essay on prescription drug abuse

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Prescription Drug Abuse: From Epidemiology to Public Policy

R. kathryn mchugh.

1 Division of Alcohol and Drug Abuse, McLean Hospital; 115 Mill Street, Belmont MA 02478

2 Department of Psychiatry, Harvard Medical School; 25 Shattuck Street, Boston MA 02115

Suzanne Nielsen

3 University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia

4 Drug and Alcohol Services, South Eastern Sydney Local Health District, New South Wales, Australia

Roger D. Weiss

Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, the optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing prescription drug abuse.

1. Introduction

Markers of public health impact ranging from incidence to mortality indicate that the abuse of prescription drugs has reached an epidemic level. The National Survey on Drug Use and Health (NSDUH) estimated that more than 16.7 million people age 12 and older in the United States abused prescription drugs in 2012, with approximately 2.1 million people meeting criteria for a diagnosis of a substance use disorder related to prescription drugs ( Substance Abuse and Mental Health Services Administration, 2013a , 2013b ). This reflects an increase of 250% in prescription drug abuse over the previous 20 years ( SAMHSA, 1998 , 2013a ). Treatment admissions for substance use disorder services for prescription opioids alone increased more than 5-fold from 2000-2010 in the U.S. ( SAMHSA Center for Behavioral Health Statistics and Quality, 2014 ), with some regions experiencing more than a 770% increase in admissions ( SAMHSA Center for Behavioral Health Statistics and Quality, 2013 ). During that time, accidental prescription opioid overdoses increased almost 400%, surpassing accidental overdose deaths from heroin, cocaine, and other stimulants combined ( Calcaterra, Glanz, & Binswanger, 2013 ).

The rapid escalation of this problem initially far outpaced clinical research on its nature and on interventions to prevent and treat prescription drug use disorders. However, in recent years, a research base on prescription drug abuse has begun to take shape. The aim of this special issue of the Journal of Substance Abuse Treatment is to highlight a sampling of the latest research on prescription drug abuse. The articles in this issue address a range of topics, highlighting the state of the science from perspectives such as epidemiology, clinical correlates, treatment outcomes, and public policy considerations. For the purpose of this special issue we use the term prescription drug abuse to encompass a range of potential patterns of nonmedical use of prescription drugs, including using a prescribed medication at a higher dose or greater frequency than instructed by the prescriber, or using without a legitimate prescription (see Compton & Volkow, 2006 ).

2. Epidemiology of Prescription Drug Abuse

The prevalence of prescription drug abuse increased dramatically and rapidly in the U.S. in the late 1990s through the mid-2000s, with some plateau since that time at approximately 2.3-2.8 million initiators of prescription drug abuse annually ( SAMHSA, 2013b ). In 2012, prescription drugs were second only to marijuana in prevalence of both illicit use and drug use disorders ( SAMHSA, 2013b ). Opioids are the most commonly abused type of prescription drug and appear to be the largest contributor to these increases. The number of adults abusing prescription opioids increased from 4.9 million in 1992 to almost 12.5 million in 2012 ( SAMHSA, 1998 , 2013a ) and the rate of treatment receipt for prescription opioid use disorders now is second only to alcohol ( SAMHSA, 2013b ). After opioids, the most commonly abused prescription drugs in the US are tranquilizers (6 million people in 2012) and stimulants (3.3 million) ( SAMHSA, 2013a ). Although much of the attention in both the research literature and the media has focused on the abuse of prescription opioids and stimulants, this problem encompasses the range of psychotropic medications that provide potentially reinforcing effects. For example, Malekshahi et al. (2014) found that 17% of inpatients sampled at a substance use disorder treatment facility had abused antipsychotic medications, such as quetiapine.

Variability in definitions of prescription drug abuse and in the availability of specific types of prescription drugs limits comparison across countries. Although the U.S. appears to have the highest prevalence of prescription drug abuse internationally, significant rates of prescription opioid abuse has been reported in countries, such as Canada, New Zealand, and India, among others ( Dengenhardt et al., 2008 ). For example, a large population-based study in Canada suggested that almost 5% of the population abused opioids in the previous year ( Shield, Jones, Rehm, & Fischer, 2013 ). The prevalence of prescription drug abuse appears to vary based on the availability of medications with abuse potential, including the prevalence of the legal availability of these medications, proximity to areas producing these medications, and availability of alternative substance abuse ( Dengenhardt et al., 2008 ).

In the US, increasing rates of prescription drug abuse have paralleled increases in the prescription of these medications. In 2012, there were as many opioid prescriptions written (259 million) as there were adults in the US ( Paulozzi, Mack, & Hockenberry, 2014 ). Prescriptions for opioids have increased significantly in adult ( Mazer-Amirshahi, Mullins, Rasooly, van den Anker, & Pines, 2014 ) and pediatric emergency departments ( Mazer-Amirshahi, Mullins, Rasooly, van den Anker, & Pines, 2014 ), and ambulatory settings ( Olfson, Wang, Iza, Crystal, & Blanco, 2013 ). A study of trends in prescription medication use and abuse among college students found evidence for significant increases in prescriptions for stimulants and decreases in opioid prescriptions among college students from 2003-2013; during that time, rates of stimulant abuse increased, while rates of opioid abuse decreased ( McCabe, West, Teter, & Boyd, 2014 ).

Large epidemiologic studies suggest that Native Americans and Caucasians have the highest rates of prescription drug abuse ( Huang et al., 2006 ; SAMHSA, 2013a ). Individuals with prescription drug abuse are younger and less likely than those without this problem to be married, and prescription drug use disorders co-occur at very high rates with other substance use disorders and psychiatric illnesses ( Huang et al., 2006 ). Although data from the NSDUH suggest that there are similar rates of prescription drug abuse between those living in rural relative to urban settings ( Wang, Becker, & Fiellin, 2013 ), prescription drug abuse appears to be more prevalent in rural than urban areas among adolescents ( Havens, Young, & Havens, 2011 ).

Several studies have identified gender differences in prescription drug abuse. For opioids, the higher prevalence in men observed across many substances of abuse appears to be smaller, with some studies reporting slightly higher prevalence among men, and others suggesting a similar prevalence in men and women ( Back, Payne, Simpson, & Brady, 2010 ; Green, Grimes Serrano, Licari, Budman, & Butler, 2009 ; Parsells Kelly et al., 2008 ; Tetrault et al., 2008 ). This may reflect the fact that women are more likely to be prescribed an opioid than men ( Parsells Kelly et al., 2008 ), or may reflect other factors that are unique to prescription drugs. For example, abusing prescription medication may be perceived as “safer” than abuse of illicit drugs ( Fleary, Heffer, & McKyer, 2013 ; Mateu-Gelabert, Guarino, Jessell, & Teper, 2014 ). In fact, women are more likely than men to abuse prescription opioids in a manner more consistent with their prescribed use, such as first receiving opioids via a legitimate prescription and using only via the intended route of administration (oral or sublingual) ( Back et al., 2010 ; McHugh et al., 2013 ).

2.1. Impact Across the Lifespan

Much like for other drugs of abuse, the primary developmental risk period for the onset of prescription drug abuse is during adolescence ( McCabe, West, Morales, Cranford, & Boyd, 2007 ). Data from the 2013 Monitoring the Future Study—an annual survey of 8th, 10th, and 12th graders in the U.S.—reported alarmingly high rates of nonmedical use of prescription drugs, particularly stimulant and opioid medications. Opioids were the most commonly abused medications, with almost 13% of 12th graders reporting lifetime prescription opioid abuse ( McCabe, West, Teter, & Boyd, 2012 ). Abuse of prescription stimulants was as common as lifetime medically approved use (9.5%; McCabe & West, 2013 ), and abuse of benzodiazepines was also high (7.5%; McCabe & West, 2014 ). As with adults, Caucasians and Native Americans have higher rates of prescription drug abuse relative to other racial and ethnic groups ( McCabe, Cranford, & West, 2008 ), and gender differences in the prevalence of prescription drug abuse are small ( McCabe et al., 2008 ; SAMHSA, 2013b ). Rates of abuse are even higher among college students, with data from the Monitoring the Future Study suggesting that 23% of college students had a lifetime history of prescription drug abuse ( Johnston, O’Malley, Bachman, & Schulnberg, 2007 ).

Certain risk factors are associated with prescription drug abuse among youth. Youth and adolescents with other substance use disorders are more likely to abuse prescription drugs ( McCabe, Boyd, & Teter, 2005 ; Whiteside et al., 2014 ). In a study of youth presenting to emergency departments, Whiteside et al. (2014) found that those with prescription drug abuse were more likely to have a number of risk factors, including poor school performance, interpersonal violence, and other substance use. Among adolescent offenders, prescription drug abuse is associated with exposure to violence, co-occurring psychiatric disorders, and delinquent behavior ( Drazdowski, Jaggi, Borre, & Kliewer, 2014 ).

Relatively little research has focused on issues related to the impact of prescription drug abuse across other specific life stages. For example, few studies have examined prescription drug abuse in reproductive age or pregnant women. Martin and colleagues (2014) found that despite a relatively constant rate of admissions of pregnant women to substance use disorder treatment settings from 1992 to 2012, the prevalence of pregnant woman seeking treatment specifically for prescription opioid abuse has increased 14-fold. Prescription drug abuse may be more prevalent among rural pregnant women ( Shannon, Havens, & Hays, 2010 ). Given the importance of treatment for pregnant women to both the health of the mother and of the developing fetus, more research with this subgroup is needed.

It appears that prescription drug abuse is less common in older adults relative to other age groups ( Huang et al., 2006 ). However, the prescription of potentially addictive medications (particularly opioids and benzodiazepines) is highly prevalent in this group ( Shannon et al., 2010 ), highlighting the importance of better understanding the potential abuse of prescription medications among older adults. For example, benzodiazepine dependence appears to be common—and underrecognized—among adults aged 65 and older ( Simoni-Wastila & Yang, 2006 ; Voyer, Preville, Cohen, Berbiche, & Beland, 2010 ).

2.2. Is Prescription Drug Abuse Different Than Other Types of Drug Abuse?

Prescription drugs can be obtained legally and are almost universally present in households, and thus are different in meaningful ways relative to both access and perceptions of risk than drugs only obtained illegally. Accordingly, there appear to be meaningful differences between prescription and illicit drugs of the same class. For example, cue-induced craving appears to be less robust among those abusing prescription opioids relative to those abusing heroin ( McHugh, Park, & Weiss, 2014 ), and these groups may also have different responses to treatment (see below). Stein et al. (2014) found that prescription opioid- and heroin-dependent individuals report different life concerns, with those dependent upon prescription opioids less concerned about infectious disease, but more concerned about alcohol use relative to heroin users. College students are more likely to abuse stimulants than college-age young adults who are not enrolled in higher education, which is not consistent with other stimulants, such as cocaine ( Johnston, O’Malley, Backman, & Schulenberg, 2013 ).

Nonetheless, there also appear to be a number of similarities between prescription drug abuse and abuse of other drugs. For example, risk factors for the development of substance use disorders also appear to confer risk for prescription drug abuse, such as earlier age of initiation of use and the presence of psychiatric and medical conditions ( Katz, El-Gabalawy, Keyes, Martins, & Sareen, 2013 ; Martins et al., 2012 ; McCabe et al., 2007 ). Like other substance use disorders prescription drug abuse is strongly associated with psychiatric severity, violence exposure, and stress in cross-sectional studies ( Berenson & Rahman, 2011 ; Martins, Keyes, Storr, Zhu, & Chilcoat, 2009 ; McCauley et al., 2009 ; McCauley et al., 2010 ).

2.2.1. Access and Motives for Use

Prescription drugs that are abused appear to come from a variety of sources, ranging from prescriptions received by a doctor, to diversion from friends and family, to purchase through illicit markets. Adolescents, most commonly reported receiving prescription for free from a friend or relative, although significant proportions of adolescents also used their own prescriptions, purchased drugs from a dealer, or took them from friends or family without asking ( SAMHSA, 2013b ). A study of adolescents and young adults aged 14-20 presenting to emergency departments found that almost 10% reported abuse of prescription opioids or stimulants, but fewer than 15% of that group had valid prescriptions for these medications ( Whiteside et al., 2013 ).

Studies on motives to abuse prescription drugs have found that, much like for other drugs of abuse, there are a range of reasons for abusing prescription drugs, such as to getting high, regulating pain and negative affect, and improving sleep. Studies in adolescents have found that motives are often but not always aligned with the intended purpose of the drug (e.g., pain relief for opioids, improving sleep for sleep aids; Boyd, McCabe, Cranford, & Young, 2006 ; McCabe & Cranford, 2012 ). It appears that those who report multiple motives for use are most likely to also experience greater problems with use ( Boyd et al., 2006 ; McCabe & Cranford, 2012 ). Moreover, negative motivations in particular (e.g., using prescription drugs in relation to unpleasant emotions, physical discomfort or conflict with others), are associated with prescription drug use disorders ( Kelly, Rendina, Vuolo, Wells, & Parsons, 2014 ). In adults, data suggest that although the most typical motive for initiating opioid use is pain relief, the primary motive often shifts over time to managing withdrawal and negative affect, to get high, or to sleep ( Barth et al., 2013 ; Weiss et al., 2014 ).

2.2.2. Prescription Drug Abuse Subtypes

In attempting to better understand the degree to which prescription drug abuse may differ from illicit drug abuse, several studies have attempted to determine whether there are meaningful subgroups in this population. Several studies have utilized large epidemiologic surveys to attempt to address this question. An analysis of prescription opioid abuse in the National Epidemiologic Survey on Alcohol and Related Conditions found four subtypes, characterized by those who also used marijuana, those who also abused other prescription drugs, those who also used marijuana and hallucinogens, and polydrug users ( Wu, Woody, Yang, & Blazer, 2010 ). These subgroups were different with respect to a number of sociodemographic variables as well as substance use and psychiatric histories. Similar results emerged from an analysis of prescription stimulant abuse in the NSDUH, with a subgroup at low risk for other substance use, a group that abused other prescription drugs, a group that used alcohol and marijuana, and a polysubstance using group ( Chen et al., 2011 ). A study in adolescents of prescription drug abuse more generally found a subgroup at low risk for any substance use, one with high risk for polysubstance use, one with risk for alcohol/tobacco/marijuana use, and one with risk for alcohol and prescription drug use ( Cranford, McCabe, & Boyd, 2013 ). Meaningful subgroups characterized by fewer risk behaviors and initiating use for the indicated purpose of the medication (e.g., opioids for pain) also have been identified ( Nielsen et al., 2011 ).

Another approach has involved classifying subtypes based on motives for use, such as recreational users, “self-medicators,” and combinations of motives ( Kelly et al., 2014 ; McCabe, Boyd, & Teter, 2009 ; McCabe & Cranford, 2012 ). Such studies have suggested that self-medicating groups report fewer problem behaviors, such as non-intended routes of administration, and other substance use. Such subgroup analyses have been relatively consistent in their findings; greater understanding of the implications of these groups on prevention and treatment will be an important direction for future research.

2.2.3. The Transition from Medical Use to Abuse

Defining and assessing prescription drug abuse is complicated by unclear boundaries between “appropriate” use of these medications and inappropriate use or abuse. Research on motives for the use of prescription drugs suggests that although motives to feel high and to enhance social experiences are common, this population also uses these medications to manage symptoms of pain, anxiety, sleep disruption, and other conditions that are receiving inadequate treatment or no treatment at all. Patients in substance use disorder treatment settings reporting prescription opioid abuse are more likely to report pain symptoms than heroin users ( Brands, Blake, Sproule, Gourlay, & Busto, 2004 ), and anxiety is more common among those abusing tranquilizers ( Chen et al., 2011 ). Ensuring that this population—and those with substance use disorders in general—are not denied adequate treatment for such conditions is critically important.

Data on the risk of developing prescription drug abuse and prescription drug use disorders from an initial medical prescription are limited. Importantly, studies of rates of prescription drug abuse among those with medical prescriptions provide a poor estimate for risk because they fail to control for the risk of abuse even if the person was not prescribed the medication (including the potentially elevated risk among those with an untreated disorder or condition). For example, results of a meta-analytic review of studies examining the risk for developing stimulant abuse suggested that medication for attention deficit hyperactivity disorder may actually protect against the development of substance use disorders ( Faraone & Wilens, 2007 ). Nonetheless, diversion of medications is common; studies suggested that approximately 1/4 of those with prescribed stimulants will divert their medications at some time ( Poulin, 2007 ; Rabiner et al., 2009 ; Wilens et al., 2008 ).

Evaluation of prescription drug abuse may be particularly important among those with psychiatric and medical conditions, who are more likely to be prescribed medications, and may also face a number of negative consequences related to use. For example, Newville and colleagues (2014) found that among HIV-positive individuals receiving antiretroviral treatment, prescription drug abuse was associated with a range of negative outcomes, such as more medication side effects.

Research on the prediction of risk groups for the development of prescription drug abuse among medical users has been mostly cross-sectional. Studies have found that individuals with chronic pain who abuse their medications have higher pain sensitivity, more catastrophic interpretations of pain, greater craving for opioids, and more psychiatric symptoms than those who do not abuse their medications ( Edwards et al., 2011 ; Martel, Wasan, Jamison, & Edwards, 2013 ; Morasco, Turk, Donovan, & Dobscha, 2013 ; Wasan et al., 2007 ; Wasan et al., 2009 ). Prior history of other substance use disorders appears to predict prescription drug abuse, both among those receiving a prescription and in the general population ( Faraone & Wilens, 2007 ; Sweeney, Sembower, Ertischek, Shiffman, & Schnoll, 2013 ). Assessment of clusters of risk factors has demonstrated some promise for identifying those at risk of prescription opioid abuse ( Butler, Budman, Fernandez, & Jamison, 2004 ; Holmes et al., 2006 ).

Another concern, particularly among prescription opioid abusers, is the transition to risky substance use behaviors, such as injection use. Mateu-Gelabert et al. (2014) found that the transition from prescription drug abuse to injection drug use was common among urban young adults, and that a subgroup also reported both drug (e.g., needle sharing) and sexual risk behaviors. Of note, heroin use among those abusing prescription opioids has been increasing ( Jones, 2013 ), and the use of heroin in those dependent upon prescription opioids appears to be associated with higher rates of other substance use disorders ( Wu, Woody, Yang, & Blazer, 2011 ) and poorer treatment outcomes ( Weiss et al., 2011 ).

Although more research is needed in this area, the rates of prescription drug abuse among those with a legitimate prescription for a psychoactive medication highlight the importance of assessing for diversion, abuse, and other aberrant behaviors. Subgroups with high risk for abusing their medications may benefit from targeted intervention to prevent these problems ( Jamison et al., 2010 ).

3. Treatment and Public Policy Considerations

Increases in prescription drug abuse and substance use disorders related to prescription drugs have resulted in a substantial increase in the need for treatment for this population. Large-scale surveys such as the NSDUH and the Treatment Episode Data Set estimate increases of between 250-400% in the receipt of treatment for prescription drugs from 2000-2012 ( SAMHSA, 2013b ; SAMHSA Center for Behavioral Health Statistics and Quality, 2014 ). Nonetheless, consistent with data on other substance use disorders, the majority of those with prescription drug use disorders do not seek treatment, and the most common type of treatment sought is self-help (e.g., 12-step groups; McCabe et al., 2008 ). Thus, there is a significant need for research on the optimal treatment of this population, as well as barriers to access.

Studies of treatment for prescription drug use disorders are few, and have focused largely on prescription opioid dependence. The Prescription Opioid Addiction Treatment Study (POATS), the largest treatment study of prescription drug abuse treatment to date, enrolled 653 patients across 10 sites in the U.S. ( Weiss et al., 2011 ). Results indicated that few (<7%) patients responded to brief treatment with buprenorphine-naloxone, consisting of a 2-week stabilization and 2-week taper. Treatment response improved dramatically with extended treatment, including 12 weeks of buprenorphine-naloxone stabilization (49%), but dropped following a second taper to less than 9%. In this study, the addition of drug counseling did not result in enhanced outcomes relative to medication management alone. An 18-month follow-up from this study ( Potter et al., 2014 ) found that the rate of past-month abstinence at this time was comparable to that during buprenorphine-naloxone stabilization during the treatment study (49%), reflecting a substantial improvement over time.

Studies examining the optimal length of buprenorphine tapers in this population have yielded inconsistent results. A randomized trial of various durations of buprenorphine taper followed by treatment with naltrexone found that a 4-week taper was associated with better outcomes and retention than shorter (1 or 2 week) tapers ( Sigmon et al., 2013 ). However, a secondary analysis from a large clinical trial of buprenorphine taper in opioid-dependent individuals found no benefit for a 28-day taper over a 7-day taper ( Ling et al., 2009 ; Nielsen et al., 2013 ). Identifying the optimal taper duration in this population is an important question for future research.

Other studies of the treatment of opioid dependence have compared treatment responses between those with primary heroin and primary prescription opioid dependence. Individuals with prescription opioid dependence appear to have superior post-buprenorphine taper outcomes relative to those with heroin dependence after a 4 week buprenorphine stabilization ( Nielsen, Hillhouse, Thomas, Hasson, & Ling, 2013 ). Nielsen et al. ( Nielsen, Hillhouse, Mooney, Ang, & Ling, 2014 ) further suggest that those with prescription opioid dependence have better outcomes (as evidenced by negative urine drug screens) and retention than those with heroin dependence in response to treatment with buprenorphine/naloxone and behavioral therapy. Prescription opioid users are also less likely to drop out of treatment ( Potter et al., 2013 ). Although these findings suggest that standard substance use disorder treatment may also be efficacious—perhaps even to a greater degree than in other populations—research on treatment response in this population is sorely needed.

Studies have begun to identify predictors of outcome in this population. Oser et al. (2014) found that those who lived in a different geographic location from their treatment center (e.g., traveling from a rural area to an urban or suburban county) were more likely to have poor treatment outcomes, such as relapse. Substance use history and other characteristics, in particular heroin use, younger age, prior treatment for opioid dependence, and using opioids via a route of administration other than oral or sublingual, appear to be associated with worse outcomes in this population ( Dreifuss et al., 2013 ; Weiss et al., 2011 ).

Additional research is needed to inform the field as to whether prescription drug users may have unique treatment needs. For example, although pain was found to be more likely amongst prescription opioid users compared to heroin users ( Brands et al., 2004 ), chronic pain did not predict poorer outcomes for prescription opioid users receiving buprenorphine ( Weiss et al., 2011 ). How to best provide treatment for those with multiple physical and mental health problems in addition to substance use is a key area for future work. Possibly the more important message is that many of the lessons learned from treatment of illicit drug use appear to apply in treatment of prescription drug abuse, particularly in the case of opioid dependence. Prescription opioid users appear to require similar doses of buprenorphine and have similar induction outcomes to heroin users ( Nielsen, Hillhouse, Mooney, Fahey, & Ling, 2012 ), and as noted above, have treatment outcomes that appear to be comparable if not more favorable on many outcome measures. Furthermore, much like for other substances of abuse, the use of urine testing to confirm self-report may be indicated given common rates of underreporting prescription opioid abuse ( Hilario et al., 2014 ).

Communication among clinicians, researchers, policymakers, and other relevant stakeholders will require coordination of efforts to understand this problem and to better coordinate prevention and treatment. McCarty and colleagues (2014) highlight the efforts of the state of Oregon to address the prescription opioid epidemic through collaboration and communication among the relevant groups, and the utilization of a multi-faceted approach to the problem. Although it remains too early to systematically evaluate the effectiveness of such efforts, there are early success in the ability to implement targeted changes (e.g., changes in prescription monitoring systems).

5. Summary and Future Directions

Although much has been learned about the nature and treatment of prescription drug abuse in recent years, there are many pressing questions in need of further investigation. Research is needed on the interactions among prescription drugs of abuse and between these drugs and other licit and illicit drugs. Schoenfelder et al. (2014) demonstrated interactions between a prescription stimulant (methylphenidate) and marijuana with respect to heart rate, cognitive performance, and subjective drug effects. Results suggested that the combination of these drugs may have concerning effects, particularly with respect to cardiac health. Research in understudied subgroups, such as older adults and pregnant women, and those with concurrent pain and opioid dependence is needed to better understand the impact of prescription drug abuse on these groups. Another critical future research direction is further study of optimal treatment approaches, including understanding of longer-term treatment outcomes. All of these research directions will benefit from the improvement of strategies for defining and assessing prescription drug abuse. Although certainly much more research is needed to understand the abuse of prescription opioids and stimulants--particularly given their prevalence--attention to other prescription drugs is also needed.

Prescription drug abuse continues to exert a substantial public health cost, as highlighted by growing rates of overdose deaths and rapidly increasing need for substance use disorder treatment. Addressing this problem will require involvement of a range of stakeholders and intervention at various levels, such as increased prescriber education and prescription monitoring, improvement in access to evidence-based substance use disorder treatment, enhanced understanding of optimal treatment approaches, and adjustments to policy to provide public health level supports (e.g., drug buy-backs). Such interventions must be accompanied by assessment of their impact to maximize the effectiveness and efficiency of efforts to stem the tide of this problem.

• Prescription drug abuse has reached an epidemic level.
• Research suggests both similarities to and differences from illicit drug abuse.
• Treatment outcomes may be superior compared to illicit drug use disorders.
• Research is needed on the nature and treatment of prescription drug abuse.

Acknowledgements

Effort on the preparation of this manuscript was supported by NIDA grants K23 DA035297 (Dr. McHugh), K24 DA022288 and U10 DA015831 (Dr. Weiss). Suzanne Nielsen is supported by a NHMRC Research Fellowship (#1013803). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund. The contents of the published material are solely the responsibility of the authors and do not reflect the views of the NHMRC.

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Regulating Opioid Prescriptions

Pain management is an inexact science; there is plenty of blame to go around for the abuse of such drugs.

To the Editor:

Re “ The D.E.A. Should Get Out of Public Health ,” by Shravani Durbhakula (Opinion guest essay, March 25):

The chilling effect on the legitimate prescribing and dispensing of opioid medications provoked by the Drug Enforcement Administration’s actions is having devastating real-world consequences among people living with chronic pain.

Although opioid therapy is not a panacea for pain management, which often necessitates a complex approach, certain patients undoubtedly benefit from these medications for long-term pain relief. People living with severely disabling pain conditions can participate in life’s activities if their opioid therapy is properly managed.

The D.EA., serving in a policing capacity, is not helping our country deal appropriately with the concerning drug overdose crisis. Public health evidence could not be clearer: The significant decline in opioid prescribing has not correlated with a significant decline in drug overdoses. Cutting the medical supply of opioids is not addressing overdoses and risks the health and lives of people who need access to essential medications.

Regulation of health-related activities to protect the public health of Americans must be guided by experts on those topics, not law enforcement agents.

Juan M. Hincapie-Castillo Pittsboro, N.C. The writer is a pharmacist and an assistant professor in the department of epidemiology of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, and the board president of the National Pain Advocacy Center, a nonprofit that receives no industry funds.

Dr. Shravani Durbhakula’s critique of the Drug Enforcement Administration is misguided and unjustified.

It is worth noting that the opioid epidemic was started in the mid-1990s by OxyContin, a potent analgesic agent approved by the U.S. Food and Drug Administration, promoted by Purdue Pharma, and overprescribed by clinicians. Overprescription and overconsumption of opioid analgesics continued rising until 2010, when the D.E.A. began to crack down on “pill mills” run by physicians.

Since 1995, hundreds of physicians have been criminally prosecuted for opioid-related offenses, with drug trafficking, fraud, money laundering and manslaughter accounting for the majority of the convictions.

On average, Americans consume about 20 times the amount of prescription opioids as the rest of the world. It is no surprise that the opioid epidemic is primarily endemic to the United States. Given that the ongoing opioid epidemic is driven by illicit fentanyl, the D.E.A. has an indispensable role to play in controlling this public health crisis.

Guohua Li Montebello, N.Y. The writer is a professor of epidemiology and anesthesiology at Columbia University.

Limiting the supply and prescription of opioids for chronic pain is crucial to addressing the opioid epidemic.

In fact, there is no lack of supply of opioids for dying patients, in whom such use is appropriate. Opioids are still overused for chronic pain, for which they don’t work well , and there is overuse for acute situations, such as oral surgery , in which nonopioids are more effective and safer.

Many people seeking opioids on the street — now a dangerous market because of adulteration with fentanyl — became addicted after receiving an opioid prescription from a physician or a dentist. The Drug Enforcement Administration’s role in regulating the opioid market should be applauded, not condemned.

Adriane Fugh-Berman Gary M. Franklin Dr. Fugh-Berman is a professor in the pharmacology and physiology department at Georgetown University Medical Center. She is also paid as an expert plaintiffs’ witness, mainly for the government, in litigation over pharmaceutical marketing. Dr. Franklin is a research professor at the University of Washington and the medical director of the Washington State Department of Labor and Industries.

Dr. Shravani Durbhakula’s guest essay implicitly repeats a mistaken belief that opioids maintain effectiveness for reducing chronic pain when given daily over long periods, if addiction is not present.

This false belief was promoted by pharmaceutical companies 25 years ago and led to the opioid crisis that has affected the United States. Actually, there is compelling biological, epidemiological, experimental and clinical evidence that when taken daily, opioids cause neuroadaptations that enhance sensitivity to pain (including with patients who show no addictive behaviors).

I have been treating opioid-dependent chronic pain patients for more than three decades. The culture of opioid overtreatment has been difficult to overcome because of a confluence of factors, but since the 2016 guidelines from the Centers for Disease Control warned against extended use, opioids are being prescribed less and deaths from the legal use of prescription opioids have declined.

When physicians try to taper opioids, it often produces resistance from the patient because of physiological and psychological withdrawal discomfort. Thus, physicians are at a loss as to how to treat opioid-dependent chronic pain patients other than maintaining opioids. Good treatments are available, though, and it is quite fulfilling to work with these patients.

Jon Streltzer Honolulu The writer is a psychiatrist and emeritus professor of psychiatry at the John A. Burns School of Medicine at the University of Hawaii.

As a pain management physician myself for more than 30 years, I believe that Shravani Durbhakula presents what may be charitably deemed a distorted view of the management of pain in this country.

Throughout the piece, it is indicated that poor pain management is mainly because of restrictions on prescribing opioids. This conveniently overlooks the fact that much pain, such as neuropathic pain, which includes cancer pain where the tumor either invades or stretches the nerve, responds better to nonopioids.

Other conditions, such as diabetic neuropathic pain and fibromyalgia, are just as poorly managed, and all are better managed with anticonvulsants and certain antidepressants. Perhaps Dr. Durbhakula might have explained this.

And as Dr. Durbhakula briefly alludes to at the end of the essay, the main reason that pain is so poorly managed in this country is that most physicians receive little education in pain management in medical school and postgraduate training programs.

A more useful piece would be entitled “Medical Schools Need to Get Into Pain Management.”

Steven A. King Philadelphia

Dr. Shravani Durbhakula’s essay mirrors my own experience. I am horrified that my primary care physician of many years dismissed my pleas for pain medication for sciatica, an excruciating and common nerve disorder.

Instead of prescribing an opiate, my doctor gave me an anti-inflammatory that did little to reduce the bolts of electricity shooting from my hip to my toes, which make walking and sleeping impossible. It wasn’t until six weeks after the onset of sciatica, when I threatened to use street drugs, that my doctor came through with a prescription for five milligrams of oxycodone every six hours, which did not relieve the pain. As a result, I am seeing a pain management specialist.

The American Medical Association and the D.E.A. seem to be in lock step in denying adequate pain medication to patients with genuine chronic pain, while veterinarians have no problem providing pain relief to animals.

How, as a society, have we gotten so far off-track, punishing patients for the abuse of addicts? If such a law were applied to driver’s licenses, we would take cars away from safe drivers to keep bad drivers off the road.

Stacia Friedman Philadelphia

The guest essay about the role of the Drug Enforcement Administration uses the word “overdose” in relation to incidents where individuals suffer serious and sometimes fatal effects from using opioids.

Overdose suggests that the person either knowingly or accidentally took an excessive amount of a medication with known potency. In the current epidemic of incidents involving street drugs, the correct term is “poisoning,” since the drugs have typically been adulterated with either very potent synthetic opiates or with a variety of other drugs. The user, being unaware of the actual potency of what is being used or what adulterants have been added, can be seriously affected even when taking his or her usual dose.

Calling these incidents overdoses is a way of blaming the victims, while calling them “poisonings” opens several avenues to reduce harm, such as making tests for opiate potency readily available to users, or making medical-grade opioids accessible as a viable alternative to street drugs.

I encourage your writers, editors and contributors to use poisonings rather than overdoses unless it is clear that the episode being described involved a genuine, correctly labeled, prescription opioid medication.

Henry Olders Westmount, Quebec The writer is a geriatric psychiatrist and a retired assistant professor in the department of psychiatry at McGill University.

Prescription drug abuse

Prescription drug abuse is a serious public health problem. Physicians have an important role of ensuring that safe and effective uses of treatment options are followed.  Many researches have showed that the cause is mostly on drug overdose. This occurs in the absence of non-medical use of prescription pain relievers. The drugs that are mostly abused are opioids, stimulants and central nervous system depressants drugs. This causes many deaths which are caused by unintentional injuries.

Prescription drug abuse has a number of definitions from different scholars. Blanchard, Janice et al. defined drug abuse is the intentional use of a specific medication without a prescription. On the other hand, Herzberg, David et al. defined prescription drug abuse as the non-medical use of a prescription drug.  They also added that the misuse has been on the rise in both the civilian and military population. The drug can be used in another way, which was not prescribed for. Others can use it because of the feeling and experience it brings after using it.

This paper will concentrate on prescription drug misuse a good example is non-sanctioned therapeutic usage without consensus. Both the elderly and the young practice drug abuse. Abusing drugs leads to many adverse effects like addiction. According to several surveys, prescribed medications that are mostly abused include those that are used to treat pain. Several researchers have looked into the issue of prescription drug abuse. Some of their findings are discussed below.

Eleven percent of service members in 2008 self-reported the misuse of prescribed medications (Blanchard, Janice et al. 410). They also added that there was an increase in prescription of opioid misuse among the military populations. This was because of the management of pain syndromes. The opioids are used by the military to for treating injuries sustained during training. Among duty army personnel deaths from drug overdose doubled between 2006 and 2011. A high percentage of the deaths involved the prescription medications. They also said that the treatment of Prescription drug abuse is dependent on the patient and drugs. They gave an example of an individual who misuses opioids can benefit from methadone treatment. An individual may respond to behavioral therapy if one misuses the prescription of stimulants.

Centers for disease control and prevention said that prescription drug abuse has reached epidemic proportions.  According to Herzberg, David et al. (408) Deaths from prescribed drugs can be compared to automobile accidents. The drugs are easily accessed in pharmacies across the streets. According to Herzberg, David et al. (409) pharmaceutical companies continue to unveil new drugs. They include sedatives like Halcion, stimulants like Adderall, antidepressants like Prozac and analgesics like extended-release opioid OxyContin.  According to the researchers, they claimed that they were less subject to abuse. However, they are still among the drugs being misused. The researchers reported that the misuse was mostly among the whites, working class and middle class Americans.

They concluded that the use of non-medical prescription is more common than the use of any illicit drug. They recommended that in order to curb the misuse of prescribed drugs all of us have to take part in it. The first step is to educate the physicians and the public (Herzberg, David et al. 409). Overdose prevention and opioid safety program awareness among the public can be held. In addition, prescription drug monitoring systems can be put in place. According to the researchers, this can be accompanied by law enforcement measures like increased criminal penalties. Herzberg, David et al. (410) concluded by saying that in order to stop the misuse of prescribed drugs, distinctions should not be made. These are the distinctions between the types of drug use. Effective treatments and harm reduction techniques to all drug users.

The internet plays a significant role in marketing drugs, selling them and in distribution. People can be able to shop for 24hrs in the market place. Several studies have shown that there is a positive association between levels of online information on purchasing of drugs (Orsolini, Laura et al. 302). The issue is mostly with vulnerable groups like children and adolescents. A good number of online pharmacies do not require any prescriptions. Due to the potential of the internet, it can be w reliable tool for prevention of drug abuse. This will be an easier way to reach the hard to reach drug misusers.

This brings the call of understanding both online drug markets and consumers (Orsolini, Laura et al. 303). They argue that this will aid in understanding the critical determinants behind making the decision of going online to purchase drugs.  They believe through this people can come up with ways to deal with drug abuse that is purchased online.  For their research, they used both PubMed and Scopus databases. Google scholar was also helpful in this research for prescription drug abuse. The data they got was stratified. They found out that most of the customers were young adults (Orsolini, Laura et al. 304). The young customers ranged between twelve and fourteen years old. They also noticed that most of their respondents were male from a number of countries.  The customers seemed to be well educated looking at the way they responded to the questions.

The researchers grouped the drug abusers into four groups. There were the enthusiastic experts, risk-averse traditionalists, inexperienced opponents and convenience –oriented rationalists (Orsolini, Laura et al. 307).  The researcher found out that the men abused drugs, which they believed would enhance their sexual performance. In addition, the people without health insurance believed that they would acquire affordable medicine from the internet. The respondents said they purchased their drugs online because of the easy accessibility.

Some researchers looked at prescription drug abuse in terms of race and ethnicity.  Singhal, Astha et al. (1) hypothesized a priori that racial-ethnic disparities complaints are associated with drug seeking behaviors. They contrasted them with conditions that are associated with pain. They used data from National Hospital Ambulatory Medical Care Survey. The data was for five years between 2007 and 2011. They found out that the early adults who used opioid were aged between 18 and 65. This was because of condition like toothache, back pain and abdominal pain as reported by Singhal, Astha et al. (1).

The researchers found out that non-Hispanic blacks were less likely to receive opioid descriptions during their emergency department visits. On the other hand, non-Hispanics whites who suffered from toothache, fractures or kidney stones were prescribed the opioids.  Singhal, Astha et al. (1) argues that the difference in prescriptions by race and ethnicity could lead to burden of opioid misuse among the whites.

All the above-mentioned researchers gave the signs and side effects of misusing prescribed drugs. The most common is drug addiction. This can be noticed by mood swings with either the availability or absence of the drugs. Some change their sleeping patterns. To some when the prescriptions are not available irritability is increased. Some increases their level of alcohol consumption. The abuse of opioid has a number of symptoms. They include confusion of familiar surroundings and breathe shortness. Depression may also occur and constipation. In some cases, there is rapid decrease in blood pressure.

Apart from the above effects, there are other advance effects.  These effects indicate complications that should be taken seriously. They include restlessness especially throughout the day. Cold flashes regardless of the weather may also occur. Vomiting and diarrhea are also common signs. Another effect can be cardiac arrest.

If the prescribed drugs are taken for emotional problems, the result will be to upset the feelings (Blanchard, Janice et al. 412). Nevertheless, the person may not be able to experience the depression for a period. The problem becomes complicated when the individual continues to use the drugs. The researchers also noted that the misuse of prescribed drugs results to negative effects on the lives of the individuals. This can affect personal relationships, which may lead to loss of employment and financial difficulties.

Prescribed drug abuse is serious conditions that require treatment once they are noticed. When the use of a drug is reduced, it may bring serious medical complications, which may lead to death. The researchers advised that detoxification of the drugs should not be done at home. One should make sure that there is medical supervision.

The researchers said that the prescription drug abuse is increasing. The main reason is the availability of drugs over the counter (Herzberg, David et al. 409).  This is also because the doctors are prescribing more drugs for health problems. The patient then goes to buy the drugs. The next time the patient will have similar symptoms they will just go to the nearest pharmacy and order similar drugs.  Orsolini, Laura et al. (310) says that online pharmacies make it much easier to get the drug without showing a prescription.

• Blanchard, Janice et al. “A Systematic Review Of The Prevention And Treatment Of Prescription Drug Misuse”. Military Medicine , vol 181, no. 5, 2016, pp. 410-423. AMSUS , doi:10.7205/milmed-d-15-00009.
• Smith, Robert J. et al. “How, Why, And For Whom Do Emergency Medicine Providers Use Prescription Drug Monitoring Programs?”. Pain Medicine , vol 16, no. 6, 2015, pp. 1122-  1131. Oxford University Press (OUP) , doi:10.1111/pme.12700.
• Herzberg, David et al. “Recurring Epidemics Of Pharmaceutical Drug Abuse In America: Time   For An All-Drug Strategy”. American Journal Of Public Health , vol 106, no. 3, 2016, pp. 408-410. American Public Health Association , doi:10.2105/ajph.2015.302982.
• Orsolini, Laura et al. “Profiling Online Recreational/Prescription Drugs’ Customers And Overview Of Drug Vending Virtual Marketplaces”. Human Psychopharmacology: Clinical And Experimental , vol 30, no. 4, 2015, pp. 302-318. Wiley-Blackwell , doi:10.1002/hup.2466.
• Singhal, Astha et al. “Racial-Ethnic Disparities In Opioid Prescriptions At Emergency Department Visits For Conditions Commonly Associated With Prescription Drug Abuse”. PLOS ONE , vol 11, no. 8, 2016, p. e0159224. Public Library Of Science (Plos) , doi:10.1371/journal.pone.0159224.
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Drugs, Brains, and Behavior: The Science of Addiction Preventing Drug Misuse and Addiction: The Best Strategy

Why is adolescence a critical time for preventing drug addiction.

As noted previously, early use of drugs increases a person's chances of becoming addicted. Remember, drugs change the brain—and this can lead to addiction and other serious problems. So, preventing early use of drugs or alcohol may go a long way in reducing these risks.

Risk of drug use increases greatly during times of transition. For an adult, a divorce or loss of a job may increase the risk of drug use. For a teenager, risky times include moving, family divorce, or changing schools. 35  When children advance from elementary through middle school, they face new and challenging social, family, and academic situations. Often during this period, children are exposed to substances such as cigarettes and alcohol for the first time. When they enter high school, teens may encounter greater availability of drugs, drug use by older teens, and social activities where drugs are used. When individuals leave high school and live more independently, either in college or as an employed adult, they may find themselves exposed to drug use while separated from the protective structure provided by family and school.

A certain amount of risk-taking is a normal part of adolescent development. The desire to try new things and become more independent is healthy, but it may also increase teens’ tendencies to experiment with drugs. The parts of the brain that control judgment and decision-making do not fully develop until people are in their early or mid-20s. This limits a teen’s ability to accurately assess the risks of drug experimentation and makes young people more vulnerable to peer pressure. 36

Because the brain is still developing, using drugs at this age has more potential to disrupt brain function in areas critical to motivation, memory, learning, judgment, and behavior control. 12  

Can research-based programs prevent drug addiction in youth?

Yes.  The term research-based or evidence-based means that these programs have been designed based on current scientific evidence, thoroughly tested, and shown to produce positive results. Scientists have developed a broad range of programs that positively alter the balance between risk and protective factors for drug use in families, schools, and communities. Studies have shown that research-based programs, such as described in NIDA’s  Principles of Substance Abuse Prevention for Early Childhood: A Research-Based Guide   and  Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders , can significantly reduce early use of tobacco, alcohol, and other drugs. 37  Also, while many social and cultural factors affect drug use trends, when young people perceive drug use as harmful, they often reduce their level of use. 38

How do research-based prevention programs work?

These prevention programs work to boost protective factors and eliminate or reduce risk factors for drug use. The programs are designed for various ages and can be used in individual or group settings, such as the school and home. There are three types of programs:

• Universal programs address risk and protective factors common to all children in a given setting, such as a school or community.
• Selective programs are for groups of children and teens who have specific factors that put them at increased risk of drug use.
• Indicated programs are designed for youth who have already started using drugs.

Young Brains Under Study

Using cutting-edge imaging technology, scientists from the NIDA’s Adolescent Brain Cognitive Development (ABCD) Study will look at how childhood experiences, including use of any drugs, interact with each other and with a child’s changing biology to affect brain development and social, behavioral, academic, health, and other outcomes. As the only study of its kind, the ABCD study will yield critical insights into the foundational aspects of adolescence that shape a person’s future.

Economics of Prevention

Evidence-based interventions for substance use can save society money in medical costs and help individuals remain productive members of society. Such programs can return anywhere from very little to $65 per every dollar invested in prevention. 39

Consequences of Drug Abuse

Benefits of using drugs, drawbacks of drug use.

Currently, people around the globe have access to a wider range of substances than ever was available to the mankind. While some substances are prescribed by healthcare practitioners to relieve pain or combat virus, others are purchased illegally for recreational purposes. The endless stream of drugs, obtainable to the individuals with little or no restrictions, poses a serious inquiry. The question is as follows – is drug use a curse or a blessing of the twenty-first century?

Attributable to environmental, social, and cultural factors, research behind drug use fails to explain why some people tend to abuse substances while others can control themselves when it comes to developing addictions. Essentially, addiction does not develop overnight rather being a consequence of using drugs with habit-forming characteristics. Therefore, there is no absolute answer to the everlasting dilemma of using drugs, and two sides need to be evaluated separately.

When assessing the advantages of using pharmaceutical drugs, it is essential to consider the severity of health conditions existing. Advanced pharmaceutical drugs allow to decrease or completely eliminate the suffering of people, minimizing their physical pain (Earp et al. 136). Apart from serving as painkillers, medical substances frequently prevent individuals from getting diseases. Vaccines, immune modulating drugs, and vitamin supplements constitute only a small portion of such substances. For example, cases of smallpox were almost annihilated with the introduction of Fleming’s vaccination in 1800. Similarly to polio, a life-threatening illness leading to permanent paralysis, which was eradicated with the help of vaccines.

Medical drugs also allow people with incurable diseases to live longer and more comfortably. With the use of daily treatments, patients with diabetes, HIV, and depression substantially improve their quality of life, reducing symptoms and pain associated with them (Earp et al. 146). Antibiotics are vital for the treatment of bacterial infections, while marijuana is effective for cancer patients. Consequently, the aforementioned advantages of using drugs advocate for the positive side of the discussion.

At its core, drug use is not harmful to people, bringing a variety of benefits to patients suffering from severe diseases. Yet, the problem arises when individuals start confusing drug use with abuse. A clear line should be drawn between consuming prescribed medical substances to treat a health condition and taking drugs without medical assistance (Earp et al. 136). The three major clusters of the issue should be addressed:

• recreational drugs;
• prescription drugs;
• unethical healthcare treatment.

First, abuse of recreational drugs is prevalent among common people due to the availability and accessibility of the so-called street substances. Reasons why individuals decide to take drugs vary depending on their ultimate goal. For instance, heroin and cocaine lead to euphorical feelings; LSD causes hallucinations; Marijuana relaxes and induces good mood. Abuse of recreational drugs is likely to result in loss of employment, crime, divorce, lower performance at school, and other consequences discussed later (Earp et al. 137). Second, Abuse of prescription drugs occurs when patients decide to present misleading information to the doctors in order to obtain necessary drugs.

One of the most commonly abused prescribed substance is marijuana. As people are seeking to use medical characteristics of cannabis to induce mood without the corresponding health condition, the addiction appears quick to develop (Earp et al. 147). Third, unethical healthcare practices constitute another cluster of drug abuse. When doctors refuse to seek causes for the real diagnosis of the person and prescribe a painkiller to ease the symptoms, patients are likely to grow the addiction to the substance consumed.

All the aforementioned constituents of drug abuse may have similar negative effects on the individual’s wellness. People facing drug abuse are more likely to engage in delinquency and commit crimes than those refusing to take substances (Earp et al. 141). While there is no proven causal relationship between drug addiction and felony, the established positive correlation suggests that individuals abusing drugs often fall under the influence of negative peer groups (Earp et al. 142).

Such adverse impact of the peers is the primary reason for higher crime rates among the addicts. With the loss of judgement and independence, addicts can find it difficult to combat stress, irritability, and anxiety, searching for alternative sources to restore the lost feeling of control over one’s life. In this case, violence and behavioral misconduct appear as accessible options.

Drug addiction oftentimes results in distorted social interaction with friends, colleagues, and family members. There is an observed tendency for drug users to distant themselves from their significant others which leads to psychological, financial, and emotional crisis of the social units (Earp et al. 138). Substance abuse impairs judgment and decreases decision-making ability, contributing to the feelings of hostility and aggression (Earp et al. 139).

Furthermore, drug abusers may alienate themselves from peers, disengaging from the usual community events. Other psychosocial dysfunctions prevalent among drug addicts include but are not limited to apathy, withdrawal, and depression, proving that people who abuse substances are more susceptible to mental problems (Earp et al. 140). In this case, mental impairments range from personality disorders to learning disabilities, as individuals struggle to maintain healthy psychomotor skills and memory capacity.

Apart from distorted social interaction, drug addiction is closely associated with the decline in the academic or professional performance. One explanation behind such finding is that drug abusers are subject to absenting from work-related activities. Another reason is cognitive and behavioral problems induced by alcohol and drug addiction that interfere with the academic performance (Earp et al. 142).

For example, drug abuse has harmful effects on the patient’s perception skills, concentration, and motor function that is one of the reasons why driving under the influence of substances is so dangerous. Behavioral problems associated with drug addiction are closely linked to the lack of judgment and controlled impulse among the substance abusers (Earp et al. 142). Adverse behavioral patterns vary from sharing used needless to engaging into non-consensual sexual activities with a high risk of getting STD.

It is evident that drugs are strongly beneficial for people suffering from severe illnesses. Minimizing pains, decreasing the risk of obtaining contagious disease, and treating existing conditions are few of the advantages of medical substances. Yet, the issue arises as drugs in harmful doses remain highly accessible for common people to purchase. Damaging to health, substances can also have negative consequences on the person’s social interactions, resulting in job losses, imprisonment, and toxic relationships. When making an informed decision to consume drugs, an individual should be able to find a balance between medical drugs that save lives and abused substances that substantially decrease life quality.

Earp, Brian D., et al. “Addiction, Identity, Morality.” AJOB Empirical Bioethics , vol. 10, no. 2, 2019, pp. 136–153. Web.

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IvyPanda. (2023, November 20). Consequences of Drug Abuse. https://ivypanda.com/essays/consequences-of-drug-abuse/

"Consequences of Drug Abuse." IvyPanda , 20 Nov. 2023, ivypanda.com/essays/consequences-of-drug-abuse/.

IvyPanda . (2023) 'Consequences of Drug Abuse'. 20 November.

IvyPanda . 2023. "Consequences of Drug Abuse." November 20, 2023. https://ivypanda.com/essays/consequences-of-drug-abuse/.

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Bibliography

IvyPanda . "Consequences of Drug Abuse." November 20, 2023. https://ivypanda.com/essays/consequences-of-drug-abuse/.

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