Fewer Young Adults are Abusing Prescription Opioids

 

 

 

The results for 2011’s National Survey of Drug Use and Health (NSDUH) are in, and for the first time in years, the nonmedical use of prescription drugs showed a significant decline among people aged 18 to 25. In 2010, 2 million U.S. citizens in this age group were using these drugs, but in 2011 the number dropped to an estimated 1.7 million, a decline of 14%, and the lowest use we’ve seen in this survey since 2003. Adolescents age 12 to 17 also had a drop in the non-medical use of prescription drugs, from 4% in 2002 to 2.8% in 2011. [1]

Health officials attribute say this drop is likely due to physician education about the dangers of prescription opioids

Other pertinent findings include: 8.7% of U.S. citizens above age 12 (or 22.5 million people) used an illicit drug within the preceding 30 days. This doesn’t mean these people were addicted, only that they used within the last month. This rate wasn’t significantly different from the preceding year, where 8.9% of the population used illicit drugs within the past month.

Not surprisingly, marijuana was the most commonly used illicit drug.

For all U.S. citizens over age 12, fewer used psychotherapeutics in 2011 than 2010.  The term psychotherapeutics includes opioids, stimulants, and sedatives, but opioids still account for 70% of all non-medically used psychotherapeutics. The percentage dropped from 2.7% of the population in 2010, to 2.4% in 2011. This means in total number of people using psychotherapeutics non-medically dropped from 7 million to 6.1 million.

Sadly, use of heroin has risen over the past several years, and now an estimated 620,000 people are using, compared to 373,000 in 2007. This fits with what I’ve been hearing from my patients, even the ones who live in rural areas. Prescription opioids are fortunately getting harder to find, meaning the price has been increasing. The downside is that now heroin is cheaper than the pills in many areas. People who have never used heroin, only pills, are now making the switch to save money, stay out of withdrawal, and of course, to get high.

As in past years, over half of the adolescents who use prescription medications to get high get their pills from friends and family.

What does it all mean, you ask? I hope it means the tide has finally turned, and people have become aware of how dangerous it is to abuse prescription medications, especially opioids. I do think doctors are slowly becoming aware of the risks of addiction to the medications they prescribe, and watch patients more closely than they have in the past. I also think the U.S. public understands that just because a drug is a prescription medication doesn’t mean it’s safe.

I hope our epidemic of opioid addiction and opioid overdose is starting to cool down, and that we’ll see addiction rates start to drop. Time will tell.

1. http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm

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6 responses to this post.

  1. Posted by Benjamin K. Phelps on November 28, 2012 at 5:54 pm

    Dr Burson, I do want to comment here on a phrase in your blog here: you said “fortunately” the prescription opioids are getting harder to find. While I understand your viewpoint, please remember that when that is the case, it only means many times that the people who would be using them are now using the MUCH more unsafe opioid heroin, as you’ve pointed out in your article by saying its use is on the rise. Prescription opioid abuse may not be safe, & I agree it’s not. However, it’s MUCH safer to use a pill that you know the potency of than a bag of powder that could be 10% pure or 90% pure. Unfortunately, once physically dependent, that potency level isn’t going to matter to the addict – s/he’s going to use it whatever the potency is to stave off withdrawal. That conundrum has always bothered me – it’s sort of like needles being illegal to sell to an addict – it’s a prescription for the spread of HIV/AIDS. Sure, selling needles to an addict seems bad on the outside. But when you consider that s/he’s going to use a needle one way or the other, do we want that person to use a dirty needle & chance HIV/AIDS, or do we want him/her to use a clean one in the hopes that s/he will find recovery soon & find a way out of this mess? If we in addiction treatment (the providers & the patients that have found recovery) say that we understand & believe that opioid dependence is a disease, then we can’t very well be angry that the addict cannot yet stop him/herself from using needles if a path to recovery hasn’t yet been found or isn’t available (for those that don’t live close to medication-assisted treatment.) It may be true that most live near a Suboxone provider, but methadone is needed for many IV users, & it simply isn’t feasible for some, nor available for nearly everyone that needs it. With NIMBY alive & well, it’s not likely to get a whole lot better any time soon, either. I’m not trying to split hairs or get caught up on semantics here. I just want to say for those still suffering in their addictions to opioids, to hear someone say that it’s fortunate that they are denied prescribed opioids, that the safer alternative to street opioids isn’t available to them or is now extremely expensive (especially when compared to heroin,) or anything like that can feel VERY much like a slap in the face to them. I know – I was once that person. I didn’t live even remotely close to MMT, bupe wasn’t yet available, & I was DESPERATELY trying to stop writing prescriptions, but had no feasible way to do so, since I couldn’t get the medication I needed legally. It REALLY HURT to hear people say that this was a good thing! I know that you didn’t in ANY way mean that to be taken in such a way. I guess I’m just wanting to give you a perspective of how it’s heard by the suffering addict that wants to get clean right now & can’t. No disrespect nor “putting you in your place” intended. I appreciate what you do each & every day & wish you the best!

    Reply

    • Yes, thanks for writing. I said “fortunately” thinking that fewer opioid pills on the street will mean fewer new addicts will be created. When supply is harder to find, fewer people become addicted. And when doctors write prescriptions too freely, we end up with an epidemic of opioid addiction, which I think we can all agree is not a good thing.

      we see the same thing with alcohol. Where there are more places to buy alcohol, and where it’s cheaper, there will be more alcoholics. And with alcohol, an increase in price reduces the use of even heavy drinkers.

      however, you are talking about harm reduction, saying prescription opioids are safer than heroin. That’s probably true, though I think some addicts tend to underestimate the danger that still exists when you inject a non-sterile substance, manufactured to be taken by mouth. Witness the TTP we are seeing in IV Opana injecters.

      I’ve heard some doctors – with good reasoning – say that buprenorphine (subutex, suboxone) should be dispensed on street corners to opioid addicts, since it is the safest of all opioids to take. From a harm reduction view that’s true. But the problem comes when one person’s harm reduction is another person’s enabling. No easy answers here…would that action create addiction in people who otherwise may not become addicted? probably.

      Reply

      • Posted by Benjamin K. Phelps on December 2, 2012 at 12:10 am

        I think my big question there is with what you said being true (and I do agree with the things you said…), why are we seemingly (as a country & as individuals) “okay with” keeping alcohol legal when the same is true for it: were it not legal & in stores everywhere, there would be far fewer alcoholics. There would be far fewer DWI’s. There would be far fewer deaths by drunk drivers. The list could go on & on & on. So why do we make the exception there & then cringe at the very notion that allowing harm reduction might cause an extra addict here & there? I’m not saying that it’s okay to cause extra addicts to exist… I’m just wondering why we have no issue with it on one hand & get completely bent out of shape on the other hand. I would not want to see heroin on the shelf in the ABC store nor see others become addicted to it that otherwise wouldn’t. But for those of us that are in desperate need of opioid maintenance, it would be wonderful to not have to jump through a million & three hoops to get it, drive everyday for it, pee for people left & right while having them stare at our genitals, attend counseling, attend group, pay 62 times what the medication actually costs, etc, etc. My scooter was stolen last week on Tuesday from the first parking space outside the Hhgregg store front door. I had gone to the clinic that morning & picked up my 3 takehomes I usually got on Tuesdays. Since I had to be at work before we opened that morning, I could not possibly get back home across town from the clinic & then drive BACK across town to work, so the lockbox had to go under my seat (which also stayed locked.) So it was double locked while I was at work, and then the steering wheel of the bike was locked to the side. Well, when it was stolen, I immediately called the police & filed a report, including for the methadone. I also immediately called our clinic’s emergency line & informed them of the situation. Long story short, they rescinded EVERY takehome I’ve earned over the past year & a half (I was at five, with perfect compliance – all clean U/A’s, all groups required were attended, all counseling attended, all payments made on time.) This was 2 days before Thanksgiving, so they completely alleviated any ability to have Thanksgiving with my family, as it was too late to guest dose. They also knew the bus does not run on holidays, & that I had no way in the world to get to the clinic. They did not care. I wrote a letter asking for consideration for the staffing meeting, & it was not even acknowledged. All I was given was a single hardship takehome for Sundays b/c the bus CANNOT get me to the clinic & work on time that morning – & they acted like that was some kind of huge favor they’d done me. Why I would be punished b/c SOMEONE ELSE decided to steal what wasn’t theirs & leave me without any transportation in this world, without my medicine that I have to have, & without any money to replace either of the two items is not only beyond me, it’s completely unacceptable. I am at the point where I’ve contacted corporate, & if they do not reverse this decision, I intend to drop out of treatment. I will sooner go back to the street life than be treated this way for doing the RIGHT thing by staying clean & being honest with the ONE place I’m supposed to be being taught to be honest by. I brought that up b/c this is the PERFECT example of what I’m talking about when I say that the system we have here, as you & I & so many others already know all too well, is SO prohibitive & full of red tape, & NIMBY is SO alive & well, that with only 1 or 2 clinics to choose from in a given area, people are constantly faced with treatment by the staff such as this B/C THEY CAN treat people this way & get by with it. Hence, most people aren’t willing to tolerate treatment centers & the rules that go with them. Can anybody blame them? Now I’m right there with them, as this is the 2nd time in the last 4 years that I’ve had my privileges completely revoked over having done NOTHING wrong. I won’t live that way. So some type of harm reduction needs to be available, or else we’re just sending the message that we pretty much don’t care if the people affected by this disease kill themselves in it & never have a fighting chance to recover. I don’t feel I can advocate for MMT any longer if I’m sending people to be treated this same way in their local clinic(s). I don’t advocate torture & punishment for punishment’s sake. I know I got a little off topic there, but I did want to get your input & view on the situation I was put in here. I can understand & see if they want to speak to me & perhaps form a plan to ensure this isn’t likely to happen again in the future – I’m already working on getting a car, in which case, I would have the ability to drive back home before heading to work, so I can store my meds in the house instead of my vehicle on days I must work in the early morning. But it wasn’t possible that day, & so there’s no need for them to think they’re teaching me some valuable lesson by doing what they’re doing. And they took them for a full 6 months, btw. What are your thoughts on this – and I’m not asking you to comment on the clinic per se, just the actions taken for the circumstances at hand, keeping in mind I’ve NEVER given them any reason whatsoever to be suspicious about my handling of my meds, nor have they even hinted that they had any thoughts that I might have taken it myself to have 3 extra doses… (That would be a crime anyway, since I would have filed a fictitious police report in that case.) And since I figured they’d do exactly what they did when I called to report it, I knew ALL too well it would NOT be worth it just for keeping 3 extra doses. I don’t crave extra opioids anyway.

      • I hate that happened to you. It’s an awful situation. Having said that, I would have made the same decision as your clinic doctor. I know that sounds harsh. Here on one hand you have an excellent patient who is doing great. And on the other, treatment programs absolutely have to follow state and federal regs in order to stay open. When I approve a take home dose, I’m telling the government agencies yes, this patient can safely store his medication. If you’ve just had three bottles stolen, no way can I say that. Plus, there are 3 bottles of methadone with my name on them as the prescriber floating around on the street. What if someone dies of an overdose and they find this bottle on the premesis? Besides an overdose tragedy, the legal ramifications could be unpleasant. You are protected since you filed a police report, thank God.
        And I have to worry about relapse and medication misuse in patients for whom I’ve approved take homes. If you’ve had a relapse, there are incentives to lie about having your bottles stolen. In an average month you wouldn’t believe all the accounts I get of stolen, misplaced, or otherwise missing medication. All of these patient swear they are telling the truth. Some of them I tend to believe and some of them I don’t, but I’m not a human lie detector. I can be fooled. Why not be safe and revoke take homes at least for a few weeks until the staff and I can come to a consensus on how the patient is really doing?
        You look at it from the view of, “I’m a good patient and I earned my take homes. Why can some fool who decided to steal mess that up for me?” I look at it from that point, but also have to consider all the policitians, eager to do away with methadone, who say, “Doctor, you are careless and wrong to give a drug addict take home medication in the first place.”

        Are you sure they took your take homes for 6 months? That’s the part that seems extreme to me.
        I hate it happened to you. I hope you take a deep breath, maybe wait until your anger abates some, then ask to meet with the program manager and explain you know the clinic has to remove take homes, but please re-consider the length of time. Emphasize your compliance with treatment, and explain your new plan to store medications safely so what happened can never happen again. If you don’t feel like you are heard, then file a grievance and explain your situation.

        Please re-think leaving treatment. People die in relapse. don’t go back to active addiction just to spite your treatment staff, because that harms you more than anyone else. If you can’t stand to stay there, go to another clinic if possible. consider suboxone or other treatments. don’t give up.

  2. Posted by nonya biz on December 10, 2012 at 3:28 pm

    this is the natural ebb and flow of opiate addiction… heroin made a huge comeback in the early 90’s, and the quality was great, but as the pharm and pain management scene began promoting roxycodone (at least in Florida and the surrounding states) heroin sales started slacking. now with the crackdown on ‘pill mills’ here in the sunshine state, heroin is back in full effect. in 2009, there were over 90 million roxys sold (according to FDA sales records for FL, i dont know the breakdown of milligrams, 15s or 30s, off hand)… after the crackdown, there has been 1/5 that amount of pills available, but i assure you there are not 1/5 less addicts in the state. so now you have the same amount of addicts competing for 1/5 the amount of pills. you dont think they just gave up, do you?

    so really the amount of addicts or use hasnt changed, only the ability to track them by the sales records of pills by pharmacies. as you probably know, heroin dealers dont report sales to the FDA like Walgreens does. the FDA also doesnt regulate the quality of heroin, so you really have to ask if there was anything good about the report… yes, fewer young adults are abusing prescriptions, but more are pursuing other avenues of attack… so the problem is not being improved per se, only hidden from public view.

    Reply

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