Prescription drug addiction

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else's prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics. Prescription drug addiction was recognized as a significant public health and law enforcement problem worldwide in the past decade due to its medical and social consequences. Particularly, the United States declared a public health emergency regarding increased drug overdoses in 2017. Since then, multiple public health organizations have emphasized the importance of prevention, early diagnosis and treatments of prescription drug addiction to address this public health issue.

Causes and risk factors

There are multiple risk factors that can increase the chance of developing drug addiction, including patient factors, nature of drug and over-prescription.

Patient factors Studies have indicated that adolescents and young adults were particularly vulnerable to prescription drug abuse. People with acute or chronic pain, anxiety disorders and ADHD were at increased risk for addiction comorbidity. History of illicit drug use and substance use disorder were consistently identified as risk factors for prescription drug abuse. Misuse of opioid analgesics is frequently associated with mental health disorder, including depression, posttraumatic stress disorder, and anxiety disorders. Some risk factors for opioid and benzodiazepine sedatives or tranquilizers addiction are white race, female sex, panic symptoms, other psychiatric symptoms, alcohol and cigarette dependence and history of illicit drug use. Addiction to pharmaceutical stimulants have been predominantly among adolescents and young adults.

Drug characteristics Patients who have been prescribed medications to treat a health condition or disorder are shown to be more vulnerable to prescription drug abuse and addiction, especially when the prescribed medicine falls into the same drug classes of common illicit drugs. For example, methylphenidate and amphetamines are in the same stimulant category as cocaine and methamphetamine, while hydrocodone and oxycodone are under the opioid category as heroin. Key pharmacological factors associated with drug addiction include:

high frequency of drug use high doses administered rapid rate of onset of action high drug potency co-ingestion of psychoactive substances with similar (eg. sedatives and alcohol) or different pharmacological profiles (eg. stimulants and nicotine) can result in additional reinforcement of addiction.

Over-prescription and doctor shopping

Health practitioners can prescribe drugs in a number of ways that inadvertently and unintentionally contribute to prescription drug abuse. They may inappropriately prescribe drugs due to influence by ill-informed, careless or deceptive patients or by succumbing to patient pressure. The American Medical Association describes four mechanism by which a physician becomes involved in overprescribing in its four-"Ds" model:

Dated: the physician is outdated regarding knowledge of pharmacology and the differential diagnosis and management of diseases. Duped: the physician may be vulnerable to a manipulative patient. Dishonest: a dishonest physician may be motivated to write prescriptions for controlled substances under financial incentives. Disabled: a physician with medical or psychiatric disability such that they have "loose" standards in prescribing controlled substances. The above over-prescription practices can lead to the aggravation of prescription drug addiction. A person may also gain access to prescription drugs via doctor shopping. "Doctor shopping" describes a practice in which a person searches for multiple sources of drugs by visiting different health practitioners and presenting a different list of complaints to each practitioner; the patient will then obtain multiple prescriptions and fill them at different pharmacies.

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