Preventing and Controlling Misuse and Abuse of Controlled Prescription Drugs
There has been a lot of attention on opioids and the ravages of addiction to them. Fortunately, there is also heightened awareness of misuse of and dependence on barbiturates, benzodiazepines many medications used for insomnia.
Other prescribed medications that are scheduled as controlled substances are also frequently misused and can lead to dependence and addiction.
Stimulant medications (amphetamines, methylphenidate) commonly used to treat Attention Deficit/Hyperactivity Disorder (ADHD) are frequently misused for their energizing and improved concentration effects and dependence can easily occur. Even when stimulant medications are taken as prescribed, developing a tolerance and eventually a dependence over time is not unusual and that is why a responsible prescriber will incorporate “drug holidays” into the medication management plan and interrupt treatment periodically to assess the need for continued use in addition to non-pharmacologic interventions.
The estimated prevalence of prescribed stimulant use in young people ages 3-24 in the U.S. is 10.6%. That’s more than 73 million individuals. Although being prescribed medication to treat ADHD does not increase the likelihood of developing a substance use disorder, it is imperative that we are vigilant with monitoring and educating children and their parents about misuse of stimulant medications since non-medical use and diversion of stimulant medications among youth tends to peak in late adolescence.
Tramadol was approved by the FDA in 1995 as a safer alternative to opioids to treat moderate pain. It was initially considered to be a drug with low abuse potential, however, within 3 years patterns of tolerance and dependence, nonmedical use and diversion as well as withdrawal symptoms similar to those seen with opioids were beginning to emerge through analyses of prescribing practices, emergency department visits and case reports. In 2014 Tramadol became a schedule IV substance that dose in fact have considerable abuse potential.
Gabapentin was approved for use as an antiseizure medication in 1994 and marketed under the brand name Neurontin. In 2002 it was approved for use in treating neuropathic pain. A generic version became available in 2004 and it has been used “off-label” to treat a variety of conditions including migraines, restless leg syndrome, mood and anxiety disorders and alcohol withdrawal. Not so coincidentally, a successor to gabapentin, pregabalin (Lyrica) was approved for use in treating chronic pain syndromes in 2004. Both drugs inhibit the release of excitatory neurotransmitters and act on the dopaminergic “reward system.” Pregabalin is more potent and absorbed more quickly. Pregabalin is a schedule V controlled substance with recognized abuse potential. Gabapentin is not a controlled drug, but has been increasingly misused over recent years either alone in doses that substantially exceed recommended doses or in combination with other substances. More details on misuse of gabapentin will be discussed in a later post.
Misuse of pregabalin often involves combining it with opioids to enhance euphoric effects.
The Long-Term Approach to Prevention
With greater awareness of the misuse and abuse potential associated with prescription medications that are not typically the focus of the addiction crisis we are facing currently, we can begin to expand our perspective on prevention strategies.
 Olfson, M., Kind, M., Schoenbaum, M. (2016). Stimulant treatment of young people in the United States. Journal of Child and Adolescent Psychopharacology, 26(6), 520-526.
 McCabe, S.E., Kloska, D.D., Veliz, P., Jager, J., Schulenberg, J.E. (2016). Developmental course of non-medical use of prescription drugs from adolescence to adulthood in the United States: national longitudinal data. Addiction, 111(12), 2166-2176.