Misuse of Opioids and Other Prescription Drugs, Over-the-Counter Drugs, and Heroin

By Calles, Joseph L., Jr. | International Journal of Child and Adolescent Health, October 1, 2014 | Go to article overview

Misuse of Opioids and Other Prescription Drugs, Over-the-Counter Drugs, and Heroin


Calles, Joseph L., Jr., International Journal of Child and Adolescent Health


Introduction

Abuse of drugs by adolescents is an increasing public health concern. As law enforcement efforts to eradicate drug use have focused on illicit substances, one aspect of the drug problem that has been underappreciated until fairly recently is the inappropriate use of prescription and over-the-counter (OTC) drugs by adolescents. In order to accurately gauge the extent of an adolescent's drug-use problem, it is important to classify the use as belonging to one-of-three categories: misuse, abuse, or dependence (1). Misuse implies that a drug was not prescribed to the person using it or is being used for the purpose of altering the person's feelings or perceptions (i.e., "getting high"). Abuse is similar in its objective to experientially alter the user, but it is also associated with significant impairments in functioning and/or negative consequences (e.g., legal). Dependence is the ultimate stage of inappropriate drug use, as it includes increasing tolerance to the desired effects of the drug and/or withdrawal effects (when drug use is decreased or terminated), as well as more time being spent procuring and using the drug, to the exclusion of life goals and obligations. Therapeutic intervention at the misuse stage provides the best opportunity to help adolescents to stop using drugs. What follows is an overview of the misuse of prescription drugs, overthe-counter drugs, and illicit opioids by young people, and options for therapeutic intervention.

Prescription drugs

Data from the 2010 National Survey on Drug Use and Health (NSDUH) helps to put the non-medical use of prescription drugs (NMUPD) by adolescents into perspective (2). In that survey year, the misuse of psychotherapeutics (i.e., analgesics, tranquilizers, stimulants or sedatives) began for 2.4 million persons aged ≥ 12 years, an average of 6,600 new users per day. A more recent survey of 8th, 10th, and 12th graders identified prescription drugs as the secondmost abused category of drugs after marijuana (3). A question that is often asked is: Where are these young people getting their prescription drugs from? The answer is that, at least in North America, the most common source is diversion from family or friends (4). In order to put this problem into social and clinical perspectives, what follows are overviews of the NMUPD by specific medication groups, and descriptions of selected pharmacotherapeutic agents to use in their treatment.

Analgesics

In the 2010 NSDUH, the most commonly misused prescription medications were pain relievers (i.e., narcotics), represented by 17.3% of those who used illicit drugs for the first time (2). In 55.0 % of all nonmedical users of pain relievers, the drug they most recently used was obtained from a friend or relative for free. The easy availability of prescription opioids is hardly surprising, given that it has been estimated that 1/25 of those medications end up being diverted for non-medical use (5). In younger people, the nonmedical use of prescription opioids seems to peak in the 12th grade (6). This is a critical time of life, associated with graduation from high school and the beginning of college or full-time employment. Complicating that transition is the association of the NMUPD, specifically opioids, and the use of alcohol, tobacco, marijuana and other illicit drugs (6). In a similar manner, the heavier the non-medical use of prescription opioids, the heavier the use of all other substances. The detection of opioid misuse may be missed during the early phase of the disorder, or attributed to other psychiatric disorders. For example, opioid intoxication, with its associated psychomotor and cognitive slowing, could be mistaken for depression. Conversely, the psychomotor agitation of opioid withdrawal could be misdiagnosed as an anxiety disorder. If opioid misuse is suspected, drug testing can help to identify it or to rule it out. As opioids, and their metabolites, tend to clear from blood and saliva fairly quickly, detection is best accomplished by examining a patient's urine (the drug is present up to 1-3 days after use) or hair (up to 7-90 days after use) (7). …

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