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June 30, 2011 — Prescription drug abuse continues to be a serious problem in the United States, according to 2 new reports by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The first report showed that although treatment admissions related to alcohol and marijuana rose between 1999 and 2009 for patients older than 12 years, one of the most notable shifts was the significant increase in the misuse of prescription opiates — from 8% to 33% of all opiate admissions.

"These data underscore the severity of our nation's prescription drug abuse epidemic and the importance of public awareness regarding the harms caused by drug use," said Gil Kerlikowske, director of the Office of National Drug Control Policy, in a release.

"All of us share the responsibility to address our nation's drug problem by working collaboratively at the federal, state, and local level to prevent drug use before it starts, expand access to drug treatment, and support enforcement efforts that disrupt the diversion of prescription drugs," he added.

The Treatment Episode Data Set (TEDS) report was published online June 23 on SAMHSA's Web site.

'Still a Great Concern'

As reported by Medscape Medical News, SAMHSA released a report last year showing that emergency department (ED) visits resulting from prescription opioid use increased by 111% between 2004 and 2008.

Dr. Gil Kerlikowske

This April, the Obama administration released a comprehensive action plan for fighting prescription drug abuse, including a call for expanding state-based monitoring programs.

Deborah Trunzo, from SAMHSA's Center for Behavioral Health, Statistics, and Quality in Rockville, Maryland, told Medscape Medical News that TEDS includes almost 2 million admission records each year, providing "an extremely detailed picture of who is going into substance abuse treatment and why. And it gives us a pretty good insight into which substances are causing the most problems."

She said researchers weren't surprised by the findings because "there has been a gradual increase in prescription pain killer admissions for quite a few years now. But it's still a great concern because it shows that it's a continuing problem out there."

The study also showed that although alcohol was the leading drug cited for treatment admissions among all major ethnic and racial groups (except for Puerto Ricans), 44% of these admissions also involved abuse of other drugs.

The drug class most abused by Puerto Ricans entering treatment was opiates.

Overall admissions related to marijuana increased from 13% to 18%. Of these, 74% of these admissions were for males and 48% for whites. Marijuana was also cited by 86% of the patients between 12 and 17 years of age as the main or secondary reason for their admission.

National Challenge

"This new report shows the challenge our nation's health system must address as the treatment needs of people with drug and alcohol problems continue to evolve," said Pamela S. Hyde, JD, SAMHSA administrator in Rockville, Maryland, in a statement.

"People often arrive in treatment programs with multiple problems — including dependency or addiction to multiple substances of abuse. As healthcare reform continues to improve the delivery of health services in our country, this type of information will increasingly be used to inform the needs of an integrated system of care."

Interestingly, cocaine-related admissions during the study period decreased from 14% to 9%. Methamphetamines/amphetamines misuse increased between 1999 and 2005 (from 4% to 9%) but then decreased to 6% by 2009.

Finally, "five substance groups account for 96% of the 1,963,089 admissions of people aged 12 and older that occurred in 2009," write the report authors. These included the following:

  • Alcohol (42%);
  • Opiates (21%);
  • Marijuana (18%);
  • Cocaine (9%), and
  • Methamphetamines/amphetamines (6%).

"I think this report shows that there is a steady need for treatment among the age groups. And there is still a lot of work to be done out there in terms of prevention," said Ms. Trunzo.

"Prescription pain killer abuse is a common problem likely to be crossing clinicians' doorsteps. It's a continuing problem, and they need to be prepared for it and to continue to find ways of treating it effectively."

Increased Suicide Attempts

The second SAMHSA report is based on data from the 2005-2009 Drug Abuse Warning Network (DAWN).

It found that ED visits in the United States for drug-related suicide attempts increased by 54.6% for younger males (21 to 34 years of age) between the 2 study periods (from 19,024 to 29,407 visits). The total ED visits for this reason for all males in 2009 was 77,971.

"Suicide ranks as the seventh leading cause of death among males, [and] in 2007, males committed suicide at nearly 4 times the rate of females," report the authors.

The study looked only at cases determined to be caused by intentional drug-related suicide attempts and not by unintentional overdose. It also did not look at suicide attempts by other methods, unless it also included drugs.

Significant increases in attempts were found between the 2 periods for the younger males involving antidepressants (by 155.2%) and antianxiety/insomnia medications (by 93.4%).

Attempts involving narcotic pain relievers increased by 79.5% for males 35 to 49 years of age and by 193.3% for those 50 years and older. For those 35 to 49 years old, visits involving hydrocodone increased by 259% and visits involving oxycodone increased by 265.4%.

"With the attempted suicides, we don't know how much a particular type of drug could be said to be responsible. All we can report on is that drugs are involved and related to the visit," DAWN project director Albert Woodward, PhD, told Medscape Medical News.

"So we cannot say that 1 drug or 1 group of drugs was the reason. These figures are noteworthy, but there could have been other drugs involved too, including alcohol," he said.

Still, the misuse of prescription drugs is clearly helping to fuel the problem, said Ms. Hyde. "Greater awareness about the warning signs and risk factors for suicide, including abuse of alcohol and drugs, can help people take action and save lives."

The researchers recommend that clinicians ask adolescents annually about any thoughts or behaviors "that may indicate risk for suicide." For those in the 21- to 34-year age range, they suggest integrating mental health services into substance abuse treatment programs. For older adults, clinicians should screen for depression as part of routine primary care.

"My feeling is that these patients need to get to the appropriate place for treatment. And those that treat them need to be aware of these potential problems arising," said Dr. Woodward.

"What we're trying to do with these reports is to alert the public, alert treatment providers, and alert people involved in prevention efforts to get them aware of what the problems are so they can then focus their efforts."

Taking an alcohol awareness class or drug education class is one of the ways to reduce abuse.

SAMHSA. TEDS 1999-2009. Released June 23, 2011.

SAMHSA. The DAWN Report. Trends in ED Visits for Drug-Related Suicide Attempts Among Males: 2005-2009. Released June 17, 2011.

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