Flashpoint: How the Prescription Drug Epidemic Started
It is clear that prescription drug abuse has reached epidemic proportions, but it is less clear how it started. Pundits, experts, and talking-heads across the nation have blamed everyone from the pharmaceutical giants to congress and the president. Who or what is really behind the problem though? The answer, of course, is complicated.
The History of Narcotics
Morphine was first manufactured in Germany in 1827, but long before the pain reliever became a mainstay of medical care in the Civil War, its predecessor, opium, was used and abused by people the world over. All narcotic drugs (i.e. “opioids”) are derived from opium, which is why they all have abuse and addiction potential. To date, no alternative has been developed that provides the same level of pain relief without the addictive potential. Though this isn’t for lack of trying.
Morphine was replaced by prescription heroin in 1898, with heroin being touted as a less addictive alternative. Of course, it turned out to be even more addictive than morphine and was one of the first drugs placed under control by the Harrison Narcotic Tax Act of 1914. It was made a Schedule I controlled substance by the 1970 Controlled Substances Act and though it can still be prescribed with special permission, it almost never is.
Attempts to replace morphine with less addictive alternatives have continued, with the most recent attempt being OxyContin. OxyContin, one of the most-abused narcotics in the United States, was only brought to market in 1996. Like heroin, it was touted as a less addictive pain reliever than its predecessor narcotics. Like heroin, OxyContin turned out to be highly addictive.
Narcotic pain relievers were introduced for a reason – they work. On a scale of one to ten, with one being least potent and ten being most potent, the best non-steroidal anti-inflammatory (NSAID) medication, Celebrex, ranks only a 3.7. On the same scale, the best opioid pain reliever, Dilaudid, receives a 10+, breaking the scale in most estimates and providing outstanding pain control. Simply put, narcotic pain relievers work. So at least part of the reason that prescription drug abuse has reached epidemic proportions comes down to the fact that the medical and pharmaceutical industries, in good faith most of the time, have introduced highly addictive medications into the population in an effort to control pain.
Perception of Safety
Another key to the rapid rise of prescription drug abuse is the perception that the drugs are safer than their illicit counterparts. Because these drugs are prescribed by health care providers to treat legitimate medical conditions and because they are FDA approved, there are a number of misunderstandings regarding their risks.
The most prevalent myth surrounding prescription drugs is that they are safe to abuse. While it is true that prescription medications are less likely than illicit drugs to be adulterated with potential toxins, it is also true that they are just as dangerous when misused. Some prescription drugs are every bit as addictive as illicit drugs and many can wreak havoc on the body when used in a manner inconsistent with best medical practices.
Many people fail to realize that prescription drugs often act on the brain and body in the same way that illicit drugs do. For instance, Vicodin and OxyContin have the same actions as heroin on the brain when taken inappropriately. Ritalin and Adderall aren’t all that different from cocaine when taken by individuals who do not suffer from a medical condition they are used to treat. Prescription medications can and often do have the same mental, physical, and psychological impacts as illegal drugs.
Another common myth about prescription drugs is that misusing them is legal. Because they are legally prescribed, many people think that prescription drugs can be shared without concern for breaking the law. In fact, controlled substances may not be used without a prescription that is specific to an individual. Taking someone else’s prescription is illegal and giving away one’s own prescription medication is equally illegal. Simply put, prescription medications can only legally be taken by the specific individual they have been prescribed to.
As much as we would like to trust the providers in whose hands we place our health care, the truth is that some do not take proper precautions when prescribing medications with abuse potential and others outright abuse their privilege for financial gain.
It is important to note that one in five cases of prescription drug abuse are due to improper prescription. While all too high, this number represents just a small fraction of prescription abuse. That said, it is up to the medical community to tighten its practices on prescribing. Potentially addictive medications should be prescribed only for as long as absolutely necessary and in limited quantities. Health care providers should follow up with patients taking these medications on a regular basis to evaluate for possible dependence. When long-term use of potentially addictive medications is required, it is important that providers explain the risks and benefits to patients and work with them to develop checks and balances that can help to prevent abuse.
Cause and Solution
If the causes of the prescription drug epidemic are myriad, then so too must the solutions be multiple. Fighting the problem will take the coordinated efforts of health care providers, pharmaceutical manufacturers, government agencies, and the people at large. Who are the major players in the fight against prescription drug abuse and what are their primary roles?
American Prescription Drug Epidemic 2
American Prescription Drug Epidemic 1