Prescribing drugs to those in need while simultaneously curbing nonmedical use of these same drugs may be one of the world’s most difficult challenges, according to a perspective article published in the journal World Psychiatry.
Nonmedical prescription drug use is defined as using without a prescription or for reasons other than what the medication is intended for. It is a global problem primarily driven by the increasing nonmedical use of prescription opioids among young people.
The perspective article was written by Silvia Martins, M.D., Ph.D., an associate professor of Epidemiology at Columbia University’s Mailman School of Public Health and a colleague at American University of Beirut. In her paper, Martins cites research showing increased rates of deaths worldwide from prescription opioids rising as high as 550 percent depending on country and time-period. For example, from 2000 to 2014, there was a 200 percent increase in overdose deaths due to opioid use.
In the U.S., past-year prevalence of nonmedical use of prescription drugs — opioids, stimulants, tranquilizers and sedatives — was reported by six percent of 12 to 17 year-olds and just under 12 percent of 18 to 25 year-olds, mainly driven by the misuse of opioids. Data from the latest U.S. school and college- based surveys show that 13 percent of 12th graders used any prescription drugs non-medically.
In Beirut, past-year nonmedical use of any prescription drugs was 22 percent among private university students, and 10 percent among high school students, with prescription opioids the drug of choice. In the Kingdom of Saudi Arabia, a recent school-based survey revealed a lifetime prevalence rate of seven percent for the nonmedical use of any prescription drug.
In Europe, three-quarters of overdose deaths and 3.5 percent of total deaths among 15 to 39 year olds were attributed to prescription opioids. Data from 36 countries collected as part of the most recent 2011 European School Survey Project on Alcohol and other Drugs showed that, on average, six percent of European school students (mean age of 16 years) reported lifetime nonmedical use of tranquilizers.
Another 2007-2009 study in Southern China showed that 6 percent of the middle and high school students had tried a prescription medication non-medically — these were mostly opioids, followed by cough medicine with codeine. In Chongqing, China, a 2012 high school survey reported a lifetime prevalence of 11 percent for the nonmedical use of prescription opioids alone.
“While there are variations in study methodologies and definitions of what constitutes nonmedical use, direct comparisons are also affected by the varied availability and cultural acceptance of the drugs worldwide,” said Martins.
“The greater ‘social acceptance’ for using these medications (versus illegal drugs) and the misconception that they are ‘safe’ may be contributing factors to their misuse.”
Nonmedical use of prescription stimulants can cause respiratory suppression and overdose, or lead to irregular heart rate, hypertension, cardiovascular system failure, stroke, and seizures. Nonmedical use of both prescription opioids and stimulants among adolescents and young adults is also associated with increased harmful use of other substances, psychiatric symptoms, psychiatric disorders, and suicidal thoughts.
To help ensure that prescription drugs are available to those who need them while strictly avoiding nonmedical use, Martins suggests that information be given to the general public, including parents and youth, about the negative consequences of sharing prescription medications.
She also suggests training medical practitioners to better recognize patients at greater risk for prescription drug misuse and that prescriptions should be monitored more closely. And finally, doctors and patients should consider alternative treatments.