Abstract
The nonmedical use of scheduled medications commonly prescribed for pain, pain-related symptoms, and psychiatric disorders began rising in the mid-1990s. Physicians are confronted with the dilemma of how to minimize the abuse and diversion potential of these products without compromising access for patients with a legitimate medical need. Using data from the National Survey on Drug Use and Health, we describe the scope of nonmedical use of opioids, stimulants, and tranquilizers; characteristics of nonmedical users; and options available to reduce abuse liability. In 2003, lifetime prevalence estimates of nonmedical use were 31.2 million for opioids, 20.7 million for stimulants, and 20.2 million for tranquilizers. Nonmedical users of psychotherapeutics were more likely to be Caucasian; use alcohol, cocaine, or heroin; and to use needles to inject drugs than those who reported using illicit drugs only. Sources of diversion are enumerated, and options for minimizing the abuse liability associated with these medications are described.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Goodwin RD, Hasin DS: Sedative use and misuse in the United States. Addiction 2002, 97:555–562.
Substance Abuse and Mental Health Services Administration. Overview of Findings from the 2002 National Survey on Drug Use and Health (Office of Applied Studies, NHSDA Series H-21, DHHS Publication No. SMA 03-3774). Rockville, MD, 2003.
Substance Abuse and Mental Health Services Administration. Results from the 2003 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-3964). Rockville, MD, 2004.
Zacny J, Bigelow G, Compton P, et al.: College on problems of drug dependence task force on prescription opioid nonmedical us and abuse: position statement. Drug Alcohol Depend 2003, 69:215–232. The authors urge balance between risk management strategies and appropriate access to pharmacotherapy for the treatment of pain.
National Institute on Drug Abuse. NIDA and partners announce national initiative on prescription drug misuse. NIDA, National Institutes of Health, U.S. Department of Health and Human Services; Bethesda, MD. News release issued April 10, 2001. Available at www.drugabuse.gov/MedAdv/01/ NR4-10.html.
Manchikanti L, Fellows B, Damron KS, et al.: Prevalence of illicit drug use among individuals with chronic pain in the Commonwealth of Kentucky: an evaluation of patterns and trends. Journal of the Kentucky Medical Association 2005, 103:55–62.
Williams RJ, Goodale LA, Shay-Fiddler MA, et al.: Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents. Am J Addict 2004, 13:381–89.
Zarba A, Storr CL, Wagner FA: Carrying habits into old age: prescription drug use without medical advice by older American adults. J Am Geriatr Soc 2005, 53:170–171.
Hall KM, Irwin MM, Bowman KA, et al.: Illicit use of prescribed stimulant medication among college students. J Am Coll Health 2005, 53:167–174.
Clark RE, Xie H, Brunette MF: Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry 2004, 65:151–152.
McCabe SE, Teter CJ, Boyd CJ, et al.: Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey. Addict Behav 2005, 30:789–805.
Young D: Federal reports say oxycodone abuse is on the rise. Am J Health Syst Pharm 2001, 58:1175,1178–1179.
Office of National Drug Control Policy 2005. http://www.whitehousedrugpolicy.gov/publications/policy/ ndcs05/ndcs.pdf.
Cicero TJ, Adams EH, Geller A, et al.: A post-marketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Abuse 1999, 57:7–22.
Arfken CL, Schuster CR, Johanson CE: Postmarketing surveillance of abuse liability of Sibutramine. Drug Alcohol Depend 2003, 69:169–173.
World Health Organization: Cancer Pain Relief, Second Edition with a Guide to Opioid Availability, Cancer Pain Relief and Palliative Care: Report of the WHO Expert Committee (WHO Technical Report Series, No. 804). Geneva: WHO; 1996.
Gilson AM, Ryan KM, Joranson DE, et al.: A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997–2002. J Pain Symptom Manage 2004, 28:176–188.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000:247.
Physicians’ Desk Reference, 2005.
DiSio JM, Bacon DR, Peer G, et al.: Intravenous abuse of transdermal fentanyl therapy in a chronic pain patient. Anesthesiology 1993, 79:1139–1141.
Meier B: Painkiller: A “wonder” Drug’s Trail of Addiction and Death. New York: Rodale Press; 2003.
Brookoff D: Abuse potential of various opioid medications. J Gen Intern Med 1993, 8:688–690.
Auriacombe M, Franques P, Tignol J: Deaths attributable to methadone vs. buprenorphine in France. JAMA 2001, 285:35.
Graham A, Smith MY, Haddox JD, et al.: Reducing the potential for diversion of prescription opioids: Tested interventions. Poster presented at College on Problems of Drug Dependence, Orlando, Florida, June 2005.
Forman R, Woody G, McLellan T: Availability of websites offering to sell opioid-containing medications without a prescription. Am J Psychiatry In press, 2005.
Joranson DE, Carrow GM, Ryan KM, et al.: Pain management and prescription monitoring. J Pain Symptom Manage 2002, 23:231–238. The authors report on prescription monitoring programs as a strategy agains diversion of prescription drugs.
Fudala P, Woody GE: Current and experimental therapeutics for opioid addiction. In Neuropsychopharmacology: The Fifth Generation of Progress. Edited by Davis KL, Charney D, Coyle JT. Philadelphia: Lippincott, Williams & Wilkins; 2002:1507–1518.
Woody GE: Psychosocial and pharmacologic treatment of substance abuse disorders. In The Science, Treatment and Prevention of Antisocial Behaviors. Edited by Fishbein DH. Kingston, NJ: Civic Research Institute; 2000. This is an important work dealing with two components of treatment in substance abuse disorders.
Cone EJ, Fant RV, Rohay JM, et al.: Oxycodone involvement in drug abuse deaths. II. Evidence for toxic multiple drug-drug interactions. J Anal Toxicol 2004, 28:616–624.
Miller S, Greenfeld A: Patient characteristics and risks factors for development of dependence on hydrocodone and oxycodone. Am J Ther 2004, 11:26–32.
Woody G, O’Brien CP, Greenstein RA: Misuse and abuse of diazepam: an increasingly common medical problem. Int J Addict 1975, 10:843–848.
Potter JS, Hennessy G, Borrow JA, et al.: Substance use histories in patients seeking treatment for controlled-release oxycodone dependence. Drug Alcohol Depend 2004, 76:213–215.
Simoni-Wastila L, Ritter G, Strickler G: Gender and other factors associated with the nonmedical use of abusable prescription drugs. Substance Use Misuse 2004, 39:1–23.
Simoni-Wastila L: The use of abusable prescription drugs: The role of gender. J Womens Health Gender Based Med 2000, 9:289–297.
Simoni-Wastila L, Strickler G: Risk factors associated with problem use of prescription drugs. Am J Pub Health 2004, 94:266–268. This paper found the greatest risk in older adults, females, those in poor/fair health, and people who consume alcohol on a daily basis.
Johnston LD, O’Malley PM, Bachman JG, et al.: Monitoring the Future national results on adolescent drug use: Overview of Key Findings, 2004. (NIH:Publication No. 04-5506). Bethesda, MD: National Institute on Drug Abuse, 2005.
Gfroerer J, Wright D, Kopstein A: Prevalence of youth substance use: the impact of methodological differences between two national surveys. Drug Alcohol Depend 1997, 47:19–30. Using two major, federally funded surveys, the authors concluded that methodologic differences in survey design can have a significant impact on prevalence estimates.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Smith, M.Y., Woody, G. Nonmedical use and abuse of scheduled medications prescribed for pain, pain-related symptoms, and psychiatric disorders: Patterns, user characteristics, and management options. Curr Psychiatry Rep 7, 337–343 (2005). https://doi.org/10.1007/s11920-005-0033-4
Issue Date:
DOI: https://doi.org/10.1007/s11920-005-0033-4