The Exchange

Commentary and Observations from
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Prescription Drug Misuse in the United States

Prescription Drug Misuse in the United States

Narcotic prescription medications have important medical uses, but they also stimulate the reward center of the brain. In susceptible individuals, this can lead to misuse, substance use disorders, addiction, and other serious consequences. Since the early 1990s, the number of prescriptions for some of these medications has increased dramatically and has consequently led to the development of an illicit market for these medications.

Misuse of prescription drugs means taking a medication in a manner or dose other than prescribed; taking someone else's prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (ie, to get high). Despite the current administration's emphasis on the regulation of these medications, prescription drug misuse and its consequences persist. Providers who prescribe these medications have an important role in preventing, identifying, and managing problems related to prescription drug misuse.

The reasons for the high prevalence of prescription drug misuse vary by many factors including age, gender, and ease of access. Moreover, misinformation about the addictive properties of prescription opioids and the misconception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem. Although misuse of prescription drugs affects many Americans, certain populations may be at particular risk.

Patient factors associated with increased risk for opioid analgesic misuse include:

  • Substance use disorder (most consistently identified), including tobacco use disorder
  • Family history of a substance use disorder
  • Mental health disorder, including depression or posttraumatic stress disorder
  • History of legal problems or incarceration
  • White race (compared with black race), despite studies that have identified greater clinician concern and closer monitoring for black patients
  • Age less than 40-45 years old, in most studies

Principal strategies for clinicians to prevent prescription drug misuse and its consequences are optimization of alternative treatments, patient risk assessment, use of a treatment agreement, and limiting dose and early refills. Patient risk assessment should include a history, physical examination, and consideration of the presence of the following contraindications:

  • Current untreated substance use disorder
  • Poorly controlled psychiatric illness
  • Erratic follow-up

Monitoring patients who are prescribed a controlled substance should include regular follow-up, drug testing, and use of prescription monitoring programs for patients who receive these medications from multiple prescribers. Monitoring should include documentation of benefits and harms of treatment, including assessment of functional status to assure that function is stable or improving on the current regimen, and evaluation for concerning behaviors that may indicate misuse or a substance use disorder.

  • Liebschutz JM, Saitz R, Weiss RD, et al. Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. J Pain. 2010;11:1047-1055.
  • McCabe SE, West BT, Veliz P, et al. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics. 2017;139:e20162387.
  • Von Korff M, Dublin S, Walker RL, et al. The impact of opioid risk reduction initiatives on high-dose opioid prescribing for patients on chronic opioid therapy. J Pain. 2016;17:101-110.

Filed under: Health Policy and Trends, Substance Abuse

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