A study in adolescents of prescription drug abuse more generally found a subgroup at low risk for any substance use, one with high risk for polysubstance use, one with risk for alcohol/tobacco/marijuana use, and one with risk for alcohol and prescription drug use (Cranford, McCabe, & Boyd, 2013). Meaningful subgroups characterized by fewer risk behaviors and initiating use for the indicated purpose of the medication (e.g., opioids for pain) also have been identified (Nielsen et al., 2011). Defining and assessing prescription drug abuse is complicated by unclear boundaries between “appropriate” use of these medications and inappropriate use or abuse. Patients in substance use disorder treatment settings reporting prescription opioid abuse are more likely to report pain symptoms than heroin users (Brands, Blake, Sproule, Gourlay, & Busto, 2004), and anxiety is more common among those abusing tranquilizers (Chen et al., 2011).

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In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines). The NIDA Monitoring the Future survey of 8th, 10th and 12th graders found that the nonmedical use of opioids, tranquilizers, sedatives/barbiturates, and amphetamines was unchanged between 2003 and 2004. Specifically, the survey found that 5.0 percent of 12th graders reported using OxyContin without a prescription in the past year, and 9.3 percent reported using Vicodin, making Vicodin one of the most commonly abused licit drugs in this population. Past year, nonmedical use of tranquilizers (e.g., Valium, Xanax) in 2004 was 2.5 percent for 8th graders, 5.1 percent for 10th graders and 7.3 percent for 12th graders.

Development of Safer Medications

Although a behavioral or pharmacological approach alone may be effective for treating drug addiction, research shows that, at least in the case of opioid addiction, a combination of both is most effective. The risks for addiction to prescription drugs increase when the drugs are used in ways other than for those prescribed. Health care providers, primary care physicians and pharmacists, as well as patients themselves, all can play a role in identifying and preventing prescription drug abuse. According to the 2001 National Household Survey on Drug Abuse (now the NSDUH), 63 percent of youth who had used prescription drugs nonmedically in the past year had also used marijuana in the past year, compared with 17 percent of youth who had not used prescription drugs nonmedically in the past year. Substance abuse is a significant public health concern affecting millions of people worldwide.

Misuse of Prescription Drugs Research Report

However, health care providers should not avoid prescribing or administering strong CNS depressants and painkillers, if they are needed. Over time, providers should note any rapid increases in the amount of a medication needed — which may indicate the development of tolerance — or frequent requests for refills before the quantity prescribed should have been used. They also should be alert to the fact that those addicted to prescription medications may engage in “doctor shopping,” moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse. Typically, they should not be used with other substances that depress the CNS, such as alcohol, antihistamines, barbiturates, benzodiazepines or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression. Illicit drug abuse involves the use of illegal substances such as cocaine, heroin, methamphetamine, and ecstasy.

Behavioral treatments encourage patients to stop drug use and teach them how to function without drugs, handle cravings, avoid drugs and situations that could lead to drug use and handle a relapse should it occur. When delivered effectively, behavioral treatments — such as individual counseling, group or family counseling, contingency management and cognitive-behavioral therapies also can help patients improve their personal relationships and their ability to function at work and in the community. Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class—referred to as prescription narcotics—include morphine (e.g., Kadian, Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet) and related drugs.

Summary and Future Directions

• Stein et al. (2014) found that prescription opioid- and heroin-dependent individuals report different life concerns, with those dependent upon prescription opioids less concerned about infectious disease, but more concerned about alcohol use relative to heroin users.
• Large epidemiologic studies suggest that Native Americans and Caucasians have the highest rates of prescription drug abuse (Huang et al., 2006; SAMHSA, 2013a).
• Many pharmacies have developed “hotlines” to alert other pharmacies in the region when a fraud is detected.
• From alcohol and prescription drugs to hallucinogens and inhalants, the misuse of these substances poses serious health and social consequences.
• For example, abusing prescription medication may be perceived as “safer” than abuse of illicit drugs (Fleary, Heffer, & McKyer, 2013; Mateu-Gelabert, Guarino, Jessell, & Teper, 2014).

Assessment of clusters of risk factors has demonstrated some promise for identifying those at risk of prescription opioid abuse (Butler, Budman, Fernandez, & Jamison, 2004; Holmes et al., 2006). The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population.

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Prescription drug abuse may be more prevalent among rural pregnant women (Shannon, Havens, & Hays, 2010). Given the importance of treatment for pregnant women to both the health of the mother and of the developing fetus, more research with this subgroup is needed. Prescription drugs can be obtained legally and are almost universally present in households, and thus are different in meaningful ways relative to both access and perceptions of risk than drugs only obtained illegally. Accordingly, there appear to be meaningful differences between prescription and illicit drugs of the same class. For example, cue-induced craving appears to be less robust among those abusing prescription opioids relative to those abusing heroin (McHugh, Park, & Substance abuse Weiss, 2014), and these groups may also have different responses to treatment (see below).

Illicit Drug Abuse

Although much has been learned about the nature and treatment of prescription drug abuse in recent years, there are many pressing questions in need of further investigation. Research is needed on the interactions among prescription drugs of abuse and between these drugs and other licit and illicit drugs. Schoenfelder et al. (2014) demonstrated interactions between a prescription stimulant (methylphenidate) and marijuana with respect to heart rate, cognitive performance, and subjective drug effects. Results suggested that the combination of these drugs may have concerning effects, particularly with respect to cardiac health. Research in understudied subgroups, such as older adults and pregnant women, and those with concurrent pain and opioid dependence is needed to better understand the impact of prescription drug abuse on these groups.

Possibly the more important message is that many of the lessons prescription drug abuse learned from treatment of illicit drug use appear to apply in treatment of prescription drug abuse, particularly in the case of opioid dependence. Prescription opioid users appear to require similar doses of buprenorphine and have similar induction outcomes to heroin users (Nielsen, Hillhouse, Mooney, Fahey, & Ling, 2012), and as noted above, have treatment outcomes that appear to be comparable if not more favorable on many outcome measures. Furthermore, much like for other substances of abuse, the use of urine testing to confirm self-report may be indicated given common rates of underreporting prescription opioid abuse (Hilario et al., 2014).