Nonmedical use and abuse of scheduled medications prescribed for pain, pain-related symptoms, and psychiatric disorders: Patterns, user characteristics, and management options

Abstract

The nonmedical use of scheduled medications commonly prescribed for pain, pain-related symptoms, and psychiatric disorders began rising in the mid-1990s. Physicians are confronted with the dilemma of how to minimize the abuse and diversion potential of these products without compromising access for patients with a legitimate medical need. Using data from the National Survey on Drug Use and Health, we describe the scope of nonmedical use of opioids, stimulants, and tranquilizers; characteristics of nonmedical users; and options available to reduce abuse liability. In 2003, lifetime prevalence estimates of nonmedical use were 31.2 million for opioids, 20.7 million for stimulants, and 20.2 million for tranquilizers. Nonmedical users of psychotherapeutics were more likely to be Caucasian; use alcohol, cocaine, or heroin; and to use needles to inject drugs than those who reported using illicit drugs only. Sources of diversion are enumerated, and options for minimizing the abuse liability associated with these medications are described.

What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review

“…Variables that have been found in the addiction and pain literature to predict ADRBs are the following: previous history of alcohol/illicit drug use [96]; current history of alcohol/illicit drug use [96]; family history for alcohol/illicit drug use [96]; treatment in a drug rehabilitation facility [97]; use of multiple drugs [98]; use of needles [98,99]; and being a smoker [96]. Predisposition to addiction is likely genetically determined [93,100], and hence the importance of the family history for alcohol/illicit drug use and previous history and current history of alcohol/illicit drug use.…”

Measures to quantify the abuse of prescription opioids: a review of data sources and metrics

“…Another important limitation is that data on past‐year nonmedical use are only collected by therapeutic class, and not at the level of individual class members or specific products. NSDUH data are typically used to assess the broad public health impact of abuse . For example, Katz et al used NSDUH data to estimate the proportion of all opioid doses dispensed that were subsequently used nonmedically.…”

Molecular genetics of addiction vulnerability

“…Recent estimates indicate that 72 million Americans report at least some nonmedical abuse of a prescribed opioid, stimulant, or "tranquilizer." 4 Family, adoption, and twin studies have contributed knowledge of the genetic contributions to drug abuse vulnerability. Drug abuse vulnerability is familial (reviewed in Uhl et al 5 ), and twin data from a number of laboratories strongly support the idea that drug abuse vulnerability has an overall genetic component that explains 40 -60% of the overall vulnerability.…”