This morning, I am releasing the deeply troubling findings of The National Center on Addiction and Substance Abuse (CASA) at Columbia University report, Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. The types of controlled prescription substances covered in the report are opioids, depressants, stimulants, and steroids.
This 214-page report is the first comprehensive analysis of all aspects of controlled prescription drug abuse in our nation--from patient scams to inadvertent addiction, from gaps in professional training to drug formulation and marketing, from parental carelessness to physician ignorance, from rogue Internet pharmacies to local, state and federal monitoring, regulation and enforcement. It represents three years of intensive work by The National Center on Addiction and Substance Abuse (CASA) at Columbia University, including landmark national surveys of physicians and pharmacists, more than 200 interviews, seven focus groups, a national conference on substance abuse and pain management, and a review of more than 2,000 publications. Findings presented in this report are also the result of an extensive and unprecedented analysis of 15 national data sets by CASA’s Substance Abuse Data Analysis Center (SADACsm). Created in 1995, SADACsm, has a unique capacity to analyze and compare the wide variety of data sets necessary for a report of this depth.
The bottom line is this: our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction. Today more people are abusing prescription drugs than the combined number who abuse cocaine, hallucinogens, inhalants and heroin. And that number underestimates significantly the extent of the epidemic. Most of the raw and survey data analyzed in this report are self-reported, often in the home, a school or over the phone. It is largely representative of the non-institutionalized U.S. population, ages 12 and older. Respondents, particularly teens, tend to under-report substance use behaviors. High-risk institutionalized populations (such as incarcerated individuals, hospital patients, nursing home residents, patients in drug abuse treatment) and the homeless are excluded in National Surveys on Drug Use and Health and Monitoring the Future Studies. The excluded populations are likely to evidence much higher levels of controlled drug abuse.
While we in America have been congratulating ourselves in recent years on curbing increases in alcohol and illicit drug abuse, and in the decline in teen smoking, abuse and addiction of controlled prescription drugs--opioids, central nervous system depressants and stimulants and steroids--have been stealthily, but sharply, rising. Between 1992 and 2003, while the U.S. population increased 14 percent, the number of people abusing controlled prescription drugs jumped 94 percent--twice the increase in the number abusing marijuana, five times the increase in the number abusing cocaine and 60 times the increase in the number abusing heroin. Controlled prescription drugs (like OxyContin, Valium and Ritalin) are now the fourth most abused substance in America behind only marijuana, alcohol and tobacco.
Particularly alarming is the 212 percent increase from 1992 to 2003 in the number of 12- to 17-year olds abusing controlled prescription drugs, and the increasing number of teens trying these drugs for the first time. The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made the medicine cabinet a greater temptation and threat than the illegal street drug dealer, as some parents have become unwitting and passive pushers.
Teens who abuse controlled prescription drugs are twice as likely to use alcohol, five times likelier to use marijuana, 12 times likelier to use heroin, 15 times likelier to use Ecstasy, and 21 times likelier to use cocaine, compared to teens who do not abuse such drugs.
America is in a perfect storm of abuse of mind altering prescription drugs. Why?
One factor driving the increase in controlled prescription drug abuse is that these drugs can be found in abundance in family medicine cabinets in every town in America, and they are just a click away on the Internet. They can be acquired with relative ease from doctors, friends, relatives and classmates. The fact that controlled prescription drugs are approved by the Food and Drug Administration and prescribed by a physician leads many to conclude that they are safe even when abused. Sadly, nothing could be further from the truth.
The Internet is a wide-open highway for distribution of illegally acquired abusable prescription drugs. Bo Dietl and his firm conducted investigations which found hundreds of Web sites advertising and selling controlled prescription opioids, depressants, stimulants and steroids. A little Internet savvy and a credit card were the only requirements to have the drugs arrive at the designated address within a few days. He is here this morning to discuss the results of his investigations.
Pharmaceutical companies may contribute to diversion and abuse by the way they formulate and market controlled drugs. The abuse potential of a drug is linked to the speed and intensity of the high it creates. Drugs like OxyContin and Dilaudid that can easily be altered to destroy their time-release mechanism are premium on the abuse market. Yet, formulation of a drug to reduce its abuse potential is not a required consideration by either pharmaceutical companies or the Food and Drug Administration (FDA) in bringing a controlled drug to market. Nor are plans to
manage the risk of diversion and abuse required for all controlled drugs prior to their release. Aggressive marketing of controlled drugs to physicians--as occurred with OxyContin for moderate as well as severe pain--is designed to increase profits with little regard for abuse potential. In recent years pharmaceutical companies have begun to market controlled prescription drugs directly to consumers in order to increase demand.
Controlled prescription drugs can be stolen anywhere along the pathway from manufacture to consumption and diverted for illicit use by individuals or sophisticated criminal operations. CASA’s surveys of physicians and pharmacists reveal their culpability.
Parents also play a key role. Their easily accessible medicine cabinets containing these very drugs are an open invitation to children--fueling “pharming” parties where teens bring drugs from home and trade or share for purposes of getting high. Parental ignorance about the dangers of these drugs and failure to safeguard them (e.g., by locking their medicine cabinets) can yield inadvertent but devastating harm to their own children. Parents should also monitor their teens’ use of the Internet.
The rapid pace of development of new mood-altering pharmaceuticals and the sharp rise in abuse and addiction of controlled prescription drug abuse makes confronting this problem a matter of the highest urgency. We need an all-fronts effort of prevention and control. The task of eliminating diversion and abuse cannot be left to law enforcement alone, for even the most well funded and staffed enforcement efforts cannot succeed on their own. Parents, physicians, pharmacists, pharmaceutical companies, schools and public health officials must sign up.
I hope this report will be a wake up call to Americans. It provides a roadmap for coming to terms with this problem--preventing children from dangerous experimentation, protecting adults from inadvertent abuse and addiction, and controlling willful diversion for purposes of abuse--while preserving the availability of these important drugs for those who can benefit from their use under a physician’s care. Dealing effectively with abuse of controlled prescription drugs is essential to preserve their availability for appropriate use to improve the lives of Americans who need them.
Many individuals and institutions made important contributions to this work.
The CASA National Advisory Commission on the Diversion and Abuse of Controlled Prescription Drugs, chaired by Alan I. Leshner, PhD, Chief Executive Officer of the American Association for the Advancement of Science and former Director of the National Institute on Drug Abuse, provided extraordinary advice and ideas. Alan Leshner’s outstanding leadership, and his commitment and that of the Commission members, contributed significantly to the quality of this product. He is here this morning.
We extend special thanks to Bo Dietl and his professional colleagues at Beau Dietl & Associates, who volunteered their time and investigative talent to conduct a baseline analysis in February 2004, and a follow-up analysis a year later, of the availability of controlled prescription drugs on the Internet, and who conducted a special investigation of online availability of steroids.
We would not have been able to analyze changes in prescribing abusable prescription drugs without the help of Intercontinental Marketing Services (IMS). IMS provided specific data analyses drawing on their database of the National Prescription Audit™ Plus.
We thank Survey Research Laboratory at the University of Illinois at Chicago for their work on the focus groups and surveys.
Susan E. Foster, MSW, CASA’s Vice President and Director of Policy Research and Analysis, directed this effort. Linda Richter, PhD, senior research manager, was the Project Manager. CASA’s Substance Abuse Data Analysis Center (SADACSM), headed by Roger Vaughan, DrPH, CASA Fellow and associate clinical professor of biostatistics at Columbia University, was responsible for the data analysis which was conducted by Hung-En Sung, PhD, research associate, with assistance from Elizabeth Peters.
# # #