Hooked on Pharmaceuticals: Prescription Drug Abuse in the World

Prescription drug abuse reached epidemic levels in the U.S. in the last decade. As the world’s leader and trendsetter in a multitude of areas, the country has a history of setting examples for the rest of the world – both good and bad.

The abuse of pharmaceuticals hasn’t officially reached pandemic levels across the globe, but it’s grown to be a major cause for concern.

According to the International Narcotics Control Board (INCB), prescription drugs as a category moved up to second on the list of the most abused and trafficked types of drugs in the world. Cannabis remained the most abused and trafficked category. The board, established by the United Nations, reported that the demand for painkillers, sedatives, stimulants and tranquilizers was developing rapidly.

As the global consumption of heroin and cocaine decreased, prescription drug abuse increased. The most common types of medications abused globally were opioids, depressants and stimulants, according to the United Nations Office on Drugs and Crime (UNODC).

According to various reports from The Guardian:

• Britain was beginning to show signs of a “US-style epidemic in the abuse of prescription drugs.”
• An Australian coroner reported that deaths from prescriptions drugs were increasing at a “frightening” rate.
• A study in France found half of all drugs prescribed by French doctors were either useless or dangerous, putting blame on pharmaceutical companies.
• Pharmacists in India regularly sell prescription drugs without prescriptions and police are bribed to keep quiet. Despite legislative reforms by the government, prescription drugs and ingredients from Indian pharmacies are being illegally trafficked out of India to other parts of the world.

Despite a lack of formal studies and organized information from parts of Asia and Africa, there are numerous reports of increased prescription abuse from those parts of the world. There also reports of prescription abuse from South and Central America, but illicit drug abuse tends to be a bigger issue, according to the UNODC.

The demographic of drug abusers also seems to be changing. While men were long-considered the most common illicit drug abusers, women seem to abuse prescriptions at a higher rate. People with college educations who are employed are also among the top prescription drug abusers in some parts of the world.

As the threat of worldwide prescription drug abuse rises, the UNODC introduced various guidelines to combat the issue. National legislators across the globe also introduced legislation to attempt to combat the growing trend of pharmaceutical abuse, but the problem is system-wide making it extremely difficult to solve.

Drugwatch recently published a story detailing the epidemic of prescription drug abuse in the U.S. This is a follow-up story detailing prescription drug abuse in the world.

Why People Abuse Prescription Drugs

People abuse prescription drugs for a variety of reasons, but the overarching theme is that people believe prescriptions are safe. This could not be further from the truth.

Reasons that people abuse prescription drugs include:

• Ill-informed friends or family may incorrectly let someone borrow a prescription in order to treat symptoms of pain, depression or anxiety.
• People, sometimes accidentally, take prescriptions for longer than they are needed. This leads to an addiction that is difficult to overcome.
• Some people abuse prescriptions because they believe they will help them perform tasks better, such as improve focus or increase physical abilities.
• Like alcohol and illicit drugs, people abuse prescriptions in order to relieve stress, feel a sense of euphoria or to escape reality.
• Prescriptions may be more easily accessible than illicit drugs. Prescriptions can be refilled when they are no longer needed, or visitors can steal them easily from medicine cabinets.

There are numerous variables that factor into the reasons people abuse prescription drugs, and the types of people who abuse prescription drugs may be surprising.

The Faces of Prescription Drug Abuse

Historically, men used illicit drugs more often than women, and illicit drug use was often associated with the lower class or people of lower socioeconomic statuses.

However, since the increase in prevalence of prescription drug use, those demographics are changing.

Women More Likely To Abuse Prescription Drugs

Almost all surveys show men are more likely to use illegal drugs. However, surveys in Australia, Spain, Afghanistan, Pakistan and the U.S. indicate women are just as likely or more likely to abuse prescription drugs. A study of treatment centers in South Africa found people seeking treatment for pharmaceutical abuse were more likely to be female, according to the UNODC.

Overall drug abuse is still most common in men, and men who abuse prescriptions are likely to abuse other illicit drugs as well. Comparatively, women who abuse prescriptions are unlikely to abuse other illicit drugs, according to the UNODC.

In a statement to the U.S. House of Representatives, National Institute of Drug Abuse (NIDA) Director Nora Volkow warned:

• Women are more likely to be vulnerable to prescription drug abuse because they are more likely than men to suffer from depression, anxiety, trauma, and victimization.
• Girls and women use drugs to cope with stressful situations.
• Women are significantly more likely than men to be prescribed a drug that can be abused.

Histories of post-traumatic stress disorder, of abuse of other substances or of drug or alcohol-facilitated rape are associated with an increased likelihood of prescription drug abuse, according to the UNODC.

Women weren’t the only demographic that health organizations labeled as a particularly vulnerable group.

Health-Care Professionals Among Educated Abusers

The lower class and people of lower socioeconomic classes are not the ones most likely to abuse prescription drugs, and the problem isn’t limited to college students abusing stimulants during finals week.

According to a survey of “well-educated working people” in Canada, the U.S. and the U.K., more than 22 percent of people surveyed abused depressants. The average age of those surveyed was 28, nine out of 10 were white, 75 percent earned between £10,000 and £40,000 (about $10,952 and $43,808) and 55 percent had a college degree.

Ironically, healthcare physicians are more likely than the general population to abuse prescription drugs, leading the UNODC to label them as a particularly vulnerable group.

At the highest risk for prescription drug abuse are anesthesiologists, emergency medicine physicians, family practitioners, psychiatrists and nurses. The ease of access and frequency of exposure to prescription drugs affects the likelihood of professionals to abuse pharmaceuticals, according to the UNODC.

Other factors that contribute to prescription abuse include stress, anxiety and depression often associated with the long hours and high stress levels of healthcare jobs.

According to the UNODC, opioids, depressants and stimulants are the top prescription drugs abused across the world.

Opioids: The Top Cause of Drug-Related Deaths

Drug overdose is the top cause of drug-related deaths in the world, and opioids are the top drug type associated with those deaths, according to the UNODC. The World Health Organization (WHO) estimated that 16.37 million people used opioids in 2012.

Derived from opium poppy seeds, opioids primarily consist of prescription painkillers and heroin. Synthetic opioids include popular prescription drugs like Oxycontin (Oxycodone), Vicodin (Hydrocodone) and Duragesic (Fentanyl).

Combined with their highly-addictive nature, opioids are dangerous because a single large dose can cause severe respiratory depression and death, according to the NIDA.

A drug user’s tolerance to opioids decreases during breaks from drug use, commonly because of personal abstinence, incarceration, or treatment. When they take the drug at the same dose as they did before a break, it often leads to an overdose.

Prescriptions As a Heroin Alternative

A developing trend among addicts is to switch back and forth between prescription opioids and heroin. They are able to fuel their dependence on the drugs because both types of opioids are derived from the same naturally-occurring morphine in poppy seeds.

Some people who became opioid-dependent from prescription drugs switched to heroin after Oxycontin was reformulated to make it more difficult to snort or inject. Reports from Estonia, Finland and the U.S. described addicts switching back and forth from heroin and prescription drugs depending on which was cheaper and more available, according to the UNODC.

North America Leads World in Opioid Abuse

In North America, the U.S.’s record number of opioid abusers isn’t the only problem. Canada ranked second for the highest opioid consumption per capita in the world, according to the Canadian Centre on Substance Abuse (CCSA).

The region consumes 80 percent of the world’s opioids, and it has the highest rate of drug-related deaths in the world, according to the INCB.

From 2004-11, the number of emergencies involving opioids in the U.S. rose 183 percent, according to the UNODC.

From 1991-2010, the number of opioid-related deaths per year increased 242 percent in Canada.

Reports of Opioid Abuse Around the World

Across the Atlantic in Europe, deaths from heroin declined, but deaths from synthetic opioids rose. Estonia saw one of the worst increases in prescription opioid deaths in the world, with a 38 percent increase from 2011-12, according to the INCB.

In New Zealand, opioid abuse is on the rise, and more than 1.2 million people abuse opioids – primarily prescription painkillers – in China, according to the INCB.

Despite reports from the WHO that tramadol has a low potential for abuse, many countries in North Africa reported problems with abuse. Tramadol requires a prescription in most countries but is available online without a prescription.  Egyptian authorities had success combating the illegal trafficking of tramadol, decreasing seizures from 650 million tablets in 2012 to 27 million in 2013. However, Libya and Nigeria reported rising rates of abuse, according to the INCB.

In South America, a continent known for its production and trafficking of illicit drugs, opioid abuse is low in most countries. However, Costa Rica reported about 2.8 percent of the population abuses the prescription painkillers.

Depressants

Depressants, more specifically central-nervous system depressants, are among the most abused types of prescription drugs in the world.

Doctors commonly prescribe depressants, also referred to as sedatives or tranquilizers, to treat anxiety and sleep disorders.  Depressants include barbiturates, such as Nembutal (pentobarbital sodium), and benzodiazepines, such as Valium (diazepam), Xanax (alprazolam) and Klonopin (clonazepam).

When taken in prescribed doses for short periods of time, people usually feel sleepy and uncoordinated. However, people return to feeling normal shortly after they stop taking the drug, according to the NIDA.

Problems occur when people take depressants in high doses or for long periods of time, because they develop a tolerance – leading to a need for higher dosages – or a physiological dependence – leading to withdrawal when they stop taking the drug. Symptoms of withdrawal can include hyperactivity, seizures and other harmful physical and physiological consequences, according to the NIDA.

Reports of Depressant Abuse Around the World

In Europe, depressant abuse alone is not considered a major problem, according to the UNODC. However, poly drug users often combine depressants with other drugs, causing harmful side effects.

Depressants are a bigger problem in the Middle East and Africa. Reports from Afghanistan indicate that about 11 percent of drug users used depressants without a prescription. In South Africa, people seeking treatment for drug abuse are most often treated for abusing depressants, beating out opioids by 2 percent.

About 3.6 percent of the Argentinian population reported abusing depressants once in their lifetime, according to the UNODC.

In the U.S., about 2.6 million people abuse depressants, and 363,300 emergency department visits per year involve depressants, according to the NIDA.

Stimulants

Another one of the most-abused prescription drugs are stimulants, also called central nervous system stimulants.

Doctors most commonly prescribe stimulants to treat people with attention-deficit hyperactivity disorder (ADHD) in order to help them focus. Some people believe in the misconception that they help people increase their ability to learn, but studies have found stimulants help increase wakefulness, not learning or thinking abilities, according to the NIDA.

Popular stimulants include amphetamines like Dexedrine (dextroamphetamine), Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate).

Stimulant side effects include hostility and paranoia, and high doses can lead to dangerous body temperatures, irregular heartbeats, seizures and cardiovascular failure, according to the NIDA.

The global use of Ritalin grew from less than 500 million daily doses in 1998 to almost 2.5 billion daily doses in 2013, according to the INCB.

Reports of Stimulant Abuse Around the World

In the U.S., more than 11 percent of adolescents aged 4-17 are diagnosed with ADHD and treated with Ritalin. Those numbers help attribute to the fact that Americans consume more than 80 percent of the world’s Ritalin, according to the INCB.

However, the U.S. isn’t the world leader in consumption per capita. That honor belongs to Iceland, followed by Norway, Sweden, Australia, Belgium, Germany and Canada, according to the INCB.

The INCB reports from around the world hone in on the increased rate of stimulant prescriptions:

• Australian 2-year-olds are being prescribed medications containing methylphenidate at an increasing rate, and more than 6,000 Australians under the age of six are on stimulants.
• The rate of Germans under the age of 19 diagnosed with ADHD increased 42 percent from 2006-11.
• In China, four percent of middle school students use prescription stimulants.
• In Brazil, 1.7 percent of students in their last four years or primary school and first three years of secondary school use prescription stimulants.
• In Argentina, 1.4 percent of students aged 15-16 use prescription stimulants.

UNODC reports also indicate increased rates of prescription stimulant abuse in Asia. The non-medical use of benzodiazepines is a problem in Brunei Darussalam, Indonesia, Malaysia, the Philippines and Singapore, but no exact statistics are available due to a lack of major studies in the region.

Combatting the issue of prescription drug abuse is increasingly difficult due to the nature of the problem.

A System-Wide Problem

Fighting prescription drug abuse is a difficult task that has just as much to do with problems in healthcare systems as it does with problems stemming from Big Pharma and consumer ignorance.

The most recent global UNODC report detailed how efforts should be made to train healthcare professionals to screen for signs of abuse and teach patients to protect their prescription drugs.

But many problems regarding prescription drug abuse arise when doctors prescribe highly-addictive drugs in too large of dosages or prescribe drugs based on inaccurate diagnoses. Increased scrutiny of doctors leads to another problem. Some doctors do not prescribe medications in high enough doses because of the fear of addicting their patients or because of fear of scrutiny from other doctors, according to the UNODC.

The WHO recommends an increased focus on training for doctors and less of a focus on preventing doctor shopping. Doctor shopping is when people go to different doctors until one prescribes them a treatment they desire. A recent Substance Abuse and Mental Health Services Administration (SAMHSA) survey in the U.S. showed doctor shopping was not as big of a concern as once thought.

Other healthcare practitioners may need increased training too. According to the UNODC, 28.4 percent of pharmacists fail to check a prescribing physician’s DEA number when providing controlled drugs. The DEA gives approved physicians in the U.S. a number for prescribing drugs. Some pharmacists also provide medications without a written prescription order or based on orders with missing information. Only half of pharmacists are trained to identify prescription drug abuse and addiction, according to the UNODC.

There is help for those suffering from prescription drug abuse. Most countries have treatment centers for people addicted to prescription drugs.

Increased training efforts for healthcare practitioners, education for the public and regulation of pharmaceutical companies can combine combat the problem.