Prescription Drugs: Misuse, Abuse and Addiction - A Research Update

United States

To raise awareness regarding the misuse and abuse of prescription drugs, to present the latest research on the topic, and to encourage discussion and further scientific inquiry in this field.

Meeting Summary 

The meeting was opened by NIDA Director, Alan I. Leshner, Ph.D. He highlighted the need for renewed attention and research regarding the abuse of prescription drugs, such as opioids, central nervous system depressants, and stimulants. His comments were followed by presentations by researchers in the field.

Alice Young, Ph.D., of Wayne State University presented a discussion of the neurobiology of addiction looking at global topics, such as effects on the reward pathway, and focusing on the differences between dependence and addiction.

Howard Chilcoat, Ph.D., of the Johns Hopkins University School of Public Health and Hygiene discussed research regarding the epidemiology of prescription drug abuse. Whites are more likely than other racial or ethnic groups to abuse prescription drugs, and many people who abuse these drugs also have psychiatric disorders. Persons age 18 to 25 are more likely than persons in other age groups to begin abusing prescription drugs. Between the ages of 12 and 17, girls are more likely than boys to begin prescription drug abuse and are more likely to abuse stimulants and sedatives than other prescription drugs.

Kenneth Schmader, M.D., of Duke University stated that the elderly (persons age 65 or older) represent about 13 percent of the U.S. population but consume one-third of all prescription drugs. These patients are generally less healthy than younger persons and often suffer from multiple diseases for which they take multiple drugs. Therefore, they are more vulnerable than younger patients to unintentionally misusing and becoming habituated to prescription medications. In one study of more than 1,500 elderly patients, 50 patients, roughly 3 percent, were abusing prescription drugs. In a study of consecutive admissions to a treatment program, 70 of 100 elderly patients admitted for prescription drug abuse were women. Eighty were dependent on sedatives, 49 on opioids, and 3 on stimulants. Thirty-six were dependent on 2 drugs and 8 were dependent on 3 drugs.

Timothy Wilens, M.D., of Massachusetts General Hospital discussed prospective studies designed to determine whether children treated for ADHD with the stimulant methylphenidate (Ritalin) are at risk for abuse of other stimulant drugs. The research involved two groups of patients diagnosed with ADHD of similar severity: one group was treated with methylphenidate and the other received treatment that did not include stimulants. Dr. Wilens reported that those who were treated with methylphenidate were less likely to abuse drugs, including prescribed or unprescribed stimulants, during treatment and throughout youth and adolescence.

Richard Brown, M.D., MPH, of the University of Wisconsin Medical School discussed how physicians’ misunderstanding of the risks associated with prescription drugs can lead to inadequate treatment of some illnesses. Dr. Brown based his comments on research in which he and his colleagues asked physicians how they would treat a set of hypothetical patients who suffered anxiety disorders, pain associated with cancer, or back pain. The researchers gave the clinicians detailed profiles of the hypothetical patients that included a treatment history and characteristics, such as use of alcohol and history of substance abuse, related to possible misuse of prescription medication. The researchers compared the physicians’ treatment plans with a plan developed by a panel of experts. Compared to the experts, the 2,000 physicians who participated in the study were more reluctant to provide opioids and less cautious about prescribing sedatives. For example, 5 percent of the respondents would underprescribe opioids for severe cancer pain and nearly 80 percent would underprescribe opioids for severe, chronic back pain. However, about 18 percent of the physicians would prescribe benzodiazepines (sedatives such as Valium or Xanax) for a hypothetical patient with an adjustment disorder, even though they showed signs of a current alcohol use disorder.

Steven Passik, Ph.D., of Community Cancer Care, Inc., in Indianapolis, IN, discussed a study designed to evaluate the risks of misuse or abuse of drugs prescribed for management of chronic pain and to compare the risks with the drugs’ benefits. The research involved 264 patients being treated with opioids for chronic pain not associated with cancer. On average, patients reported that the drugs relieved nearly 60 percent of their pain, and more than 90 percent said the pain relief made a significant improvement in their quality of life. Nearly 80 percent reported improvement in overall aspects of daily life such as mood, physical functioning, relationships, and sleep patterns. More than 60 percent of patients reported some adverse side effects from their medication, but only 1.2 percent described the side effects as intolerable. Overall, roughly 6 percent of patients (or their physicians) reported misuse of prescribed drugs. Drug abuse issues in pain management are complex, but these study results suggest that the risk of opioid abuse is low compared with the benefits of the drugs in chronic pain management.

For Additional Information

Link directly to our research program announcement “Prescription Drug Abuse” at grants.nih.gov/grants/guide/pa-files/PA-01-048.html. Or, go to www.nida.nih.gov/DrugPages/Prescription.html to find additional prescription drug abuse resources including:

• NIDA’s Research Report, Prescription Drugs: Abuse and Addiction
• NIDA NOTES articles of interest and other related NIDA publications
• Links to partner organizations in our Prescription Drug Research Initiative