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Prescription Drug Misuse Highlighted as National Problem

Cheryl A. Thompson

An estimated 4 million Americans 12 years or older in 1999 used oral sedatives, stimulants, antipsychotic agents, or opioids in ways not intended by prescribers, according to a government-funded survey.

Results from the most recently available National Household Survey on Drug Abuse suggest that nonmedical use of prescription drugs is increasing among adolescents and adults over 60. In announcing the results, the National Institute on Drug Abuse (NIDA) called on pharmacists, physicians, and patients to prevent medication misuse. NIDA said it wants to act now to reverse the increasing trend of toward misuse and abuse.

Thomas E. Menighan, president of the American Pharmaceutical Association, told attendees at the April 10 NIDA-convened press conference in Washington, D.C., that pharmacists serve a difficult dual role as health care professional and gatekeeper.

"Determining legitimate medical purpose can be challenging," Menighan said. "Despite their best efforts to balance their roles as health care providers and gatekeepers, pharmacists still struggle with the lack of a formal process for dealing with incidents of suspected or recognized abuse." Creation of a process to deal with these incidents, he said, should be the next step that NIDA pursues in trying to curtail prescription drug misuse and abuse. In the meantime, "good communication with prescribers is essential," as is inclusion of a medication’s indication for use on every prescription order.

Not mentioned directly during the press conference or the subsequent series of presentations by researchers was the illegal abuse and diversion of Purdue Pharma’s OxyContin tablets, containing oxycodone. The problem has attracted national attention, with reports appearing on network news shows and in local newspapers. Purdue announced in late March that it has distributed more than 400,000 brochures on diversion prevention to pharmacists and health care professionals and started a pilot program in Maine and Virginia involving free tamper-resistant prescription pads for physicians.

NIDA launched its campaign to highlight a problem not well appreciated by most people. In 1998, the National Household Survey found that Americans misused prescription drugs and cocaine to the same extent in the previous 12 months, said Johns Hopkins University epidemiologist Howard Chilcoat. About 9% of the people questioned had taken a prescription drug for "extramedical" use at least once in their lifetime. Despite the fact that "medication use is almost a fait accompli as we grow older," said geriatrics professor Kenneth Schmader from Duke University Medical Center, inappropriate drug-taking by the elderly has not been well studied, with much of the information tending to be anecdotal. Some of the inappropriate drug-taking behaviors "are quite innocent," he said, citing misuse of laxatives and diuretics as examples. Opiate misuse, on the other hand, is not much of a problem among the elderly because they fear addiction, Schmader speculated.

Chilcoat, relying on 1998 survey results, said girls between the ages of 12 and 17 are the most likely females to misuse analgesics and "are at the highest risk for misusing drugs" of any type. He said there is no research on how teenage girls obtain the prescription drugs for nonmedical uses.

Psychology researcher Alice Young, of Detroit’s Wayne State University, said that early experience and availability influence whether a person abuses a substance that provides a mind-altering reward. The risk of abuse can be minimized, she said, through pharmaceutical technology—by delivering drugs directly to the target, such as the spinal column, or slowly releasing drugs in the brain.