Prescription Drug Abuse in the USA

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Wilson M. Compton, M.D., M.P.E.Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Director, Division of Epidemiology, Services and

Prevention ResearchPrevention ResearchNational Institute on Drug AbuseNational Institute on Drug Abuse

2 November 20112 November 2011

Wilson M. Compton, M.D., M.P.E.Wilson M. Compton, M.D., M.P.E.Director, Division of Epidemiology, Services and Director, Division of Epidemiology, Services and

Prevention ResearchPrevention ResearchNational Institute on Drug AbuseNational Institute on Drug Abuse

2 November 20112 November 2011

Numbers in Millions

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21 Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

Pharmaceutical Drug Abuse is a Major Problem in USA: Current Drug Use

Rates in Persons Ages 12+

Source: SAMHSA, 2010 National Survey on Drug Use and Health

Prevalence of Past Year Drug Use Among 12th gradersPrevalence of Past Year Drug Use Among 12th graders2010 Monitoring the Future Study2010 Monitoring the Future Study

* Nonmedical use

Drug Prev. Drug Prev.

Alcohol 65.2 MDMA (Ecstasy) 4.5

Marijuana/Hashish 34.8 Inhalants 3.6

Vicodin* 8.0 Cocaine (any form) 2.9

Amphetamines* 7.4 Ritalin* 2.7

Cough Medicine* 6.6 Cocaine Powder 2.6

Adderall* 6.5 LSD 2.6

Tranquilizers* 5.6 Ketamine 1.6

Salvia 5.5 Steroids* 1.5

Hallucinogens 5.5 Rohypnol 1.5

OxyContin* 5.1 Crack 1.4

Sedatives* 4.8 GHB 1.4Categories not mutually exclusive

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Numbers in Thousands

Marijuana

Pain Relievers

Tranquilizers

Ecstasy

Inhalants

Cocaine

Stimulants

LSD

Sedatives

Heroin

PCP

Large Number of Past Year Initiates of Pharmaceuticals: Persons Aged 12 or

Older, 2010


First Specific Drug Associated with Initiation of Illicit Drug Use among Past Year Illicit Drug

Initiates Aged 12 or Older: 2010

Note: The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day. The first specific drug refers to the one that was used on the occasion of first-time use of any illicit drug.

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3.0 Million Initiates of Illicit Drugs

Marijuana (61.8%)

Pain Relievers (17.3%)

Inhalants (9.0%)

Hallucinogens (3.0%)

Stimulants (2.5%)

Tranquilizers (4.6%)

Cocaine (0.1%)Sedatives (1.9%)

Heroin (0.1%)


Numbers in Thousands7

Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older,

2010


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Numbers in Thousands

415 424466

547 558601

360+

0

100

200

300

400

500

600

700

2002 2003 2004 2005 2006 2007 2008+ Difference between this estimate and the 2008 estimate is statistically significant

at the .05 level.SAMHSA: 2008 National Survey on Drug Use and Health

66% Increase in Treatment Admissions Increasing for Pharmaceutical Opioids:

Ages 12+ in USA

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Increasing Treatment for Pharmaceutical Opioids

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Source: Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2010

Opioid Analgesics increased from 144,600 to 305,900 (111%), 2004 to 2008

Benzodiazepines increased from 143,500 to 271,700 (89%), 2004 to 2008

No change in illicit drug reports (1.9 million to 1.9 million overall, non-alcohol illicit 1.0 million to 1.0 million, cocaine 475,425 to 482,188, ).

Emergency Department Mentions Increasing for Pharmaceuticals, Not for Illicit Drugs in the USA

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Source: CDC Vital Signs, November 2011

DEATHS: Marked Increase in Unintentional Drug OverdoseDrug overdose death rates in the

US have more than tripled since 1990. Nearly 15,000 persons died of prescription opioid overdoses in

2008.

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Deaths from Opioids Vary by State: Unintentional Overdose Deaths in U.S. States

2008


Total Number of Prescriptions for Hydrocodone and Oxycodone Products Dispensed by US Retail Pharmacies, Years

1991−2009

Source: SDI’s Vector One® National, VONA 03-16-10 Hydrocodone & Oxycodone 1991-2009

Source: SDI’s Vector One®: National, VONA 03-16-10 Stimulants 1991-2009

Projected Number of Prescriptions for Stimulants* Dispensed by US Retail Pharmacies, Years 1991-2009 *excludes modafinil and

atomoxetine products

Increases in deaths parallel opioid sales increases as well as prescription

opioid treatment admissions


1Other category includes Wrote Fake Prescription," "Stole from Doctor’s Office/Clinic/Hospital/Pharmacy," and "Some Other Way."

Free from Free from

Friend/Friend/Relative Relative (55.0%)(55.0%)

Bought/Took from

Friend/Relative (16.2%)

Drug Dealer/Stranger (4.4%)

Bought on Internet (0.4%)

Other1 (4.6%)

One Doctor (17.3%)

More than One Doctor (2.1%)

Source Where Respondent Obtained

Free from Friend/Relati

ve (6.3%)Bought/Took

from Friend/Relative (6.5%)

Drug Dealer/Stranger (2.3%)

One Doctor One Doctor (79.4%)(79.4%)

More than One Doctor

(3.6%)

Bought on Internet (0.2%)

Other1 (1.7%)

Source Where Friend/Relative Obtained

People Abusing Analgesics Mostly Do Not Obtain Them by Prescription: Most Recent

Source for Ages 12+

Source: SAMHSA, 2009 and 2010 National Survey on Drug Use and Health

ResponsesResponses

Effects of Preventive Intervention on Lifetime Effects of Preventive Intervention on Lifetime Prescription Drug Use: Data from 2 StudiesPrescription Drug Use: Data from 2 Studies

Adapted from Spoth, Trudeau, Shin, & Redmond (2008).

Preventing Prescription Drug Abuse: A Need for New Thinking

• Availability of drugs within homes• Abuse and “misuse” as an intervention targets• Relaxed attitudes and misperceptions about

prescription drugs• Drug disposal resistance and concerns• Multiple drug effects• Friends as a key source of drugs

Take Back Programs

Maine model– Postage paid medicine return

envelopes distributed across the state

– Disposal in compliance with state and federal laws and sound environmental practices

– 3850 envelopes returned (85% prescription drugs)

– Psychotherapeutics made up 31% of returns for individuals ages 50 and under

Prescription Drug Monitoring Programs (PDMPs)

• Statewide electronic database collects data on substances dispensed in the state.

• Through the database, physicians and pharmacies can identify patients who are seeking multiple prescriptions.

• As of Fall 2011, all but 2 states have PDMPs

Other Approaches:Other Approaches:

• Consider ways to Prevent Overdose Deaths through Outreach to Provide Naloxone more Widely

• Improve Public and Provider Education

• Develop Electronic Health Record Items

• Consider ways to Prevent Overdose Deaths through Outreach to Provide Naloxone more Widely

• Improve Public and Provider Education

• Develop Electronic Health Record Items

SummarySummary

Abuse of pharmaceuticals, especially opioids, is an urgent matter requiring coordinated

federal, state and local responses. Yet, when used

properly, opioid, sedative and stimulant pharmaceutical

agents have many benefits. Balancing these competing

issues is necessary.

Abuse of pharmaceuticals, especially opioids, is an urgent matter requiring coordinated

federal, state and local responses. Yet, when used

properly, opioid, sedative and stimulant pharmaceutical

agents have many benefits. Balancing these competing

issues is necessary.

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www.drugabuse.govwww.drugabuse.gov

http://www.nida.nih.gov/nidamed/

Prescription Drug Abuse in the USA

Health & Medicine

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