Prescriptive Drug "Abuse"- the REAL facts

Emergency Department Visits Involving Non-medical Use of Selected Prescriptions - Unites States 2004-2008 MMWR 2010;59:705-509
JAMA, August4, 2010 -Vol.304, No.5, p 515

"In contrast to the results of this study, NSDUH (National Survey of Drug Use and Health) results have shown no increase in self-reported rates of non-medical use of selected pharmaceuticals since 2004. Increasing ED visit rates in the context of stable self-reported nonmedical use rates might indicate that persons seen in EDs are different from typical respondents to NSDUH; a shift towards riskier types of pain relievers and benzodiazepines, riskier modes of use, more frequent or heavier use; and/or an increased tendency to seek emergency care because of greater awareness of the serious consequences of nonmedical use of such drugs."

I have repeatedly pointed out in responses to the FDA's proposed REMs on opioids, on the web site of the National Foundation for the treatment of Pain, on the blog: jfshmd.blogspot.com, and in e-mail to journalists, attorneys, federal and state representatives, precisely what is reported above - that government sponsored research has shown no increase in self-reported rates of non-medical use of selected pharmaceuticals since 2004.

This stunning fact has been ignored, obscured, or un-reported, in the latest media frenzy to create fear and hysteria in the public, about prescription drugs. The reason is clear - it undercuts the propaganda about the "epidemic" of prescription drug overdoses in America.

In fact, of the 1.6 million ED visits for the abuse and misuse of drugs in 2004, and the 2.0 million such visits in 2008, illicit drugs such as cocaine and heroin were involved in 1 million visits in both 2004 and 2008. The estimated number of ED visits involving the non-medical use of opioid analgesics increased from 144,000 in 2004 to 305,000 in 2008, an increase in rate from 49.4/100,000 to 100.6/100,000 in 2008. The number of overdoses, even increased from 2004 to 2008, represent a statistically tiny and insignificant number, compared to the hundreds of millions of doses of prescriptive medications ingested annually, and safely.

The essential fact is that the abuse of prescriptive drugs has NOT increased in the general population. Rather, what has increased is the abuse and overdose of prescriptive medications by an aberrant and atypical cohort amongst the general public, and the extensive and flamboyant coverage in the media this group has gotten. The media, encouraged by selected federal agencies, has then falsely extrapolated the aberrant phenomenon to the general population. The plain truth is that, despite the large increase in prescribing of analgesic medications over the last four years, there has been NO increase in the rates of non-medical use of selected pharmaceuticals.

The governmental campaign to reduce the availability of prescriptive pharmaceuticals is without validity or value. If implanted, it will simply make it more difficult for patients to obtain the medications for which they have a medical necessity, it will only further deter physicians from prescribing "unpopular" and "demonized" medications, it will further confuse and mislead the public about prescriptive medicines, and it will have no impact, whatever, on the core group of atypical and aberrant abusers of prescriptive and illicit drugs.

In sharp contrast to "Drug War" propaganda, it would be far more valuable to focus attention, funding and resources on identifying the aberrant group who present a mortal risk to themselves, educating the public on the need to provide them effective intervention and medical help, and reduce the pathology that underlies their increased rates of harm to themselves. In that regard, it is not clear to what extent this group is increasing as psychologically damaged military veterans return to civilian life, bringing their substance abuse symptoms and suicidality with them.

J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org