Drugs in America: Not Just for Celebrities

By Karen Sternheimer

My grandfather was a drug dealer. Shocked? Don’t be: he was a pharmacist who at one time owned his own neighborhood drug store, not an underworld kingpin.

What images do you think of when you hear the term “drug user”? Someone who steals, lies, or manipulates to maintain their habit? And what sort of drugs do you imagine them using? Crack? Heroin? Meth?

The speculation surrounding Michael Jackson’s death has brought celebrity pharmaceutical use to our attention. But the misuse of prescription drugs is not just for the rich and famous.

It’s interesting how we tend to ignore the use of pharmaceuticals in discussions of the so-called War on Drugs. Most of us have legally used drugs that our doctors have prescribed, and often we don’t question whether they are safe or healthy for us. In discussions of illegal drugs we often hear of the many potential dangers the drugs might pose for users, but seldom is this conversation extended into legal pharmaceuticals.

Recently, an FDA advisory panel recommended a ban on Percocet and Vicodin because of their potential harmful effects on the liver. The panel also voted to reduce the amount of acetaminophen (the active ingredient in drugs like Tylenol and Excedrin) in over-the-counter drugs.

According to the Survey on Drug Use and Health (NSDUH), in 2007 (the most recent year for which data are available) one in five Americans twelve and older have used pharmaceuticals for “nonmedical” use in their lifetime; just under seven percent have done so in the past year. This might be an undercount, since the NSDUH data does not include people who have asked for and received prescriptions for medications that they might not legitimately need or might be misusing.

To put pharmaceutical use in context, nonmedical use is more common than any other illegal drug other than marijuana (two in five Americans over twelve have tried marijuana). By contrast, just under fifteen percent have tried cocaine, (less than four percent have used crack), about five percent have used methamphetamines, and less than two percent have used heroin at least once in their lives.

The Department of Health and Human Services defines nonmedical use as “the use of prescription-type psychotherapeutic drugs that were not prescribed for the respondent by a physician or were used only for the experience or feeling they caused.” These drugs include opiates, or painkillers like oxycodone, benzodiazepines like valium and other tranquilizers, sedatives, stimulants, or muscle relaxants.

Nonmedical use of prescription drugs during the past year is most common for people in their late teens and early twenties, and peaks at age 21, with seventeen percent reporting use during 2007. Americans 25-44 were more likely to have misused pharmaceuticals than teens under fifteen were in the past year. Yet typically public service announcements, like the one below, focus on kids as the main users.

According to the Drug Abuse Warning Network (DAWN)’s most recent data, nearly half a million emergency room visits per year are due to nonmedical pharmaceutical use. As the graph below indicates, Americans aged 35-54 were most likely to visit emergency departments (EDs) for pharmaceutical use.

It seems that we often underestimate the dangers of middle-aged drug use. While young adults might use pharmaceuticals more often, their bodies might be more resilient in handling the drugs. Older adults might have been using the drugs for a longer period of time as well, which could increase their tolerance and thus the amount of the drug used.

It shouldn’t be a big surprise that people would use pharmaceuticals without prescriptions if we think about the big picture. Consumers have been encouraged to seek out specific drugs since the Food and Drug Administration (FDA) legalized direct-to-consumer advertising of prescription drugs in 1997.

You know all those ads for drugs you see during sporting events or the evening news? The pharmaceutical companies want us to ask our doctors for drugs. Before 1997 drug companies could only market to physicians, and the ad campaigns are designed to sell more drugs to a wider array of patients.

That is, if you really are a patient. If you have ever gotten spam in your email inbox you probably have been offered the chance to buy drugs for which you have no medical condition (or the right anatomy). Online drugstores have been able to operate with little impunity and sometimes substitute a checklist for an actual medical exam.

The misuse of pharmaceuticals is a difficult problem to control. The industry is extremely profitable—a 2004 report estimated that Americans spent $200 billion annually on prescription drugs. As America ages, this number will surely skyrocket.

And let’s not forget that medications have extended lives and improved the quality of life dramatically. Pharmaceuticals have made diseases like HIV that were once death sentences into more manageable, though still serious, chronic conditions.

Even the prescription drugs most likely to be abused have done far more good than harm in the grand scheme of things. Unlike many illegal drugs, which have been demonized for decades, it is impossible to do this for pharmaceuticals. They cannot be unilaterally condemned like some other drugs have been (and may not deserve to be; but that’s a subject for another post).

What other sociological factors have made us less likely to recognize the problem of pharmaceutical abuse in the past?

Comments

[teen drug treatment]

I agree with your article, this is definitely true. What was the better things to do with this matter.

-mj-

[Lei He]

Drug abuse always reminds me of cocaine, heroin or marijuana. I never think over-the-counter and prescribed drug abuse is also a common and serious problem. We should increase the social awareness of the problem and find more effective way to prevent it.

[Brian]

I've believed for some time now that abuse of pharmaceutical drugs is the most dangerous addiction a person can have, even before Michael Jacksons and, even earlier, Heath Ledger and Anna Nicole Smiths deaths. Not just because of the obvious risks of overdose and the effects of withdrawal symptoms, but because pharmaceuticals have an illusion of safety. In my personal experience I've known a number of xanax addicts who first, admit their addiction (often through the admission of severe withdrawal symptoms) but also acknowledge the fact that they have the symptoms that could (or in some cases do) get them the drug prescribed legally. They claim to really need the drug, just in larger amounts than prescribed and often taken in different ways, e.g., snorted or smoked.

And for drugs like percocet, oxycodon, vicodin and the hundreds of knock offs, you don’t need to go to sketchy websites like Erowid to learn about the drugs; you can go to WebMD and legitimate medical journals. There’s a false feeling of safety even in that seemingly innocuous fact. Not to mention that in large amounts using these drugs and driving can be just as dangerous as alcohol is.

If you haven’t already you should check out Vanguard’s The Oxycontin Express, which really shines a light on the extent of prescribed drugs use and danger. http://www.hulu.com/watch/100279/vanguard-the-oxycontin-express

Your mention of the number of emergency room visits in the 35-54 year old range does surprise me, given the amount of drug abuse I witness in the 17-24 year old range. I feel as though the latter does benefit from its youth in terms of physical health, which you also mention, but the drug’s effects on their judgment and both social and psychological development is an even worse problem. And trust me, it’s a growing problem, and there’s no clear sign of when it will become a diminishing one.

[Carolin Newmeyer]

In order to minimize the cases of prescriptive drug overdose, people should be more responsible in handling them by putting these in secret medicinal cabinets to keep them out of reach of children. It would be better to keep that location to yourself to keep others from breaking and taking the drugs.