Pain reliever abuse

Wu, Li-Tzy, Christopher L. Ringwalt, Paolo Mannelli, and Ashwin A. Pat-kar. Prescription Pain Reliever Abuse and Dependence among Adolescents A Nationally Representative Study. Journal of the American Academy of Child and Adolescent Psychiatry 47, no. 9 (September 2008) 1,020-1,029. According to the results of this study, 7 percent of youth ages 12 to 17 reported nonprescription use of prescription pain relievers and 1 percent met criteria for abuse or dependence on the prescription pain relievers. Although the results depend on potentially biased self-reports from youth, the reliance on a representative national sample allows the results to be generalized widely. 

Tramadol is a pain reliever (analgesic). Its action is similar to opioid narcotics such as codeine and morphine, but it does not depress breathing the way the others can, and less often leads to abuse and addiction. 

Abuse. We have all heard the terms substance abuse, drug abuse, alcohol abuse, cocaine abuse, and so on. In one sense, any illicit use of a substance is abuse. For example, from the legal point of view, whenever someone smokes crack (even if it is the only time), (s)he has broken the law and abused cocaine. Likewise, if you borrow a prescription sedative or pain reliever from a friend, then you have similarly abused that medication. That is an appropriate use of the term in many cases, but this is not customarily the way that mental health specialists use the term. From our perspective, substance abuse involves a pattern of repeated use over time that results in problems in one or more areas. These include compromised physical health and well-being, legal proceedings, job status, and relationships as well as overall day-to-day functioning. 

Unlike other pain-relievers such as aspirin or Tylenol, which have a limit to the amount of pain relief they can deliver, OxyContin s effectiveness increases in proportion to the amount taken. In other words, after a certain point, adding another aspirin will not do anything more for pain, whereas an increase in OxyContin will keep the patient feeling better and better. Under these circumstances, it is easy to see why the drug lends itself to easy abuse. 

Hydrocodone is a widely prescribed (and abused) pharmaceutical designed as a pain-reliever. The drug works by converting into a form of morphine once it enters the body. Hydrocodone can be derived from either codeine or thebaine and is three times more powerfiil than codeine. Hydrocodone has various trade names. 

Derived from the alkaloid thebaine, oxycodone is a highly effective pain-reliever and prescribed to postsurgical patients, cancer patients, and others with severe pain. Oxycodone is sold under various trade names in combination with aspirin, including Per-codan , Endodan, and Roxipirin with acetaminophen it is marketed as Percocet , Endocet, and Roxicet. Oxycodone is also the main ingredient in OxyContin. The most frequent side effect of oxycodone is constipation, but naseua is also common. Oxycodone is highly abused in the United States. 

Drug use by teenagers in 2004 appears to have declined, though use of inhalants and oxycodone (OxyContin ), a prescription opioid pain reliever, are on the rise. Recent reports indicate that a ready source of drugs of abuse for adolescents is prescription drugs found in the home medicine cabinet, as well as prescription drugs available on the Internet. ... 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives tranquilizers can reduce anxiety and help patients with sleep disorders and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction. 

Research still continues into opiate analogs in order to produce pain relievers of high potency and low abuse potential. 

By 2003 the total annual federal budget for drug control efforts exceeded 19 billion, with many hundreds of millions of dollars more spent by state and local governments. An estimated 3.5 million Americans received some sort of treatment for drug abuse during the year preceding the 2002 survey. Of these, about 2.2 million received treatment for alcohol, about 974,000 for marijuana, 796,000 for cocaine, 360,000 for abuse of pain relievers, and 277,000 for heroin. 

The increase in concern seems to reflect a true increase in incidence. The numbers of new nonmedical users of the four major classes of prescription-type drugs (narcotic pain relievers, tranquilizers, stimulants, and sedatives) increased between 1991 and 2001.4 There were substantially more new users for narcotic pain relievers than for the other three drug categories — an increase from 628,000 initiates in 1990 to 2.4 million in 2001.5 This increase in new users was accompanied by a 76% increase between 1997 and 2000 in the number of primary treatment admissions for narcotic-analgesic abuse.6 Initiation of nonmedical tranquilizer use also increased steadily during the 1990s, from 373,000 initiates in 1990 to 1.1 million in 2001.5... 

An alkaloid pain reliever, morphine, is an often abused drug. Chronoampero-metric MIP chemosensors have been devised for its determination [204]. In these chemosensors, a poly(3,4-ethylenedioxythiophene) (PEDOT) film was deposited by electropolymerization in ACN onto an ITO electrode in the presence of the morphine template to serve as the sensing element [204], Electrocatalytic current of morphine oxidation has been measured at 0.75 V vs AglAgCllKClsat (pH = 5.0) as the detection signal. A linear dependence of the measured steady-state current on the morphine concentration extended over the range of 0.1-1 mM with LOD for morphine of 0.2 mM. The chemosensor successfully discriminated morphine and its codeine analogue. Furthermore, a microfluidic MIP system combined with the chronoamperometric transduction has been devised for the determination of morphine [182] with appreciable LOD for morphine of 0.01 mM at a flow rate of 92.3 pL min-1 (Table 6). 

It is known that the abuse of prescription fentanyl is on the rise, but the degree of increase is difficult to distinguish. Doctors are increasingly wary of turning down requests for pain medication for fear of lawsuits if the patient truly is in a lot of pain. Determining how much pain a patient feels is nearly impossible for the doctor, so they must rely on what the patient tells them. This has led to an increase of people illicitly getting pain relievers for personal use or distribution. Some patients lie to their doctors about their conditions in order to get painkillers others have gone to several doctors to get several prescriptions. 

Women are more likely than men to receive prescribed drugs that are abused among adult populations. These prescribed drugs are most often antidepressants and pain relievers. Evidence indicates that men and women are at similar risk for becoming addicted to opioids. However, women are far more likely to become addicted to other types of prescription drugs than men. 

Each year, the National Household Survey on Drug Abuse (NHSDA)—the United States Department of Health and Human Services—collects statistical data on five drug groups marijuana and hashish psychotherapeutic drugs cocaine and crack hallucinogens and inhalants. Psychotherapeutic drugs include stimulants, sedatives, tranquilizers, and pain relievers. Meperidine and other opioids constitute the majority of the pain relievers in that group. 

In 1999, four million people in the United States were using prescription drugs outside medical use. Of these, 2.6 million were misusing pain relievers, according to the National Institute on Drug Abuse (NIDA). 

National surveys have shown that abuse of prescription drugs is on the rise in the United States. Compared with the 1980s, when fewer than 500,000 people took a prescription drug for a nonmedical reason each year, the number of people who engaged in this behavior increased 181% from 1990 to 1998 for pain relievers alone. 

Similarly, alcohol should be avoided when taking oxycodone. It, too, increases feelings of drowsiness and can cause dizziness when combined with oxycodone. Avoiding alcohol is especially important when taking pain-relievers containing oxycodone and acetaminophen, as studies have shown that liver damage can occur when even relatively small amounts of alcohol are combined with acetaminophen. A current or past history of alcohol or drug abuse should be carefully considered before oxycodone is prescribed. 

The majority of people who use narcotic pain relievers do so safely and appropriately without becoming addicted. Despite widely held assumptions that increased prescribing of these drugs will lead to increased abuse, recent studies suggest this is not the case. 

As seen in Figure 3.7, the most widely abused opiate pain relievers are Darvocet , Darvon , and Tylenol with codeine , followed by Vicodin, Lortab , and Lorcet . Methadone is the least addicting of the opiate pain relievers and stays in the body the longest. Because of this, methadone is often used as a substitute for morphine, heroin, and other more addictive opiates to wean people off the drug to which they are addicted. 

Many of the pain relievers described in this book are currently classified into these schedules, as listed in the table below. However, scheduling of individual drugs can change over time as trends in abuse potential and addiction to a particular drug change. Thus, the classification of drugs is continuously updated by the Drug Enforcement Administration (DEA). 

Nonmedical Use of Prescription Pain Relievers. Substance Abuse and Mental Health Services Administration (SAMSA), Office of Applied Studies. May 21, 2004. Available online at http //www.oas.samhsa.gov/2k4/pain/pain.cfm. 

Aerosols comprise compounds such as spray paints, hair sprays, pain-relieving sprays, deodorants, fabric-protector sprays, vegetable frying-pan lubricants, and hundreds of other everyday chemicals that are found in homes or are readily available commercially. Products that create an aerosol use propellants to keep tiny particles suspended in the air. For the most part these propellants, not the liquid product, are the chemicals abused. Virtually any aerosol product can be abused. 

---