National Drug Control Policy and Prescription Drug Abuse: Facts and Fallacies

In a recent press release Joseph A. Califano, Jr., Chairman and President of the NationalCenter on Addiction and Substance Abuse at Columbia University called for a major shift inAmerican attitudes about substance abuse and addiction and a top to bottom overhaul inthe nation’s healthcare, criminal justice, social service, and eduction systems to curtail therise in illegal drug use and other substance abuse.Califano, in 2005, also noted that while America has been congratulating itself on curbingincreases in alcohol and illicit drug use and in the decline in teen smoking, abuse and addition of controlled prescription drugs-opioids, central nervous system depressants and stimulants-have been stealthily, but sharply rising. All the statistics continue to show that prescription drug abuse is escalating with increasing emergency department visits and unintentionaldeaths due to prescription controlled substances.While the problem of drug prescriptions for controlled substances continues to soar, so arethe arguments of undertreatment of pain. The present state of affairs show that there were6.4 million or 2.6% Americans using prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 4.7 million used pain relievers. Current nonmedical useof prescription-type drugs among young adults aged 18-25 increased from 5.4% in 2002to 6.3% in 2005. The past year, nonmedical use of psychotherapeutic drugs has increasedto 6.2% in the population of 12 years or older with 15.172 million persons, second only tomarijuana use and three times the use of cocaine.Parallel to opioid supply and nonmedical prescription drug use, the epidemic of medicaldrug use is also escalating with Americans using 80% of world’s supply of all opioids and99% of hydrocodone.Opioids are used extensively despite a lack of evidence of their effectiveness in improvingpain or functional status with potential side effects of hyperalgesia, negative hormonal andimmune effects, addiction and abuse. The multiple reasons for continued escalation of prescription drug abuse and overuse are lack of education among all segments including physicians, pharmacists, and the public; ineffective and incoherent prescription monitoring programs with lack of funding for a national prescription monitoring program NASPER; and areactive approach on behalf of numerous agencies.This review focuses on the problem of prescription drug abuse with a discussion of facts andfallacies, along with proposed solutions.Key words: Prescription drug abuse, opioid abuse, opioid misuse, National Drug ControlPolicy, NASPER, prescription drug monitoring programs.