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Science & the Public

Science & the Public

Abuse of pharmaceuticals is rising sharply

They now trigger as many ER visits as illicit drugs do

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In 2008, the most recent year for which data are available, an estimated 1 million Americans entered a hospital emergency room for treatment of an overdose due to “nonmedical” use of an over-the-counter or prescription drug. That’s double the number of such visits five years earlier, according to data just reported by the Centers for Disease Control and Prevention.

The agency’s Substance Abuse and Mental Health Services Administration maintains a Drug Abuse Warning Network, or DAWN. It collects data from emergency room visits to a random but representative cross-section of some 220 U.S. hospitals (patient names and personal data were removed before hospitals shared the information). The institutions chosen varied some from year to year, but over-sampled hospitals serving big metropolitan areas.

Because deaths from an overdose of drugs has been on the rise, CDC researchers wanted to know whether there was a similar climb in the number of people who were being sickened by drugs. So they collected all DAWN data from 2004 through 2008 and focused on signs of pharmaceutical abuse. These included instances where someone took a deliberate overdose, took a drug prescribed for someone else, “assaulted” someone by forcing that person to take a drug, or exhibited some other inappropriate behavior.

Throughout the five-year period, ER visits for abuse of cocaine, heroin and other illicit drugs held steady at around 1 million. But ER admissions for nonmedical use of commercial medicines climbed steadily. In the June 18 Morbidity and Mortality Weekly Report, a CDC publication, several federal researchers summarized their new data.

The biggest contributors to medicinal abuse in 2008: prescription pain killers such as oxycodone, hydrocodone and methadone (305,900 cases) and tranquilizers in the benzodiazepine family, including alprazolam, diazepam (best known as valium) and the sleep aid zolpidem (271,700 cases). In some instances, the drugs were used alone. Other times, meds from both categories were taken in combination or with alcohol.

The abuses tallied did not include accidental overdoses or would-be suicides; those were counted in a separate category. And the peak age of people taking these drugs for recreational or other nonmedical purposes: twenty-somethings.

An accompanying editorial notes that as recently as 2006, the rate of fatal drug overdoses involving opiate pain killers (like oxycodone) was peaking in older adults — those 35 to 54.

The escalating rate of pharmaceutical abuse “suggests that previous prevention measures, such as provider and patient education and restrictions on use of specific formulations, have not been adequate,” the editorial adds. “Given the societal burden of the problem,” it argues that “additional interventions are urgently needed . . . [including] the routine monitoring of insurance claims information for signs of inappropriate use, and efforts by providers and insurers to intervene when patients use drugs inappropriately.”

I’m not sure I trust insurers to play pharma-cops. But it would make sense for physicians to follow up with their patients and confirm that the medications they prescribed are working — or discontinue their authorization. The new data also offer another argument for pharmacy take-backs, especially of unused drugs subject to abuse or trafficking on the black market.

Citations

Cai, R., et al. 2010. Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs--United States, 2004-2008. Morbidity and Mortality Weekly Report 59(June 16):705.

____. 2010. Editorial Note. Morbidity and Mortality Weekly Report 59(June 16):708.
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