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Massachusetts Medical Society's
Physician Focus

January 2011

Prescription Drug Abuse


  • An estimated 48 million people -- or 20 percent of the population age 12 and older -- have used prescription drugs for nonmedical reasons in their lifetimes.

  • The elderly are vulnerable to abuse and misuse because they are prescribed more medications – 90 percent of seniors rely on a prescription medicine on a regular basis.

  • Abuse by young people is alarming, with nearly two million youth age 12-17 abusing painkillers, steroids, stimulants, and other prescriptions.

  • A common and frequent source of many of these drugs is the home medicine cabinet.

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Substance Abuse and Mental Health Services Administration

National Institute on Drug Abuse

Prescription Drug Abuse

Partnership for a Drug-Free America

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Prescription Drug Abuse PSA

From left: Dr. Bruce Karlin, Dr. Barbara Herbert, Dr. Daniel Alford
hi-res photo
promo slide

Prescription drugs are some of medicine’s greatest therapies, relieving pain and curing illness. Yet despite all the good, a dark side has emerged: Prescription drugs have become the second most commonly abused category of drugs, behind only marijuana and ahead of cocaine, heroin, and other drugs.

“Locally, regionally, and nationally, prescription drug abuse is a huge, widespread problem,” says Daniel Alford, M.D. “People have a false sense of security about these drugs. They think that because they are prescriptions, they must be safe.”

Dr. Alford, medical director of the Massachusetts Screening, Brief Intervention, Referral and Treatment Program and the Office-Based Opioid Treatment Program, based at Boston Medical Center, and Barbara Herbert, M.D., medical director of the Comprehensive Addiction Program at St. Elizabeth’s Medical Center in Boston, offered an in-depth discussion of prescription drug abuse with host Bruce Karlin, M.D. on the January edition of Physician Focus with the Massachusetts Medical Society.

Spurred in part by more aggressive medical treatments of pain and anxiety and marketing and advertising by drug makers, demand and use of prescription drugs has soared in the last decade: from 1999 to 2009, the number of prescriptions written in the United States increased by 39 percent, while the population increased only 9 percent, according to the Kaiser Family Foundation.

The problem of abuse and misuse is especially alarming with young people. More than two million youth age 12-17 are abusing painkillers, steroids, stimulants, depressants, and other prescriptions. And the primary source of these drugs is not dealers on the street, but most often from a far more common source that’s right at their fingertips: the family medicine cabinet.

“Many of the young people who start to use these drugs have gotten them often from family members who got them for a reason that was totally appropriate,” says Dr. Herbert. “Young people raid family medicine cabinets and discover that this is a way to get high and they become addicted. We see that this is the clearest pathway that we’re losing our young people to heroin.”

Part of the problem, and part of the solution, says Dr. Herbert, lies in meaningful communication between physician and patient. “The role of opioid pain medication,” she says, “is that they take away pain, so there are meaningful and good uses for these drugs.”

“But how much you need, what you do if you don’t need all of it, and how to dispose of it properly are conversations that doctors and patients should be having. Having a bunch of opiates hanging around when they’re not needed is a problem waiting to happen. When people get so caught up in the idea that they have to have the next dose, that it takes over their lives, that’s when we’re worried about addiction,” she says.

Dr. Alford emphasizes, and expands on, the point. “Communication with families is incredibly key,” he says. He encourages family members to come to physician visits with patients to provide additional information that will help the physician learn more about the patient’s situation. “Oftentimes, patients don’t appreciate that they’re overmedicated or just not functioning well,” he says. “There needs to be some educating of both patient and families that these medications have a role and can be safely prescribed.”

For patients on such prescriptions, Dr. Alford offers this suggestion: “These medications for pain can be incredibly effective, but they do carry risk. It is critically important for patients to have an honest dialogue with their doctor about the risks and benefits on an ongoing basis.”

Watch the accompanying video for the full discussion, which includes conversations about the difference between addiction and physical dependence, aspects of safe disposal of prescription drugs, the tools physicians use to keep patients safe and how they can detect whether patients are seeking drugs or seeking pain relief, and what physicians can do for patients who are addicted.

MMS/Richard Gulla