Prescription pain medication abuse on surprising increase, with unexpected geographic distribution

Researchers at Rush University Medical Center found prescription pain medication (PPM) abuse is a rapidly growing problem with surprising and often unpredictable distribution patterns. The research was presented at the Annual Meeting of the American Society for Anesthesiologists in Chicago, October13, 2006.

Mario Moric, PhD, a researcher in the department of Anesthesiology at Rush, and colleagues used survey data from the National Survey on Drug Use and Health for 2002-04 to estimate the prevalence of drug abuse across the United States for various illicit and prescription substances.

Moric found that PPM abuse did not follow traditional patterns. "Individual states with high levels of PPM abuse may not recognize the problem. The prevailing assumption that only those states with high levels of traditional illicit drug abuse should be vigilant is clearly misleading."

The researchers found distribution of PPM abuse across the United States varied greatly and differed from other seemingly similar drug abuse trends. PPM distribution differed substantially from inhalants, heroin and sedatives, was somewhat similar to cocaine and stimulants and was closely related to distribution of tranquilizers.

Furthermore, the researchers found that states with large metropolitan areas (New York, Illinois, Texas and California) did not have a high distribution of abuse, despite the common view that drug abuse is associated with the fast-paced lifestyle of city dwellers.

"Distribution of PPM abuse across the states differs from high-profile street drugs and even particular PPMs such as oxycodone, which has its own specific pattern," Moric said. "It is for this reason that PPM abuse must be monitored separately from other illicit substances, and the most commonly abused or most problematic PPMs should be monitored individually."

Oxycodone, in particular, was singled out by Moric's group because of its highly addictive nature and specific distribution pattern, which differed from many other PPMs and illicit drugs. Similar to heroin in both its effect on the body and addictive nature, oxycodone is often crushed or mixed with other drugs and used for its heroin-like "rush." Moric warned that the key to understanding and identifying abuse requires a more sophisticated understanding than that abusers simply want to "feel good."

"As users become addicts, they undergo a fundamental neurobiological change," Moric said. "Processes such as learning, memory, perception, arousal and motivation all drastically change, and to classify abuse purely as 'pleasure seeking' is a gross oversimplification."

The surprising results from the study should offer something of a wake-up call to physicians and other health care workers everywhere in the country. "Clinicians need to be aware of the level of abuse in their area and moderate their vigilance accordingly," Moric said.

If PPM abuse is identified in a particular area, a multifaceted response should be implemented, he said. "Drug abuse prevention, outreach and information dissemination programs by federal, state and nonprofit agencies should be notified so that public awareness can be heightened and action be taken to reduce the problem."

According to Moric, anesthesiologists who practice pain medicine play a particularly crucial role in combating PPM abuse. "We feel that the most important function of anesthesiologists with respect to PPM abuse is in education. Anesthesiologists are the most relevant spokespersons for both the benefits of PPMs and the potential abuses," Moric said.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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