The Changing Landscape of Prescription Drug Abuse and Diversion

LAS VEGAS — Drug abuse in the United States has been changing over the years, and as more people become dependent on their drug of choice, clinicians are being forced to deal with the consequences. 

“Drug abuse has been going on for centuries,” said Lisa McElhaney, president of the National Association of Drug Diversion Investigators. “We cannot regulate our way out of this problem without addressing the negative behaviors that are creating a growing epidemic.”

According to Ms. McElhaney, a range of misconceptions about prescription drug abuse and diversion exist, but a single issue stands out from the rest.

“The most common misconception is that the individual has made a conscious decision to inappropriately use and therefore they can stop whenever they choose,” she said. “The lack of understanding creates strong patterns of denial, anger, and disassociation with the entire addiction process.”

Drug usage itself is not new, but three components of it have changed over the years: public perception of drug usage (recreationally accepted), types of drugs in demand (abuse of prescription drugs has reached epidemic proportions), and access to drugs (laws of supply and demand).

“Most individuals do not want to ‘get their hands dirty' when dealing with an individual with a prescription drug abuse problem. It makes them uncomfortable,” Ms. McElhaney said. “This allows the problem to fester and grow at an alarming rate. Through broad-based education and action this cycle can be minimized and controlled.”

Any patient who is prescribed medication should be considered at risk for potential drug abuse. Clinicians should be paying close attention to all of the signs (don't ignore any red flags) and applying risk-mitigation strategies to prevent patients at higher abuse risk from misusing their medications.

“This is not an easy task because many abusers are very skilled at deception. Good diagnosticians should make every effort to hone their own skills if they are prescribing medications with an abuse potential,” she said. “Education is the framework, action is the key.”

Drug diversion—when someone illegally sells legal drugs—is contributing to the overall abuse problem. Ms. McElhaney reports that the majority of pharmaceutical drugs bought and sold on the street come from legal sources (this excludes counterfeits).

The two most common ways to divert drugs is through a licensed physician and a licensed pharmacy or hospital. Methods of diversion include selling prescription drugs, doctor shopping, illegal Internet pharmacies, drug theft, prescription pad theft and forgery, and illicit prescribing. The most abused narcotics today include oxycodone, hydrocodone, methadone, hydromorphone, fentanyl, codeine, meperidine, and oxymorphone.

“The list of most abused drugs changes as access to the substances on it changes,” she said. “Demand-reduction strategies primarily address only the substance and not the addiction; therefore, abusers will just seek out the next readily available substance to meet their needs.”

Other medications likely to be abused include stimulants, antianxiety drugs, sedative drugs, steroids, antidepressants, and psychedelics.

Spreading awareness of opioid abuse, misuse, and overdose—and drug abuse in general—is how Ms. McElhaney believes the medical community can curb the current opioid epidemic.

“The stigma of addiction needs to be changed and the problem needs to be clearly recognized as a disease,” she said. “Once the openness of this issue is accepted true discussion, treatment, and prevention will accelerate.”

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