Tag: SAMHSA

Misuse of Prescription Drugs: A Research Study

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From the Website of the National Institute on Drug Abuse
Dr. Lora, Volkow, Executive Director
June 2020

Misuse of prescription drugs means taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (i.e., to get high). The term non-medical use of prescription drugs also refers to these categories of misuse. The three classes of medication most commonly misused are:

  • opioids—usually prescribed to treat pain
  • central nervous system [CNS] depressants (this category includes tranquilizers, sedatives, and hypnotics)—used to treat anxiety and sleep disorders
  • stimulants—most often prescribed to treat attention-deficit hyperactivity disorder (ADHD)

Prescription drug misuse can have serious medical consequences. Increases in prescription drug misuse over the last 15 years are reflected in increased emergency room visits, overdose deaths associated with prescription drugs, and treatment admissions for prescription drug use disorders, the most severe form of which is an addiction. Overdose deaths involving prescription opioids were five times higher in 2016 than in 1999.

Misuse of prescription opioids, CNS depressants, and stimulants is a serious public health problem in the United States. Although most people take prescription medications responsibly, in 2017, an estimated 18 million people (more than 6 percent of those aged 12 and older) have misused such medications at least once in the past year. According to results from the 2017 National Survey on Drug Use and Health, an estimated 2 million Americans misused prescription pain relievers for the first time within the past year, which averages to approximately 5,480 initiates per day. Additionally, more than one million misused prescription stimulants, 1.5 million misused tranquilizers, and 271,000 misused sedatives for the first time.

The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely include ease of access. The number of prescriptions for some of these medications has increased dramatically since the early 1990s. Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem. Although misuse of prescription drugs affects many Americans, certain populations such as youth and older adults may be at particular risk.

Adolescents and Young Adults

Misuse of prescription drugs is highest among young adults ages 18 to 25, with 14.4 percent reporting non-medical use in the past year. Among youth ages 12 to 17, 4.9 percent reported past-year non-medical use of prescription medications.

After alcohol, marijuana, and tobacco, prescription drugs (taken non-medically) are among the most commonly used drugs by 12th graders. NIDA’s Monitoring the Future survey of substance use and attitudes in teens found that about 6 percent of high school seniors reported past-year non-medical use of the prescription stimulant Adderall® in 2017, and 2 percent reported misusing the opioid pain reliever Vicodin®.

Although past-year non-medical use of CNS depressants has remained fairly stable among 12th graders since 2012, use of prescription opioids has declined sharply. For example, past-year non-medical use of Vicodin among 12th graders was reported by 9.6 percent in 2002 and declined to 2.0 percent in 2017. Non-medical use of Adderall® increased between 2009 and 2013, but has been decreasing through 2017. When asked how they obtained prescription stimulants for non-medical use, around 60 percent of the adolescents and young adults surveyed said they either bought or received the drugs from a friend or relative.

Youth who misuse prescription medications are also more likely to report use of other drugs. Multiple studies have revealed associations between prescription drug misuse and higher rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other illicit drug use among U.S. adolescents, young adults, and college students. In the case of prescription opioids, receiving a legitimate prescription for these drugs during adolescence is also associated with a greater risk of future opioid misuse, particularly in young adults who have little to no history of drug use.

Older Adults

More than 80 percent of older patients (ages 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily. This can potentially lead to health issues resulting from unintentionally using a prescription medication in a manner other than how it was prescribed, or from intentional non-medical use. The high rates of multiple (co-morbid) chronic illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions make medication (and other substance) misuse more dangerous in older people than in younger populations. Further, a large percentage of older adults also use over-the-counter medicines and dietary and herbal supplements, which could compound any adverse health consequences resulting from non-medical use of prescription drugs.

Find Help Near You

The following can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. A step by step guide on what to do to help yourself, a friend or a family member on the Treatment page.

Narcotics Anonymous National Hotline: 1(877) 276-6883.

2019 Monitoring the Future Survey Raises Worries about Teen Marijuana Vaping

From the monthly blog of Dr. Lora Volkow,
Executive Director
National Institute on on Drug Abuse

Originally posted December 18, 2019

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For the second year in a row, rapid rises in vaping among adolescents are the top story from the Monitoring the Future survey of drug use and attitudes among the country’s 8th, 10th, and 12th graders. What became evident in 2018 was that vaping devices, which have exploded in popularity over the past several years, are now exposing a new generation to nicotine. Those trends continued in 2019, but with the additional concern of a rapid rise in the vaping of marijuana, as well as increases in daily marijuana use in 10th graders.

More than one fifth of high school seniors (20.8 %) reported having vaped marijuana in the past year, as did nearly that same proportion of 10th graders (19.4 %). From 2018 to 2019, the percentage of seniors vaping marijuana in the past month increased from 7.5 percent to 14 percent—the second largest one-year increase in any drug use that has ever been recorded in the 45-year history of the MTF survey. (The first largest increase was nicotine vaping from 2017 to 2018 reported last year.) Among 10th graders, past-month use was 12.6 percent.

Overall, marijuana use has held relatively steady over the past several years despite wider availability and diminished perception of the drug’s harms by this age group (and by the U.S. population more generally). But the increases in vaping of THC, the active ingredient in marijuana, are alarming for a number of reasons. For one thing, we don’t yet know if THC’s effects differ when vaped versus when smoked in a traditional fashion or whether the amount of THC that youth are being exposed to differs with these methods.

Also, the students took the survey in January of this year, which was before the alarming news this summer about serious lung illness and a number of deaths (48, as of this writing) in people using vaping devices. Most of the illnesses occurred in people who had vaped THC. It is not known whether the cause may have been contamination in certain black market vape fluids, or some other factor. The CDC has named vitamin E acetate as a chemical of concern in vape fluids, but it is too soon to rule out other chemicals or device attributes that may also contribute to the illnesses.

At this point, we know very little about the health and safety effects of administering THC at high concentrations, and this applies not only to vaping but also to smoking of concentrated THC products and new edible products and beverages coming on the market in states that have legalized marijuana for adult use. Research is urgently needed to answer these questions. However, marijuana is federally classified as a Schedule 1 substance. Scientists face administrative hurdles when studying Schedule 1 substances, and currently there are no provisions allowing federally funded researchers to study marijuana products coming from the black market or even from dispensaries in states where they are permitted to operate. Resolving these research barriers is an urgent priority.

Daily marijuana use has remained steady among 12th graders, at 6.4 percent, but this number conceals a very significant gender difference. Eight percent of male seniors report using marijuana daily, whereas 4.6 percent of females do. This suggests that a disproportionate percentage of male students may not be performing to their potential because of daily impairment by that drug.

Increased daily marijuana use by younger teens is another worrying trend in this year’s survey results. This year, 4.8 percent of 10th graders reported daily marijuana use, as did 1.3 percent of 8th graders. The brain is very much a work in progress throughout adolescence, and this is especially true at younger ages, so there is increased risk of long-term harms as well as addiction when 8th and 10th graders use any substance, including marijuana.

The continued increase in nicotine vaping by adolescents is also concerning. A quarter of 12th graders reported past-month vaping of nicotine, as did nearly 20 percent of 10th graders and nearly 10 percent of 8th graders. It is not yet leading to increased cigarette use in this age group—one of the many bright spots in this year’s survey is continued downward trends in smoking—but many public health experts worry that vaping will lead to nicotine addiction in many users of these devices.

The number of 12th graders who vape because they say they are “hooked” more than doubled between 2018 and 2019, from 3.6 percent to 8.1 percent. Addiction to nicotine could lead some users to switch to conventional cigarettes—a trajectory already found in some studies. Another noteworthy statistic in the MTF findings is that teens’ second most cited reason for vaping was liking the taste—a strong argument in favor of limiting the flavorings in vape products as a way of limiting these products’ tremendous appeal.

Apart from the real concerns linked to marijuana and nicotine vaping, the general picture painted by the MTF survey continues to be largely encouraging, however. Most illicit drug use continues to decline or hold steady at low levels. Cocaine and methamphetamine use are as low as they have ever been despite increases seen in adults. Nonmedical use of prescription opioids, which had raised worries several years ago in this survey, is also way down. And thankfully, the crisis of heroin use that continues unabated in U.S. adults also does not seem to be affecting high school students—heroin use continues to be very rare among teens surveyed, with past year use among high-school seniors at 0.4 percent. The fact that MTF is a survey of students in school is important to remember, however. It necessarily does not sample from those who have dropped out of school, and thus misses capturing a segment of the youth population for whom drug use is likely more prevalent.

See all the findings of the 2019 MTF survey, our press release, fact sheet and two infographics on vaping and other drug categories. For more information on the increases in marijuana vaping and what they mean, read the research letter published today in JAMA.

The MTF survey is a valuable indicator of substance use trends in the segment of the population most vulnerable to the short- and long-term effects of drug exposure. It is also the most “real-time” survey of drug use patterns: Every January, 42,531 students in 396 public and private schools across the nation take an hour or so to complete the MTF questionnaire—increasingly, on tablets rather than on paper—and the results are tabulated and analyzed by the end of that same year. It gives the NIDA-funded researchers at the University of Michigan, currently led by Richard A. Miech, an unprecedented ability to track substance use in real time.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org.

Using Science to Address the Opioid Crisis in America

FROM THE BLOG OF NORA VOLKOW, MD
September 19, 2018

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The public health emergency regarding opioid misuse, addiction, and overdose affects millions of Americans and requires innovative scientific solutions. Today, during National Prescription Opioid and Heroin Awareness Week, we are sharing news of an important step towards these solutions through the HEALing Communities Study—an integrated approach to test an array of interventions for opioid misuse and addiction in communities hard hit by the opioid crisis.

Six months ago, the National Institutes of Health (NIH) launched the Helping to End Addiction Long-Term (HEAL) Initiative, a bold multi-agency effort to catalyze scientific discoveries to stem the opioid crisis. HEAL will support research across NIH, using $500,000 of fiscal year 2018 funds, to improve prevention and treatment of opioid use disorder and enhance pain management.

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Through HEAL, NIH will harness the power of science to bring new hope for people, families, and communities affected by this devastating crisis. The current menu of evidence-based prevention, treatment, and recovery interventions has not been fully implemented nationwide. An unacceptably low fraction – about one fifth — of people with opioid use disorder receive any treatment at all. Of those who do enter treatment, only about a third receive any medications—which are universally acknowledged to be the standard of care—as part of their treatment. However, even when medications are used as a component of treatment, the duration is typically shorter than clinically indicated, contributing to unacceptably high relapse rates within the first 6 months. 

To take on this challenge, as part of the broader HEAL initiative, NIH has partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to launch the HEALing Communities Study. This study will evaluate the impact of implementing an integrated set of evidence based practices for prevention and treatment of opioid use disorders in select communities with high rates of opioid overdose mortality, with a focus on significantly reducing opioid overdose fatalities by 40%. Targeted areas for intervention include decreasing the incidence of opioid use disorder, increasing the number of individuals receiving medications for opioid use disorder treatment, increasing treatment retention beyond 6 months, receiving recovery support services, and expanding the distribution of naloxone.

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Toward this goal, today NIDA issued funding opportunities for cooperative agreements for components of the HEALing Communities Study: a data coordinating center and up to three research sites to measure the impact of integrating evidence-based prevention, treatment, and recovery interventions for opioid misuse, opioid use disorder, opioid-related overdose events and fatalities across multiple settings, including primary care, behavioral health, and justice. We also encourage evidence-based interventions for prevention and treatment that involve community resources such as police departments, faith-based organizations, and schools, with a focus on rural communities and strong partnerships with state and local governments.

The evidence we generate though the HEALing Communities Study, the most ambitious implementation study in the addiction field to date, will help communities nationwide address the opioid crisis at the local level.  By testing interventions where they are needed the most, in close partnership with SAMHSA and other Federal partners, we will show how researchers, providers, and communities can come together and finally bring an end to this devastating public health crisis.

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/Treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. We also have step by step guides on what to do to help yourself, a friend or a family member on our Treatment page.