Prescription opiate medications: medical uses and consequences, laws and controls

Drug abuse and dependence continue to be major threats to public health in the United States and throughout the world. Drug use causes major deleterious psychological and social problems, including family dysfunction, domestic and criminal violence, and child abuse. Drug and alcohol abuse and addiction cost nearly $300 billion annually in the United States or 25% of the national health care budget, and $34 billion are attributed to direct health care costs for hospitals, treatment programs, residential care, and professional services [1,2]. Drug and alcohol use/addictions are implicated in 25% to 50% of all general hospital admissions and 50% to 75% of psychiatric admissions. Additionally, they contribute substantially to medical complications and costs to those admitted to hospitals for other reasons [3,4]. According to government surveys, nearly 1 million people are active in specialized treatment for drug and alcohol problems, 29% for drug addiction, 45% for alcoholism, and 26% for both alcoholism and drug addiction [5]. For unclear reasons, the prevalence of addictive use of prescription opiate medications is not accurately known, as there are not systematic longitudinal surveys of heterogeneous populations [6]. The rates of addiction in patients with chronic, noncancer pain have been estimated between 3.2% and 18.9%, however, and higher rates have been reported in multi-disciplinary pain management programs [6-10]. The use of opiate medications is relatively contraindicated in patients with alcoholism and drug addiction because of their vulnerability to developing a tolerance, dependence, and addiction to these medications. In addition, the potential for addiction during the treatment of chronic pain must be considered when prescribing narcotic medications to anyone, whether they have an existing or pre-existing alcohol or drug problem [8]. Although the total pharmaceutical market doubled to S145 billion between 1996 and 2000, the prescription medication market, including opiate medications, tripled to S1.8 billion over the same period. Additionally, the incidence of first-time abuse and addiction to these medications has surged in recent years. In 1999, an estimated 4 million Americans over the age of 12 used prescription pain analgesics, sedatives, and stimulants for nonmedical reasons in the previous month, with nearly half for the first time [11]. According to the Drug Enforcement Agency (DEA), the most-abused drug is oxycodone (OxyContin) and hydrocodone (Vicodin), which are synthetic opiate medications. According to the Drug Abuse Warning Network (DAWN), emergency room visits involving hydrocodone increased from 6100 incidents in 1992 to more than 14,000 in 1999, and oxycodone-related visits increased from 3750 to 6430. alprazolam (Xanax)-related visits increased from 16,500 to 20,500. Over the same time period, illegal drug-related visits increased from 120,00 to 169,000, and heroin- and morphine-related visits increased from 48,000 to 84,000 [12].