Risky Behavior - Abuse Of Over-the-counter And Prescription Medications

The National Institute on Drug Abuse (NIDA) reports that the number of people who abuse prescription drugs far surpasses the 2.1 million people who use heroin, cocaine, and/or crack cocaine. NIDA says an estimated 9 million people aged 12 and older used prescription drugs for nonmedical reasons in 1999, which constitutes abuse and signals a public health crisis in the making. NIDA bases its conclusions on recent data from the National Household Survey on Drug Abuse (NHSDA). The survey was completely redesigned in 1999, so comparisons to earlier data (like that on the chart above and the table below) cannot be made.

Percent of Population Aged 12 and Over Who Are Current Users: 1985-1999

	Ever Used				Current User
Drug	1985	1990	1995	199826	1985	1990	1995	1997	1998	1999
Stimulants	7.3	5.5	4.9	4.4	1.8	0.6	0.4	0.3	0.3	0.3
Sedatives	4.8	2.8	2.7	2.1	0.5	0.2	0.2	0.1	0.1	0.1
Tranquilizers	7.6	4.0	3.9	3.5	2.2	0.6	0.4	0.4	0.3	0.4
Analgesics	7.6	6.3	6.1	5.3	5.3	1.4	0.9	0.6	0.7	0.8

The chart shows the percentage of the population aged 12 and over who reported being current nonmedical users of prescription drugs in the period 1985-1999 (earlier data are not available).a²⁷ The table adds data on persons who ever used the named substance. Data are for stimulants (e.g., Ritalin; Adderall), sedatives (e.g., Seconal), tranquilizers (e.g., Valium), and analgesics (e.g., Oxycontin, Percodan). It appears from the chart and the table that nonmedical current use and lifetime use of all the named types of substances declined between 1985 and 1999. The high percentages of users in 1985 and the abrupt drop between then and 1990 simply may be due to what the Washington Post described in1998 as "different methods of calculating the number of drug users [which] continue to produce widely gyrating estimates."

Nonmedical Users of Prescription Drugs in the Past Year

The small chart shows data for 1999-2000 obtained using the new NHSDA survey methods. Media Awareness Project has this to say about the new method: "Teasing out precise trends is difficult." The chart shows 9.2 million past-year users in 1999, falling to 8.7 million in 2000. In 2000, an estimated 3.8 million people — almost 2 percent of the population aged 12 and older — were currently (use in past month) using certain prescription drugs nonmedically: pain relievers (2.8 million users), sedatives and tranquilizers (1.1 million users), and stimulants (0.8 million users).

The three most commonly abused prescription drugs are pain relievers (6.6 million past- year users in 1999, 6.5 million in 2000), tranquilizers (2.7 million past-year users in 1999 and 2000), and stimulants (including methamphetamine). The three groups most at risk for prescription drug abuse are older adults, adolescents, and women. Older adults are most likely to abuse tranquilizers and sleeping pills; usually the drug has been prescribed but in a too-high dosage, and frequently it is abused accidentally because the patient does not follow instructions. Adolescents favor painkillers like Oxycontin7 and stimulants like methamphetamine (see below). Studies suggest that women are more likely than men to be prescribed easily abused prescription drugs such as narcotics and anti-anxiety drugs.

Of the approximately 2 million past-year users of stimulants in 1999 and 2000, half used methamphetamine, commonly known as speed, meth, or chalk. In its smoked form, it is often referred to as ice, crystal, crank, or glass. The substance is easily and illegally manufactured using inexpensive, over-the-counter ingredients found in nasal decongestants and bronchial inhalers. The government reports that methamphetamine abuse reached alarming proportions in the 1990s based on deaths and emergency-room episodes related to its abuse. Also of concern is a recent trend among adolescents to illegally purchase the stimulant Ritalin from individuals who have been prescribed the medication.

Of particular concern to the Drug Enforcement Agency (DEA) is abuse of Oxycontin7, a sustained-release formulation of oxycodone, an opium-based drug of abuse since the early 1960s. According to DEA, the number of emergency room visits involving oxyco- done was stable from 1990-1996 but more than tripled from 1996-2000 (from 3,190 visits to 10,825). When drug enforcement authorities and the media get hold of evidence showing that a legitimate and effective legal prescription drug like Oxycontin7 is being widely abused, doctors grow leery about prescribing it, even for people who have a compelling need for it. Carolyn Kleiner²⁸ summarizes the medical establishment's dilemma this way: "Pain care in this country is already characterized by widespread undertreatment and stigma, and the worry is that doctors, pharmacies, and insurance companies will overreact — to avoid addicting patients or to avoid prosecution, or both."

Reinforcing its fears that prescription drug abuse is on the rise is this NIDA conclusion: "In 1998, an estimated 1.6 million Americans used prescription pain relievers nonmedically for the first time. This represents a significant increase since the 1980s, when there were generally fewer than 500,000 first-time users per year. From 1990 to 1998, the number of new users of pain relievers increased by 181 percent; the number of individuals who initiated tranquilizer use increased by 132 percent; the number of new sedative users increased by 90 percent; and the number of people initiating stimulant use increased by 165 percent."

Over-the-counter drugs of abuse include aspirin, cough syrup (may contain alcohol and dextromethorphan, an opium-like agent used as a cough suppressant), diet pills, athletic performance-enhancing substances like creatine and androstenedione, and any other legally-obtained nonprescription medication. The University of Michigan Institute for Social Research estimates that up to 4% of boys and 2% of girls use performance-enhancing legal and illegal drugs.

Sources: Graphic/table: Statistical Abstract of the United States: 2001, Table 189. Primary source: U.S. Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse, annual. "Drugs and Chemicals of Concern," http://www.deadiversion.usdoj.gov/. Small chart: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000, http://www.samhsa.gov/oas/NHSDA/2kNHSDA/appendixf1.htm. NIDA Research Report, "Prescription Drugs: Abuse and Addiction, http://www.nida.nih.gov/ResearchReports/Prescription/Prescription.html. Analyses of Substance Abuse and Treatment Issues, http://www.samhsa.gov/oas/NHSDA/Treatan/httoc.htm. "Muscles now, problems later: Performance-enhancing drugs may put teens at future health risk," http://www.med.umich.edu/opm/newspage/1999/perfen.htm. Carolyn Kleiner, "A Curse and a Cure," U.S. News & World Report, July 27, 2001. Media Awareness Project, "US: Mixed Message On Prescription Drug Abuse," http://www.mapinc.org/drugnews/v01/n776/a06.html. Jeff Leen, "Number Jumble Clouds Judgment of Drug War," Washington Post, January 2, 1998, http://washingtonpost.com. All information retrieved August 14, 2002.