Prescription Drug Abuse Overview
Prescription drug misuse is a widespread issue that often goes unnoticed due to the legal nature of these substances. This section outlines the concept of substance use disorders and the role stigma and discrimination play in perpetuating this crisis.
Understanding Substance Use Disorders
Many people are unaware that the root of a substance use disorder lies in changes in the brain that make drug use compulsive. Some individuals may resort to aggressive or even criminal behaviors to support their drug problem. This lack of understanding can lead to stigma and discrimination against individuals with substance use disorders.
The question of why prescription drugs are so commonly abused is multifaceted. The misuse stems from a variety of factors, including the accessibility of these drugs, misunderstanding about their safety due to their legal status, and the changes in the brain that occur with prolonged use, leading to compulsive drug-seeking behavior.
Impact of Stigma and Discrimination
People with substance use disorders often face stigma and discrimination due to negative stereotypes. Some view addiction as a personal or moral failure, which can evoke fear and anger towards individuals with substance use disorders, further alienating them from society. Commonly used terms like "junkie" and "addict" perpetuate negative biases and dehumanize individuals with substance use disorders. Language and criminalization of drug use can contribute to the stereotype of people who use drugs as dangerous, perpetuating stigma against them.
Moreover, racial disparities in drug-related arrests contribute to stigma surrounding drug use, disproportionately affecting Black people and communities of color in the United States. Despite similar usage rates between Black and white populations, punitive drug policies lead to higher arrest rates for drug-related offenses within these communities.
To combat these stigmas, institutions like NIDA conduct research on the biomedical and environmental factors of substance use disorders. This research aims to debunk myths, challenge stereotypes, and promote appropriate treatment and services. Additionally, NIDA research addresses the causes and effects of stigma and discrimination, aiming to develop interventions to combat stigma.
The understanding of the true nature of substance use disorders and the elimination of stigma and discrimination are crucial steps towards addressing the issue of prescription drug misuse. The next sections will delve deeper into the specific factors contributing to this problem and potential solutions.
Direct-to-Consumer Advertising
Direct-to-Consumer (DTC) advertising refers to the practice of promoting prescription drugs directly to potential patients, rather than through healthcare professionals. This type of marketing strategy has been linked to increased prescription drug utilization and strained patient-physician relationships, contributing to the question of why prescription drugs are so commonly abused.
Influence on Prescription Drug Utilization
DTC advertising can significantly impact prescription drug utilization. Studies have shown that patients who request drugs after seeing an advertisement are significantly more likely to receive them. This can lead to overutilization and inappropriate prescribing, contributing to rising drug costs and over-prescribing of both inappropriate and brand name drugs when cheaper generics are available.
Further, DTC advertising has been shown to overemphasize treatment benefits, underemphasize risks, and promote drugs over healthy lifestyle choices. This can misinform patients and influence inappropriate prescribing behaviors, leading to misuse of prescription drugs [2].
The influence of DTC advertising on prescription drug utilization can be seen in the increase in the number of prescriptions purchased due to increased exposure to advertising. For instance, an increase of approximately 6% in drug utilization was observed among the non-elderly population in areas with a high Medicare-eligible share [3].
Figures courtesy USC Schaeffer Center
Impact on Patient-Physician Relationship
DTC advertising can also impose strains on the patient-physician relationship. By promoting specific prescription drugs, these advertisements may limit the valuable appointment time between patients and physicians, as discussions may shift from an overall health perspective to a focus on a specific drug.
This strain on the patient-physician relationship can lead to miscommunication and misunderstanding about the appropriate use of prescription drugs, potentially contributing to their misuse. In addition, the emphasis on specific brand-name drugs can lead to rising drug costs due to over-prescribing, especially when cheaper generic options are available [2].
In understanding the potential dangers of prescription drug misuse, it's essential to consider the role of DTC advertising. The influence of these advertisements on prescription drug utilization and the patient-physician relationship can contribute to the misuse and overuse of these drugs. As such, strategies to mitigate the impacts of DTC advertising could help prevent prescription drug misuse.
Prescription Drug Abuse Statistics
To understand why prescription drugs are so commonly abused, it's vital to look at some revealing statistics. These figures shed light on the extent of prescription drug abuse and the role of various platforms, like social media, in propagating this issue.
Overdose Deaths and Misuse Data
Prescription drug abuse has become the fastest-growing drug problem in the United States, contributing to approximately 27,000 overdose deaths during 2007. It is estimated that 48 million Americans (approximately 20% of the population) aged 12 and older have used prescription drugs for nonmedical reasons at some point in their lifetime [4].
Social Media and Prescription Drug Mentions
Social media platforms often act as channels of conversation and information exchange about prescription drugs. From November 2011 to November 2012, there were 3,389,771 mentions of prescription drug terms on Twitter.
In social circles of Twitter users who discussed prescription drug abuse, on average 53.96% of the users used prescription drug terms at least once in their posts. In these identified social circles, 37.76% of the users mentioned another Twitter user by name in a post with a prescription drug term.
Furthermore, there was a strong correlation between the kinds of drugs mentioned by the index user and his or her social network, with a mean correlation coefficient of 0.73.
These statistics underscore the widespread nature of prescription drug abuse and the role of social media in facilitating conversations about this issue. Awareness of these figures is a crucial step towards understanding and addressing the challenge of prescription drug misuse.
Direct-to-Consumer Advertising Effects
Direct-to-consumer (DTC) advertising can have profound effects on patient behavior and healthcare utilization, as well as perceptions of non-pharmaceutical interventions. These effects can influence why prescription drugs are so commonly abused.
Patient Behavior and Healthcare Utilization
DTC advertising has been shown to lead to overutilization and inappropriate prescribing. Patients who request drugs are significantly more likely to receive them, contributing to rising drug costs and over-prescribing of both inappropriate and brand name drugs.
This type of advertising also imposes strains on the patient-physician relationship, limiting appointment time with patients. It can lead to rising drug costs due to over-prescribing, especially when cheaper generics are available.
Prescription drug spending in the US was about $457 billion in 2015, a significant portion of which was absorbed by the government through Medicare and Medicaid. This spending impacts federal and state budgets, insurance premiums, and patient out-of-pocket costs.
Perception of Non-Pharmaceutical Interventions
DTC advertising has been shown to overemphasize treatment benefits, underemphasize risks, and promote drugs over healthy lifestyle choices. This could potentially misinform patients and influence inappropriate prescribing behaviors.
The average television viewer in the United States watches as many as nine drug advertisements per day and about 16 hours per year. This totals to $5 billion spent on drug commercials in recent years.
These findings highlight the need for increased regulation and oversight of DTC advertising to prevent the misuse and over-prescribing of prescription drugs.
Preventing Prescription Drug Misuse
The misuse of prescription drugs is a significant public health issue, contributing to the ongoing opioid crisis and raising concerns about the prevalence of nonmedical use of stimulants, sedatives, and other medications. However, several strategies can be employed to prevent this problem, with Prescription Drug Monitoring Programs (PDMPs) and the development of abuse-deterrent formulations leading the way.
Prescription Drug Monitoring Programs (PDMPs)
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that track the prescribing and dispensing of controlled prescription drugs to patients. These programs are designed to prevent and identify prescription drug misuse. PDMPs help to ensure that patients are using medications correctly and minimize the risk of drug interactions and overdoses.
According to the National Institute on Drug Abuse (NIDA), some states that are utilizing PDMPs have seen lower rates of opioid prescribing and overdose. However, the impact of these programs is mixed, and issues such as best practices, ease of use, and interoperability still need resolution.
Abuse-Deterrent Formulations and Research Focus
Another strategy to prevent prescription drug misuse is the development of abuse-deterrent formulations (ADFs). These formulations are designed to prevent misuse by making it more difficult, if not impossible, to snort or inject the medication. The FDA has called for the development of ADF stimulants as well, indicating the scope of this issue extends beyond opioids.
The NIDA reports that these formulations have been effective in decreasing the prescribing of opioid medications, suggesting that they may play a role in curbing the misuse of prescription drugs.
In addition to ADFs, the development of non-addictive pain medications is a public health priority. This is especially crucial given the increasing number of older adults and military service members who need effective pain management. Current research is focused on alternative approaches, such as targeting signaling systems like the endocannabinoid system. The goal is to manage pain effectively while preventing the substance use disorders associated with prescription drugs.
In conclusion, while the misuse of prescription drugs is a complex and multifaceted problem, there are promising strategies and research directions that can help address this issue. By continuing to support these efforts, it is possible to reduce the number of individuals who misuse prescription drugs and mitigate the harm caused by this pervasive public health problem.
Healthcare Professional Role
Healthcare professionals play a crucial role in mitigating the common abuse of prescription drugs. Their responsibilities span from educating patients about the risks of misuse to adhering to careful prescribing practices and conducting regular screenings.
Educating Patients about Prescription Drug Misuse
Healthcare professionals are advised to educate patients and caregivers routinely about the dangers of prescription drug misuse and how to prevent and reduce it. Messages should be science-based, individualized, and clear to effectively address this issue [5].
This education should encompass the dangers of mixing prescription medications with other drugs or alcohol, the importance of taking medication exactly as prescribed, and the risks associated with sharing or selling prescription drugs. Patients should also be made aware of the potential for addiction, even when drugs are prescribed by a healthcare provider.
Furthermore, patients should be informed about proper disposal methods for unused or expired medications to prevent nonmedical use.
Prescribing Practices and Screening Strategies
Prescription practices play a significant role in why prescription drugs are so commonly abused. As such, it's recommended for healthcare providers to prescribe medications carefully, starting with the lowest therapeutic dosage for the shortest possible duration when necessary. Regular monitoring of patient medication use and symptoms can also aid in preventing addiction.
Screening young patients for prescription drug misuse is essential, with the American Academy of Pediatrics recommending the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach as part of all pediatric primary care routine visits. This proactive measure aims to address the opioid epidemic among young patients.
Healthcare professionals should balance patients' legitimate medical needs with the potential risk for misuse and related harms when prescribing prescription stimulants, sedatives, or opioid pain relievers.
In addressing the opioid misuse crisis, the National Institutes of Health (NIH) launched the Helping End Addiction Long-term (HEAL) Initiative in 2015. Coordinated federal efforts are ongoing to manage and treat pain, including guidelines like the CDC Guideline for Prescribing Opioids for Chronic Pain, issued in 2016. In 2019, the CDC advised against misapplication of guideline recommendations due to inconsistent policies and practices.
Through education, careful prescribing practices, and regular screenings, healthcare professionals can play a pivotal role in preventing and addressing the common misuse of prescription drugs.
References
[1]: https://nida.nih.gov/research-topics/stigma-discrimination
[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910355/
[3]: https://healthpolicy.usc.edu/article/should-the-government-restrict-direct-to-consumer-prescription-drug-advertising-six-takeaways-from-research-on-the-effects-of-prescription-drug-advertising/
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785991/
[5]: https://drugfree.org/article/medication-misuse-what-health-care-professionals-should-know-and-do/
[6]: https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/how-can-prescription-drug-misuse-be-prevented
