Illegal Abuse Could Restrict Legitimate Use

 Nonmedical use of prescription opioids is increasing in the United States. In a new position statement, a task force of the College on Problems of Drug Dependence says programs to control and reduce such abuse must be balanced against the need for access to these drugs for legitimate medical purposes.

Opioids are drugs that include morphine, codeine, hydrocodone (Vicodin), and oxycodone (Percodan, OxyContin), to name a few.

Prescription opioids often are prescribed to treat pain that is not alleviated by such nonopioid medications as acetaminophen.

Results of surveys and other data collection sources show that use of prescription opioids appears to have risen in recent years.

Data from the Monitoring the Future survey show that usage of prescription opioids over a 30-day period by high school students who reported taking these drugs without a physician telling them to do so increased by 173 percent between 1991 and 2001. The Monitoring the Future survey is conducted annually by the University of Michigan for the National Institute on Drug Abuse.

The National Household Survey on Drug Abuse tracks incidence and prevalence of drugs of abuse in Americans aged 12 and older. Survey results showed that the number of people using prescription opioids for nonmedical purposes for the first time increased by 400 percent between the mid-1980s and 2000 (from 400 thousand to 2 million).

Prevalence of opioid abuse was higher in people aged 12�25 than in people aged 26 and over. The survey also showed that the prevalence of opioid abuse is similar to that of cocaine and heroin.

Emergency Visits Increase
The Drug Abuse Warning Network collects information on drug-related visits to emergency departments. It shows that the number of ED visits related to opioid analgesics and opioid analgesic combinations increased by 123 percent between 1994 and 2001.
The task force emphasized that prescribed opioids are an effective means for treating pain. It also expressed the concern that an undue focus on opioid abuse, and the addiction that may result because of misuse of opioids, may unwittingly lead to less use of opioids for treating pain.

Members of the task force recommend several steps be taken to improve the ability to make informed policy decisions on prescription opioid abuse. These include: further epidemiological research, laboratory testing of prescription opioids to determine abuse liability, and clinical trials to determine the efficacy of different approaches to the prevention and treatment of prescription opioid abuse.

Overuse and abuse of prescription opioid drugs can have harmful ramifications for their legitimate and appropriate use. A balanced approach is needed so programs developed to reduce and prevent such abuse do not deter physicians from prescribing these drugs for appropriate patients.

Dr. James Zacny of the University of Chicago chaired the task force. The position paper was published in the April 2003 issue of Drug and Alcohol Dependence.

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