Prescription drug addiction: the treatment challenge

As misuse of prescription drugs increases, treating addiction to these drugs has become as crucial as preventing it. Yet best practice in this area remains elusive. David Holmes reports.

Last June, the UN flagship World Drug Report 2011 launched by Ban Ki-moon outlined the scale of the problem - declining world markets for cocaine, heroin, and cannabis, almost entirely offset by increases in the misuse of prescription opioid drugs. Then, in November, the European Monitoring Centre for Drugs and Drug Addiction annual report for 2011 painted a similar picture, showing that although drug misuse is fairly stable in Europe, there has been a striking increase in the misuse of synthetic opioid drugs. But, as the most recent figures from the US Substance Abuse and Mental Health Services Administration (SAMHSA) showed in December, it is the USA that is the epicentre of the world's problems with prescription drugs.

The SAMHSA data, which are taken from the nationwide Treatment Episode Data Set, show that although the overall rate of treatment admissions for substance misuse among people aged 12 years and older in the USA was stable from 1999 to 2009, there was a huge 430% increase in the rate of treatment admissions for the misuse of prescription opioid drugs in the same period—from ten per 100 000 people in 1999 to 53 per 100 000 people in 2009. And these are just the latest in a long list of numbers released in 2011 that were so stark the US Centers for Disease Control and Prevention has classified prescription drug misuse as an epidemic; the White House calls it “the Nation's fastest-growing drug problem”.

Frank Falco agrees. Falco is the incoming President of The American Society of Interventional Pain Physicians (ASIPP) and Clinical Assistant Professor at Temple University Medical School, Philadelphia, PA, USA. "Opioids are now abused more than any other illicit drug or controlled prescription drug, passing marijuana for the first time", he says, before reeling off the kind of statistics that have forced policy makers to sit up and take notice: "80% of Americans between the ages of 12 and 20 have used a controlled drug that was prescribed for someone else at least once for an unintended prescribed indication. The state of Florida consumes 80% of the world's supply of oxycodone [a powerful analgesic drug]. More Americans die from an opioid overdose than those that die from motor vehicle accidents. In Florida, 10 people per day die from an overdose of opioids or benzodiazepines. In Delaware, where I practice, one person dies every other day from an overdose of opioids."

After initially facing criticism for being too slow to react to the growing crisis, the Obama administration has made the 2011 Prescription Drug Abuse Prevention Plan a central plank of its National Drug Control Strategy. As part of the plan, the Drug Enforcement Administration is working on implementing Risk Evaluation and Mitigation Strategies to reduce the misuse and diversion of opioid drugs and other prescription controlled drugs, at the same time as developing mandatory education requirements for physicians who prescribe and pharmacies that dispense opioid analgesic drugs. There will also be a renewed commitment to prescription drug monitoring programmes. Despite being signed into law in 2005, the National All Schedules Prescription Electronic Reporting Act (NASPER) has often failed to get funding from the US Congress because it costs too much. "If consistently funded on an annual basis, [NASPER] would significantly prevent doctor shopping and drug diversion by allowing physicians and pharmacists to access patient records showing what prescribed controlled drugs have been prescribed and dispensed to a patient anywhere in the US", says ASIPP's Falco, whose organisation's founder and CEO Laxmaiah Manchikanti first introduced the Act to Congress.