health insurers up to $72.5 billion annually in direct health care costs. Local snapshot of opiate addiction
In Hennepin County and Ramsey County combined, opiate-related deaths rose from 92 in 2010 to 120 in 2011, a 30.4 percent increase. And in 2011, in an unprecedented development, heroin and other opiates accounted for just over 20 percent of admissions to addiction treatment programs in the Twin Cities, second only to treatment admissions for alcohol. Heroin users, in particular, were quite young. In 2011, 41.6 percent of the 2,223 heroin admissions to addiction treat-
Published on Oct 12, 2012
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