Esharoe 1

Napassorn Esharoe

Chris Spielvogel

Cas 138

April 8th, 2017

Prescription Drug Abuse in a Non-Medical Context in the United States

Prescription drugs play a substantial role in the world of modern medicine, it

improves health outcomes, quality of life, and replaces excessive surgery. The advancement of

pharmaceutical industry have led to the production of many effective medications that improves

the quality of life of many patients when prescribed appropriately. However, these medications

can create serious consequences to the health of users and lead to dependence when used

inappropriately. Therefore, drug controls and the creation of prescription drugs policy have been

established to ensure the health of growing population around the world. Series of uncontrollable

addiction have raised concerns among the medical world which is why the passing of policies is

necessary to help prevent drug abuse. Different policies aim to not only ensure the availability of

these medications for medical purposes, but to also prevent diversions. In the United States,

prescription drugs have doubled the share of U.S. health care spending and as well as spending

per person. Around

6.1 million Americans

have reported using

prescription drugs in a

non-medical context

in 2011 ("Prescription

Drug Abuse: The

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National Perspective."). The growth of prescription drugs usage isnt problematic until the

prescribed medicines are used in a non-medical context. Of 38,329 drug overdose deaths in

2010, around 22,100 deaths involved prescription drugs exceeding the number of deaths

involving opioid painkillers, which was 16,651 ("Prescription Drug Abuse: The National

Perspective."). The most common type of prescription medication that are used non-medically

are hydrocodone, oxycodone, propoxyphene, hydromorphone, meperidine, fentanyl,

pentobarbital sodium, benzodiazepines, diazepam, alprazolam, amphetamines,

dextroamphetamine, and

methylphenidate ("The

Non-Medical Use of

Prescription Drug").With

that being said, the boom

in non-medical use of

prescription drugs

expands the channel for

diversion and production

of counterfeit drugs.

Individuals are able to possess prescriptions through uncomplicated sources and

procedures such as prescription drugs from peers and family, over-prescribing by physicians,

multiple doctor visitations for multiple prescriptions, forged prescriptions, illegal online

pharmaceutical units, theft and burglary, and immoral physicians selling drugs. According to a

study reported by Columbia University in the department of addiction and substance abuse,

people are able to access prescription drugs in the internet as easy as buying a candy from a
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grocery store (Manchikanti). Anyone, including children can readily obtain without a

prescription as long as that person owns a credit card (Manchikanti).

The use of prescription drugs has exceeded the use of illicit drugs nowadays especially

for younger people. Young individuals pay closer attention to pharmaceutical drugs instead of

illicit drug in reason for its accessibility and social acceptance. Without a doubt, this statement

represents a problematic issue among young consumers since they face a greater risk for drug

experimentation and addiction development. Exposure to inappropriate drugs at a wrong dosage

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can implement prefrontal cortex complications that deals with judgement and decision making.

Moreover, the abuse of prescription drugs also implements health consequences to all users such

as a lifetime dependence, respiratory depression leading to death, lack of coordination, tolerance

leading to higher use of drugs, seizures due to hyperactive response showing signs of addiction

and dependency, and HIV and Hepatitis B and C for injected prescription drugs etc.

("Prescription Drug Abuse: The National Perspective."). Since pharmaceutical drugs are socially

acceptable, it is even popular among highly educated individuals in college facing a competitive

setting where a persons career depends on their academic performances and resumes. On top of

that, many social recreation, especially among knowledgeable individuals involves the use of

prescription drugs. The reason for the widespread in prescription drug usage among highly

educated people is its already known composition and effect.

The problem of prescription drug abuse in a non-medical context has been readily raised

among society today as it is seen as a global health concern. In accordance to the world drug

report in 2010, the misuse of prescription drugs, including opioids, benzodiazepines, and

synthetic prescription stimulants, is a growing health problem in a number of developed and

developing countries. An overdose can occur both by the obtaining of legitimized prescriptions

or by obtaining drugs that were not prescribed. The issue is rather complex because the root of

the problem is very disputable. The difficulty in preventing diversion while ensuring

accessibility to those who need it for medical purpose proposes the complication of establishing

an effective policy on prescription drug abuse. Policy makers or those with the appropriate

authority must go through complicated procedures to exactly pinpoint improper or illegitimate

prescribing. An existence gap in tracking the distribution of prescription drugs allows for

diversion to individuals not prescribed with the following medication (Morgan, Steve). Close
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monitoring covers more towards illegal drugs, alcohol, and tobacco. Therefore, monitoring non-

medical use of prescription drugs is a special case that requires attention in an inventive level.

This issue requires immediate attention because not only that there is a rapid increase in the use

of these medications, but younger consumers are also turning to this manner. As a matter of fact,

2.6% of people aged 12 years or older have reported using prescription drug non medically in

2005 (Manchikanti). Within the 12 to 17 years age group, females are more likely to use

prescription drugs in a non-medical context than males (Manchikanti).

The future of the United States is at stake, especially when younger individuals are

growing into a pill popping culture where non-medical use of prescription drugs is already a

cultural norm. Most life issues are treated through medication along with the expansion in the

market of lifestyle drugs for obesity, sexual performance, and stress related conditions.

With prescription drugs being widely available and accessible to the general public than

illegal drugs, tackling the hidden populations that may be using prescription drugs for

nonmedical purposes might be difficult. In addition, many consumers on prescription drugs

without medical purposes dont partake in the consumption of illicit drug use and would not seek

help in established medical premises. Therefore, these individuals are typically not identified and

included in datasets to monitor drug abuse. With its approachable and harmless appeals,

identifying an abuse becomes sticky. Not only normal consumers are at risk for prescription drug

dependence, but also health care professionals. As a matter of fact, physicians are at an

unfavorable risk of using prescription solely because of their already easy access to these drugs.

Even nurses are more likely than others to use prescription drugs for nonmedical purposes.

Health care professionals like physicians, dentists, veterinary surgeons can unintentionally

contribute to the problem of prescription drug abuse. Although these individuals knowingly hold
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responsibility and are accountable to abide by laws to control the substances appropriately,

preventing false prescription while distributing them to patients who urgently need the

medications is far from easy. The current policy on prescription drug abuse is already trying to

tackle the overuse of prescription drug non medically. But, the underlying problem lies within

the efficiency in monitoring and educating people. Over billions of dollars are spent each year on

drug control strategy, but yet the handling of prescription drug abuse still cant cover between

the lines of abusing prescription drugs and not realizing it (Commissioner). Joseph A. Califano

stated that the current war on drugs has not been able to blow down the nations house of

substance abuse and addiction.

With an ongoing rise in the problem of prescription drug abuse, there are several ways in

keeping the current and uprise populations of prescription drug abuse under control. The first

flagrant solution is the alteration in education control, especially for healthcare professionals.

About 67.5% of pharmacists have reported receiving only 2 hours or less of substance abuse

education and even 29.2% have reported receiving no education in the unit of substance abuse at

all ("Prescription Drug Abuse: The National Perspective."). With these individuals dictating the

release of prescription drug and making the moral decision in which to whom the drug will be

distributed to, it is critical to give them the necessary education in the most sensitive topic. As a

matter of fact, pharmacists with greater knowledge in drug abuse are able to counsel patients

more effectively and frequently ("Prescription Drug Abuse: The National Perspective.").

Therefore, there should be a regulation in requiring mandatory education for all healthcare

professionals who prescribe drugs other than over the counter drugs. Not only that, the

legislation should carefully go over the curriculum for health profession schools and set a floor

for minimum hour or course for substance abuse education. Students in health care profession
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schools need to be informed about drug abuse and treatment options for drug use to eliminate

excessive prescribing. Also, these students should be able to master patient assessments to

further evaluate problems in normal patients to point out any problems early on. There are

numerous predictive behavioral indicators of substance abuse, so an education on pinpointing

different behavioral actions would be very helpful for future physicians ("The Non-Medical Use

of Prescription Drug"). These changes will make a distinct difference towards the way

physicians distribute controlled substances. An increase in the subsidy or tax credit for further

research and development in abuse prevention can also reduce the outrage of prescription drug

abuse. Since substance abuse, especially on prescription drug abuse doesnt receive an

appropriate amount of attention, an increase in the education in this field will substantially lessen

the severity of this problem.

Another preventive measure to tackle the issue of prescription drug abuse is the

regulation in monitoring the system of prescribers and individuals who receive the prescribing.

Right now, the system lacks uniformity and scrutiny in the integration process of prescription

medications among patients. This is often the root to overprescribing and wrongful prescriptions.

Other than that, the current system needs more control in the management of medications. The

government still has a huge gap in identifying different distributors such as wholesalers and

retailers of each prescription drugs. Therefore, a tighter measure in monitoring the person who

creates those medications, distributor of the medication itself, and patients who receive these

medications will reduce the severity of prescription drug abuse. In some nations, physicians or

pharmacists have much more information about their patients than that of pharmacists in the

United States ("The Non-Medical Use of Prescription Drug"). Additional information which may

seem excessive at first will become handful when pharmacists are identifying abnormal
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behaviors among uprising drug abusers. An example of additional information comes with the

request of contact after a physician prescribes a patient with prescription medicine. Moreover,

the states itself should have an online database to keep track of each prescribed medicine. Policy

makers should enforce a legislation where each pharmacy is required to have a well established

computer system which directly links to the online databases. Although many problems about

privacy may arise with the rising use of electronic health records, the benefits of this new policy

will definitely outweigh the concurring losses on prescription drug abuse. The legislation can

work out an appropriate measure that doesnt exploit a patients privacy and as well help

organize the cluttered monitoring system. A stricter pharmacy will eliminate forged

prescriptions, since theres an establishment of computer database which keeps track of

prescriptions. The computer based system can readily identify health care providers and patients

and detect misguided supply of medicine in pharmacies. The pharmacy itself can even give out

prescription pads that have a uniform format nationwide to quickly detect unlicensed drugstores

("The Non-Medical Use of Prescription Drug").

Apart from close monitoring, another measure that could be implemented to the

pharmaceutical industry is the increase in law enforcement. Since many physicians or upcoming

health care professionals lack the knowledge of handling with prescription drug abuse, there

should be a stricter training program around prescription drugs. Many concentrate on the

problem of illicit drugs and often underestimate the harm of low degree medications. So, there

should be a provision of technical assistance to regulate clinics and support prescription drug

abuse related training. It is important to prevent diversion whilst ensuring that prescription drugs

are available to those who need them. By distinguishing between high risk, low value and high

risk, high value medications, pharmacists will be able to distribute prescription drugs more
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efficiently. High risk, low value drugs are those that have intoxicating, sedating, euphoric

qualities, and prescribed at high dosages but have low therapeutic value ("The Non-Medical Use

of Prescription Drug"). While, high risk, high value drugs are those crucial for treating specific

illness, produce dependence, intoxicating effect, and contribute severe morbidity ("The Non-

Medical Use of Prescription Drug"). To understand the science behind drug abuse, scientists can

potentially produce new prescription medicine with smaller potential for abuse (Throckmorton).

With higher law enforcement and stricter control on prescribing medicine, guidance on new drug

formulations could be applied. As a result, the market will have a smaller amount of high risk

low value drugs.

By comparing the three implementations on prescription drug abuse, one should be

prioritized more than the other. The improvement of monitoring system seems to be the most

crucial one, since it regulates the distribution of prescription drugs among users. If the system is

closely controlled, the chance of wrongly prescribing will be less likely. Since physicians or

healthcare professionals have the basic understanding of drug abuse in general, the

implementation of strengthening the educational program especially on prescription drug abuse

can be set aside. Until the monitoring system is carefully organized, other policy like stronger

law enforcement and stronger instruction on prescription drug abuse can be applied. However,

the three policies go closely hand in hand that once one is applied, another automatically follows.

When there is a mandatory increase in prescription drug abuse classes, it means that the law

enforcement is strengthened. Once the monitor system is more secure, the legislation is applying

a stricter enforcement.

The issue of prescription drug abuse should be taken seriously and treated with the same

importance as illicit drug abuse. The era is shifting into the time where more people are educated
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and know how to responsibly take actions of their wrongdoings. The population projected to

prescription drug abuse are usually among commoners who are looking to improve their

academic performances or use prescription drugs for social advantages. Even though the

legislation is currently tackling the problem, a strong and more secure policy might be able to

eliminate the problem into a minor stage. The current circumstance of prescription drug

exploitation can be handled by strengthening educational programs, improving monitor systems,

and toughening law enforcements. These policies will help ensure that prescription medicines are

attainable, but also appropriately restricted.

Works Cited

Commissioner, Office Of the. "Combating Misuse and Abuse of Prescription Drugs: Q&A with

Michael Klein, Ph.D." U S Food and Drug Administration Home Page. Office of the

Commissioner, 30 Aug. 2015. Web. 09 Apr. 2017.

"A History of the FDA and Drug Regulation in the United States." FDA, n.d. Web. 9 Apr. 2017.

"The History of Prescription Drugs." Good Medicine, Bad Behavior: Drug Diversion in

America. DEA, n.d. Web. 09 Apr. 2017.

Manchikanti, Laxmaiah. "National Drug Control Policy and Prescription Drug Abuse: Facts and

Fallacies." Health Policy Review. Drug Enforcement Administration, May 2007. Web. 9

Apr. 2017.

Morgan, Steve. "Prescription Drug Accessibility and Affordability in the United States and

Abroad." Issues in International Health Policy. The Commonwealth Fund, June 2010.

Web. 9 Apr. 2017.

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"The Non-Medical Use of Prescription Drug." UNODC. United Nations, Sept. 2011. Web. 8

Apr.

2017.

"Prescription Drugs: Accessibility and Prices." Almanac of Policy Issues. N.p., Apr. 2000. Web.

09 Apr. 2017.

"Prescription Drug Abuse: The National Perspective." California State Medical & Pharmacy

Boards, 21 Feb. 2013. Web. 9 Apr. 2017.

Throckmorton, Douglas C. "FDAs Commitment to Reducing Prescription Drug Abuse and

Misuse." FDA Voice. U.S. Food & Drug Administration, 25 Apr. 2012. Web. 09 Apr.

2017.