NEW CASA REPORT: CONTROLLED PRESCRIPTION DRUG ABUSE
AT EPIDEMIC LEVEL
More than 15 million Americans Abuse Opioids, Depressants, Stimulants
Teen Abuse Triples in 10 Years
WASHINGTON, July 7, 2005 – The number of Americans who abuse controlled prescription drugs has nearly doubled from 7.8 million to 15.1 million from 1992 to 2003 and abuse among teens has more than tripled during that time, according to a new report by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.
Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S., a 214-page CASA report detailing the findings of an exhaustive three-year study of prescription opioids (e.g., OxyContin, Vicodin), central nervous system (CNS) depressants (e.g., Valium, Xanax) and CNS stimulants (e.g., Ritalin, Adderall), found that from 1992 to 2003, while the U.S. population increased 14 percent, the number of 12 to 17 year olds who abused controlled prescription drugs jumped 212 percent and the number of adults 18 and older abusing such drugs climbed 81 percent.
The 15.1 million Americans abusing controlled prescription drugs exceed the combined number abusing cocaine (5.9 million), hallucinogens (4.0 million), inhalants (2.1 million) and heroin (.3 million).
“Our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction,” said Joseph A. Califano, Jr., CASA’s chairman and president and former U.S. Secretary of Health, Education and Welfare. “While America has been congratulating itself in recent years on curbing increases in alcohol and illicit drug abuse, and in the decline in teen smoking, abuse of prescription drugs has been stealthily, but sharply, rising.”
Among the report’s major findings:
From 1992 to 2002, prescriptions written for controlled drugs increased more than 150 percent, almost 12 times the rate of increase in population and almost three times the rate of increase in prescriptions written for all other drugs.
From 1992 to 2003, the number of people abusing controlled prescription drugs increased seven times faster than the increase in the U.S. population.
From 1992 to 2003, abuse of controlled prescription drugs grew at a rate twice that of marijuana abuse; five times that of cocaine abuse; 60 times that of heroin abuse.
From 1992 to 2000 –
The number of new opioid abusers grew by 225 percent; new tranquilizer abusers, by 150 percent; new sedative abusers, by more than 125 percent; new stimulant abusers, by more than 170 percent.
The increase in new abusers 12 to 17 years old was far greater than among adults (four times greater for opioids; three times for tranquilizers and sedatives; two and one-half times for stimulants).
From 1992 to 2002, new abuse of prescription opioids among 12 to 17 year olds was up an astounding 542 percent, more than four times the rate of increase among adults.
In 2003, 2.3 million 12 to 17 year olds (nearly one in 10) abused at least one controlled prescription drug; for 83 percent of them, the drug was opioids.
In 2003, among 12 to 17 year olds, girls were likelier than boys to abuse controlled prescription drugs (10.1 percent of girls vs. 8.6 percent of boys).
Between 1991 and 2003, rates of lifetime steroid abuse among high school students increased 126 percent, with abuse among girls up by nearly 350 percent, compared to 66 percent among boys.
Teens who abuse controlled prescription drugs are twice as likely to use alcohol, five times likelier to use marijuana, 12 times likelier to use heroin, 15 times likelier to use Ecstasy and 21 times likelier to use cocaine, compared to teens who do not abuse such drugs.
Many Sources of Diversion
Controlled prescription drugs can be diverted from their lawful medical purpose to illicit use from manufacturing facilities, distributors, warehouses, pharmacies, hospitals, practitioners’ offices and patients’ medicine cabinets. In CASA’s unique national surveys conducted in 2004, most physicians (59.1 percent) and pharmacists (51.8 percent) blame patients, who can obtain controlled prescription drugs by faking symptoms treated with opioids, depressants and stimulants, visiting a number of doctors to obtain prescriptions from each (doctor shopping), and altering prescriptions. For children, access to controlled prescription drugs for the purpose of diversion can be as close as a household medicine cabinet.
“The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made their parents’ medicine cabinet a greater temptation and threat than the illegal street drug dealer. Parents who do not want to become inadvertent drug pushers should consider locking their medicine cabinets,” said Califano. “While many parents lock their liquor cabinets, most do nothing to ensure that controlled prescription drugs are not accessible to children.”
In 2004, CASA and Beau Dietl & Associates (BDA) investigated the availability of controlled prescription drugs over the Internet and found hundreds of Web sites offering these addictive drugs for sale without requiring a prescription and without regard to age. BDA investigators found that only six percent of the sites required a prescription, and virtually none restricted in any way the sale of controlled prescription drugs to children.
A year later in 2005, BDA repeated its investigation and found little had changed. In fact, opioids were offered on considerably more sites in 2005 and a larger percentage of sites indicated that drugs would be shipped from within the United States. BDA conducted a similar analysis with steroids and found that 95 percent of sites that sell these drugs do not require a prescription.
“Anyone with a credit card and Internet access can get their hands on these dangerous drugs,” noted Beau Dietl, BDA’s chairman and chief executive officer. “Like predators in the forest, these vultures that call themselves ‘Internet pharmacies’ hide in the darkness of cyberspace, where they hunt down and feast on our children, then disappear only to return another day under a new name and in search of new prey.”
Consequences of Abuse
The CASA report’s analysis of emergency room data confirms the sharp increase in abuse of controlled prescription drugs and its consequences.
- In 2002, controlled prescription drugs were implicated in 29.9 percent of drug related emergency room deaths. Opioids were implicated in 18.9 percent of such deaths compared to 15.2 percent for cocaine, 12.6 percent for heroin and 2.6 percent for marijuana.
- In 2002, abuse of controlled prescription drugs was implicated in at least 23 percent of drug-related emergency department admissions.
- Between 1994 and 2002, controlled prescription drug-related emergency room mentions increased by nearly 80 percent, with opioid mentions jumping 168 percent, far more sharply than the increases of 48 percent for heroin and 39 percent for cocaine, and second only to the 198 percent increase in marijuana mentions.
Comprehensive Approach Needed
As a result of its findings, the CASA report calls for an all fronts effort to reduce abuse of controlled prescription drugs, including a major public health education and prevention campaign, better training of physicians, pharmacists and other health care professionals, new laws and better law enforcement to close down rogue Internet sites peddling controlled prescription drugs, Food and Drug Administration and pharmaceutical company efforts to reformulate controlled substances to make abuse more difficult, improved treatment, and additional research.
The CASA report Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S., is based on three years of intensive work, including landmark surveys of physicians and of pharmacists, more than 200 interviews, seven focus groups, a national conference on substance abuse and pain management, an extensive and unprecedented analysis of 15 national data sets by CASA’s Substance Abuse Data Analysis Center (SADAC), an Internet investigation by Beau Dietl & Associates, and a review of more than 2000 publications. CASA has used the latest data available, which varies among the national data sets. Highlights of the physician and pharmacist surveys are attached.
CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA has issued more than 50 reports, has conducted demonstration projects focused on children, families and schools at 89 sites in 41 cities in 22 states, and has been testing the effectiveness of drug and alcohol treatment, monitoring 15,000 individuals in more than 200 programs and five drug courts in 26 states. CASA is the creator of the nationwide Family Day initiative – the fourth Monday in September – that promotes parental engagement as a simple and effective way to reduce children’s risk of smoking, drinking and using illegal drugs. To become a CASA member, please visit http://www.casacolumbia.org/ and click “Become a Member” on the main menu or send an e-mail to email@example.com for more information.
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Highlights of CASA Surveys of Physicians and Pharmacists on Diversion and Abuse of Controlled Prescription Drugs
Physician Survey Highlights
Pharmacist Survey Highlights
CASA surveyed 979 physicians and 1,030 pharmacists from July 21 to October 31, 2004. The margin of error is +/-3%.
- 28.4 percent do not regularly validate the prescribing physician’s DEA number when dispensing controlled drugs; one in 10 (10.5 percent) rarely or never do so.
- 61 percent do not regularly ask if the patient is taking any other controlled drugs when dispensing a controlled medication; 25.8 percent rarely or never do so.
- When a patient presents a prescription for a controlled drug, 26.5 percent “somewhat or very often” think it is for purposes of diversion or abuse; 78.4 percent become “somewhat or very” concerned about diversion or abuse when a patient asks for a controlled drug by its brand name.
- 83.1 percent have refused to dispense a controlled drug in the past year because of suspicions of diversion or abuse; 51.8 percent believe that patients account for the bulk of the diversion problem.
- 28.9 percent have experienced a theft or robbery of controlled drugs at their pharmacy within the last five years; 20.9 percent do not stock certain controlled drugs in order to prevent diversion.
- Only about half received any training in identifying prescription drug diversion (48.1 percent) or abuse or addiction (49.6 percent) since pharmacy school.