09/15/14

Homegrown Epidemic

The White House reported that the Centers for Disease Control and Prevention (CDC) identified prescription drug abuse as an epidemic.  The 2012 National Survey on Drug Use and Health (NSDUH) reported that 4.9 million people, 1.9% of the population, abused prescription drugs. Nonmedical use of psychotherapeutics, particularly pain relievers, was the most commonly used illicit substance after marijuana. “In our military, illicit drug use increased from 5% to 12% among active duty service members from 2005 to 2008, primarily due to non-medical use of prescription drugs.” Drug induced deaths have almost doubled since 1999 and are now second only to motor vehicle fatalities.

At the end of 2013, Genetic Engineering & Biotechnology News (GEN) published a list of the top 17 abused drugs of 2013. The table below combines most of the given statistical information in the list of abused drugs and presented them in rank order, from one to seventeen.

There is no surprise that seven of the listed drugs are either prescribed for some kind of “pain” condition or are opioids (OxyContin, Suboxone, Opana, Fentora [fentanyl], Percocet, Soma, Vicodin). Vicodin is now classified as a schedule 2 controlled substance. Soma is now a schedule 3 controlled substance. Suboxone  (schedule 3) is an opioid approved for opioid drug treatment.

Three of the medications are used to treat ADHD (Concerta, Ritalin, Adderall); all three are in the top 8 most abused drugs. Four of the drugs are benzodiazepines (Xanax, Klonopin, Ativan, Valium; schedule 4).  Two medications are sleep aides (Ambien, Lunesta). One, Zoloft, is an SSRI used to treat depression.

Drug

Rank

2012 Sales

2011 Sales

Patent

Use

OxyContin

1

2.7 billion

2.8 billion

until 2025

pain

Suboxone

2

1.4 billion

1.2 billion

until 2020

mainten

Concerta

3

1.1 billion

1.3 billion

invalid

ADHD

Ambien CR

4

671 million

661 million

until 2020

sleep

Ritalin

5

554 million

550 million

expired

ADHD

Zoloft

6

541 million

573 million

expired

depression

Lunesta

7

447 million

420 million

until 2014

sleep

Adderall XR

8

429 million

533 million

expired

ADHD

Opana

9

299 million

384 million

until 2025

pain

Xanax

10

274 million

308 million

expired

anxiety

Klonopin

11

194 million

211 million

expired

anxiety

Fentara

12

161 million

186 million

until 2019

pain

Percocet

13

103 million

104 million

expired

pain

Ativan

14

30 million

25 million

expired

anxiety

Soma

15

27 million

46 million

expired 1/12

pain

Valium

16

8 million

11 million

expired

anxiety

Vicodin

17

N/A

168 million

expired

pain

Suboxone is likely on the list because of its use by opioid abusers and addicts as a “back up” to forestall withdrawal when the opioids aren’t available. However, along with other opioids it can be combined with benzodiazepines for a heroin-like euphoria. The combination of these two classes of drugs has increasingly become one of the signatures of accidental overdose deaths worldwide. The 2012 NSDUH reported that 4.8% of the population over the age of 12 had used pail relievers illicitly within 30 days of being surveyed.

In their own right, benzodiazepines have a long history of abuse. Valium was the best selling drug in the Western world from 1968 to 1981. It wasn’t until 1975 that the U.S. Justice Department required that benzodiazepines be listed as schedule 4 drugs under the Controlled Substances Act. As Robert Whitaker noted: “This designation limited the number of refills a patient could obtain without a new prescription, and revealed to the public that the government had concluded that benzodiazepines were, in fact, addictive.” The 2012 NSDUH reported that 2.3% of the population over the age of 12 had used tranquilizers illicitly within 30 days of being surveyed.

Attention-deficit disorder did not appear as a “disease” in the Diagnostic and statistical Manual until 1980. In 2007, the CDC reported that one in every twenty-three American children between the ages of four and seventeen is taking an ADHD medication. Concerta, Ritalin and Adderall are all schedule II controlled substances; classified to be as potentially addictive as OxyContin, Opana, Fentara, Percocet, and Vicodin. Concerta and Ritalin are the brand names for the generic drug, methylphenidate.  The 2012 NSDUH reported that 1.3% of the population over the age of 12 had used stimulants illicitly within 30 days of being surveyed.

The medications on the GEN list of abused drugs include some of the most commonly prescribed classes around: drugs for pain relief, anxiety, ADHD, and sleep problems.  The Daily Beast reported that: “The US, which holds 5 percent of the world’s population, is responsible for 75 percent of global prescription drug use.” So the chances that at some time in your life you will be prescribed one of these 17 drugs for a legitimate medical reason is high. Be careful in how you use them and most especially, how long you use them.

Do you think it is overstating the problem to say that prescription drug abuse is an epidemic?