Pharmageddon: An American Epidemic
Education & Research Prescription drug abuse has become a public health epidemic. Drug overdose death rates in the United States have more than tripled since 1990.
One hundred people die everyday in this country from accidental drug overdoses. Every year more than 16,500 people in the U.S. die, specifically, from prescription opiates. In fact, every 19 minutes, a death occurs. This is equivalent to 1.2 million years of potential life lost before age 75. These deaths exceed those from heroin and cocaine combined. The direct health care cost of prescription drug abuse exceeds 70 billion dollars per year. Sadly, this epidemic has engulfed our country, our practices, our society and our livelihoods.
How did we get to this state of affairs? I believe that in the late 1900s there was a paradigm shift in the treatment of chronic pain and in the prescribing of these drugs. The Joint Commission on Hospitals mandated physician documentation of the fifth vital sign, i.e., pain. At the same time, direct consumer advertising of pharmaceuticals was generally broadcast.
Have we evolved into a society that believes we are supposed to feel good all the time? Are physicians expected to alleviate all discomfort? Even though medicine has advanced with the use of psychotherapeutics, have we become intolerant of any pain? Our “better living through better chemistry” mantra and “quick fix” attitudes have played havoc with many lives.
What is prescription drug abuse? Prescription drug abuse is the intentional use of a medication without a prescription; or in a way other than as prescribed; or for the experience or feeling it causes. The three classes of prescription drugs that are most commonly abused are:
Opioids, which are most often prescribed to treat pain
Central nervous system (CNS) depressants, which are used to treat anxiety and sleep disorders
Stimulants, which are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD)
Knowing the risks
Opioids (used to treat pain):
Addiction: Prescription opioids act on the same receptors as heroin and therefore can be highly addictive. People who abuse them sometimes alter the route of administration (e.g., snorting or injecting versus taking orally) to intensify the effect—some even report moving from prescription opioids to heroin.
Overdose: Abuse of opioids alone or in combination with alcohol or other drugs can depress respiration and lead to death. Overdose is a major concern—the number of fatal poisonings involving prescription pain relievers has more than tripled since 1999.
Heightened HIV risk: Injecting opioids increases the risk of HIV and other infectious diseases like Hepatitis B and C through use of unsterile or shared equipment.
CNS depressants (used to treat anxiety and sleep problems):
Addiction and dangerous withdrawal symptoms: These drugs are addictive and, in chronic users or abusers, discontinuing them without a physician’s guidance can bring about severe withdrawal symptoms, including seizures that can be life-threatening.
Overdose: High doses can cause severe respiratory depression. This risk increases when CNS depressants are combined with other medications or alcohol.
Stimulants (used to treat ADHD and narcolepsy):
- Health consequences include psychosis, seizures and cardiovascular complications.
- A growing epidemic: Since the 1900s the prescriptions for stimulants has increased eightfold.
Preventing the abuse
A United Nations panel charged with monitoring global patterns of drug abuse warned that the worldwide abuse of prescription drugs will soon exceed illicit drug abuse. So what are our next steps? Prevention is a key factor in abating this epidemic. Parents, patients, health care providers and manufacturers play a critical role in preventing prescription drug abuse. The potent medications science has developed have great potential for relieving suffering as well as great potential for abuse. Therefore, we need to minimize abuse of prescription drugs and ensure access for their legitimate use.
"Every year more than 16,500 people in the U.S. die, specifically, from prescription opiates."
When asked how prescription pain relievers were obtained for non-medical use, 59 percent of 12th graders said they were given to them by a friend or a relative. The number obtaining them over the Internet was negligible.
Our prevention plan should include education, enhancement and increased utilization of prescription drug monitoring programs, development of consumer friendly and environmentally-responsible prescription drug disposal programs and provide law enforcement support and tools to expand their efforts to shut down “pill mills” and to stop “doctor shoppers” who contribute to prescription drug trafficking.
As far as treating prescription drug abuse, there is no single type of treatment, which is appropriate for all individuals addicted to prescription drugs. Treatment options must take into account the specific type of drug used along with the needs of the individual.
I believe our goals in this country will continue to be inclusive of an approved and implemented Risk Evaluation and Mitigation Strategy for certain long-acting and extended release opioids, writing and disseminating a Model Pain Clinic Regulation Law and engaging and working with Federal agencies and stakeholders to continue the implementation of a national public education campaign on prescription drug abuse and safe and proper medication disposal.