TORONTO — Prescription drug abuse is growing at a faster rate than is illegal substance abuse, particularly among adolescents, Joseph A. Califano Jr. said at the annual meeting of the American Psychiatric Association.
“We think the country has got to deal with this problem, because the reality is we are seeing a tremendous increase in prescription drug abuse, particularly in young people,” said Mr. Califano, chairman of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, New York and a former Health and Human Services secretary under the Carter administration.
According to a large research project conducted by CASA that drew on several surveys and databases, the number of Americans abusing prescription drugs exceeds the numbers abusing illegal drugs, except marijuana, he said.
In 2003, 15 million Americans were abusing prescription drugs, compared with only 6 million using cocaine and 4 million using hallucinogens.
The number of Americans abusing drugs increased dramatically between 1991 and 2003, with the greatest rate increase coming among adolescents, for whom the absolute numbers rose from about 700,000 in 1992 to 2.3 million in 2003, an increase that surpasses 200%, Mr. Califano said.
That increase coincided with a huge increase in prescriptions for controlled substances, he noted. From 1992 to 2002, the population of the country grew 13%. The number of prescriptions written grew 57%. But the number of prescriptions for controlled substances rose 154%.
Physician and pharmacist surveys suggest that lax practice by members of both professions is partly to blame, or at least represents a missed opportunity to curb some prescription drug abuse, Mr. Califano said.
In a survey of 1,000 physicians and 1,000 pharmacists, a little more than half of each group said they blamed patients for most prescription drug abuse; altered prescriptions, doctor shopping, and outright lying were cited as ways people obtain controlled substances for abuse. However, 33% of the doctors said that before prescribing a controlled drug, they do not check and obtain patients' medical records to investigate patients' previous conduct and contact with physicians. Forty-three percent of doctors do not ask patients about their drug abuse history.
Sixty-one percent of the pharmacists said they never question patients about prescriptions for controlled drugs before they fill the prescriptions; one-third said they never review the patients' other previous or current prescriptions, and 28% said they do not regularly validate the Drug Enforcement Administration number on the prescription.
It is clear, too, that these prescription drugs are getting into the hands of teenagers and that teenagers who abuse prescription drugs will abuse other drugs, Mr. Califano said. Teenagers who abuse prescription drugs are twice as likely to abuse alcohol, five times more likely to use marijuana, and 15 times more likely to use ecstasy.
Focus groups suggest that adolescents do not view prescription drugs with the same reservations that they view illegal substances such as marijuana and cocaine.
“They don't look at them as illegal drugs,” Mr. Califano said. Part of that probably stems from the ubiquitous nature of prescription drugs. Teenagers see prescription drugs advertised, and they also see their friends—and even their parents—taking them. “For some kids, the medicine cabinet is a worse threat than the local dealer,” he added.