Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Abstract

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

Prescription Psychoactive Medication Use in Adolescent Survivors of Childhood Cancer and Association With Adult Functional Outcomes

“…The use of psychoactive medications to treat emotional distress symptoms is unfavorable in populations with multiple comorbidities, because of reasons such as medication burden, poor adherence, and risk of adverse events associated with polypharmacy ( 27 ). Within the general population, addictive properties of psychoactive drugs may lead to other psychoactive prescription drug use disorders such as substance abuse and risky health behaviors ( 28 , 29 ). These collective findings underscore the need for more effort in directing balanced and appropriate use of psychopharmacologic and nonpharmacological interventions to treat distress symptoms in survivors of childhood cancer.…”

The (Mis)use of Psychotropic Drugs and Addiction to Anxiolytics among Older Adults Living at Home or in Retirement Homes: Implications for Quality of Life

“…However, it is also important for primary care physicians to be well-educated in order to avoid potential risks, including errors in symptom recognition and treatment of mental disorders, prescribing medications without appropriate indications, inadequate patient medication adherence monitoring, potential drug interactions and misuse, insufficient management of adverse effects or patient deterioration, and the issue of stigmatization, among others. Numerous studies indicate high risks of consumption above permitted doses and other irregularities dealing with prescribing medications [22,24].…”

“…For a longer period, there has been a growing trend in the consumption of various psychotropic medications by older adults without any confirmation of a mental disorder [20]. Numerous studies show high risks of their usage above the permitted dose, as well as other irregularities in prescribing them [21][22][23][24]. The most commonly used and misused medications are painkillers, antibiotics, and anxiolytics [16].…”

Prescription drug misuse during pandemic

“…Such self-medications can potentially alleviate mental disturbances and could lead to abuse. 4 The study included both male and female young respondents and majority of them admitted of using prescription drugs especially painkillers very frequently. Respondents also shared the experience of change in behavior and problems with memory.…”