The Prescription Drug Abuse Epidemic
Prescription drug abuse is a growing national epidemic. Addiction, overdoses and deaths involving non-medical prescription drug use, especially narcotic pain relievers, have risen dramatically over the last decade. A recent study estimated that in 2006 the total cost in the United States of nonmedical use of prescription opioids was $53.4 billion (Hansen et al. (2011) Economic costs of nonmedical use of prescription opioids. Clinical Journal of Pain, 2:3). Of this total, $42 billion was attributable to lost productivity, $8.2 billion to criminal justice costs, $2.2 billion to drug abuse treatment, and $944 million to medical complications. Given that indicators of prescription drug abuse (e.g., overdoses, deaths, emergency department visits and treatment admissions) have increased since 2006, and that opioids are just one class of abused prescription drugs, current costs stemming from their illicit use are likely to be substantially greater. Below we present findings that illustrate the scope and seriousness of the prescription drug abuse epidemic. We will update this page as new information becomes available.
You can view or download a full slide presentation on the epidemic prepared by Dr. Len Paulozzi of the Centers for Disease Control, and please see sidebars on the left for links to further reading.
Steep Rise in Deaths and Emergency Room Visits
Drug-related poisonings are now the leading cause of death due to unintentional injuries in the United States, having surpassed motor vehicle accidents in 2009, according to a Los Angeles Times analysis of data from the Centers for Disease Control and Prevention (article, data chart, interactive map). The number of unintentional overdose deaths per year involving opioid pain relievers (e.g., oxycodone and hydrocodone) nearly quadrupled from 1999 to 2007, rising from 2,900 to 11,500, while overdose deaths due to these drugs in 2007 were nearly twice those due to cocaine, and over 5 times those due to heroin (CDC). In Florida, according to medical examiner data, the death rate from oxcycodone increased 265% betweem 2003 and 2009 (CDC). From 2004 to 2009, emergency department visits in the U.S. related to the misuse or abuse of oxycodone rose 242%, hydrocodone 124%, and all pharmaceuticals 98%, while those for illicit drugs declined slightly (Drug Abuse Warning Network).
Drug-related poisonings nearly doubled between 1999 and 2006:
Increasing Prevalence of Non-medical Prescription Drug Use
Overdose deaths and emergency department visits are driven by increasing non-medical, illicit use of prescription drugs, now outpacing use of traditional street drugs except for marijuana. According to the National Survey on Drug Use and Health (NSDUH), of the 3.1 million individuals 12 or older estimated to have used an illicit drug for the first time in 2009, 28.6% initiated use with prescription drugs, second only to those initiating with marijuana (59.1%). The same survey found that 20.6% reported non-medical use of prescription drugs in their lifetimes, while 2.8% reported past month use, again second only to marijuana (41.5%, 6.6%). Frequent use can result in drug-related behavioral problems: 1.9 million individuals 12 and older reported either abusing or being dependent on prescription pain relievers in the past year, compared to 399,000 for heroin (NSDUH). Drug treatment admissions for pharmaceutical opioids in 2008 (121,091) were six times what they were in 1998 (19,941) (Treatment Episode Data Set).
Risk Factors Related to Opiate Overdose and Death
According to data from Drug Abuse Warning Network (DAWN), emergency room visits related to non-medical use of opioid analgesics were highest for males and females aged 21 to 29, while the Centers for Disease Control (CDC) reported that those at most risk of fatal opioid overdose were middle-aged, with non-Hispanic whites at the highest risk. Risk of fatal overdose also seems to increase with increasing doses of opiates, rapid dose escalation, number of prescriptions, early refills, concomitant use of sedative-hypnotics (e.g., benzodiazepines) and doctor or pharmacy shopping (CDC).
Newborns are increasingly at risk of suffering withdrawal related to opiate addiction, a trend that parallels the rise in prescription opiate use and abuse. See these related news stories and the following graph of recent data from Florida:
Prescription Drug Use Among Youth
According to the 2009 National Youth Risk Behavior Survey, approximately 20% of high school students reported having taken a prescription drug at some point in their lives without it being prescribed for them. Among youth aged 12 to 17, 3.1% reported past month non-medical use of psychotherapeutics, second only to marijuana (7.3%) in 2009 (NSDUH). Analysis of NSDUH survey data indicates that illicit prescription drug use seems more common among rural teens (see related article). Results from the 2010 Monitoring the Future Survey show prescription and over-the-counter medications second only to marijuana in illicit drug use among 12th graders. Past year non-medical use of Oxycontin held steady for all grades surveyed and has increased among 10th graders over the last 5 years. (See related video on prescription drug abuse among Arkansas adolescents.)
Drugged Driving on the Rise
Although fatalities from automobile accidents are declining, a recent traffic fatality analysis from the National Highway Transportation Safety Administration (NHTSA) indicates that 33% of drivers killed in such accidents in 2009 tested positive for drugs. Among these drugs are prescription narcotics, depressants and stimulants, whether used medically or non-medically. See this Office of National Drug Control Program press release on drugged driving.
Pharmacy Robberies Increasing
Another consequence of the rise in prescription drug use, misuse and addiction has been an increase in robberies and thefts from pharmacies. Those with severe addiction problems who are unable to obtain controlled substances from friends, family, street dealers or by doctor shopping, and who can’t or won’t enter treatment, will sometimes demand drugs at gunpoint from pharmacists. As the number of such desperate individuals grows, so does the probability of such incidents. This highlights the need for more treatment resources to help those who’ve become dependent on prescription drugs. See recent news stories about the increase in pharmacy robberies.
Explaining the Epidemic
The rise in the misuse and abuse of prescription drugs, opiates in particular, has been attributed to their increased availability over the last decade, a result of increased prescribing. Increased prescribing in turn has been driven by more aggressive treatment of pain in response to patient advocacy groups, the development of new formulations of opiate analgesics to meet this demand, and increased marketing of opiates by pharmaceutical companies (see related article). Hydrocodone-acetaminophen, sold under the brand name Vicodin™, is among the most widely prescribed medications in the US in any drug category. Synthetic opioids such as Oxycontin™, oxycodone and methadone are more frequently prescribed to treat non-cancer pain than in prior decades. Because of their psychoactive and addictive properties, these drugs, along with tranquilizers (e.g., benzodiazepines such as Xanax, Klonapin, and Valium) and stimulants (Ritalin, Adderall) have high street value. They are diverted for illicit use by means of sharing among friends and family, doctor shopping, prescription fraud, and theft.
Reports suggest that those who become dependent on prescription opiates will sometimes switch to heroin due to its low cost, easy availability, and the fact that it can be smoked or snorted. This phenomenon has been reported in Chicago, and see also the Massachusetts Oxycontin and Other Drug Abuse Commission, Final Report, 2009, p. 13, and the Ohio Prescription Drug Abuse Task Force, Final Report, 2010, pp. 20-21. Lankeneau et al. write that “A new pattern of drug use may be emerging whereby [injection drug users] initiate prescription opioid misuse before using heroin” (Initiation into prescription opioid misuse amongst young injection drug users, International Journal of Drug Policy, in press).