This is particularly true of young people, who are at the highest risk of starting to abuse prescription drugs.“For adolescents, the primary source is friends and relatives,” says Carol Boyd, who studies prescription medicine abuse at the University of Michigan in Ann Arbor.
These are electronic systems that can show doctors, pharmacists and law enforcement officials what a patient has been prescribed over the past three to six months, who prescribed it, how many times a prescription has been refilled and other data.
There is some patchy evidence from the United States that such systems can reduce overprescribing, but getting doctors on board is tricky.
Regulations, according to Boyd, run up against “a quality of life issue”.
She says: “I would never want patients to not have access to these medications.”Governments can also help doctors prescribe more wisely by setting up prescription drug monitoring programmes, says Rebecca Haffajee, a pharmaceutical policy researcher at Harvard Medical School, Boston, Massachusetts.
In 2012, the agency introduced a requirement that the manufacturers of slow-release opioids make educational materials available to doctors and patients.
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So far around 20,000 prescribers have taken educational courses, and the FDA hopes to increase that number to around 80,000 this year. “We want to get the best information to the doctors so they decide who’s going to benefit from these drugs, and who’s going to be potentially placed at risk of harm by using them.”But regulators and doctors need to strike a balance between keeping the drugs away from those who might abuse them, and ensuring that they are available for patients who genuinely need them.Drug monitoring programmes are usually separate from other e-health records, and often have clunky or slow user interfaces.Every state except Missouri has a system in place but participation rates are only around 35%, says Haffajee.Stamford, Connecticut-based Purdue Pharma, which makes the often-abused painkiller Oxy Contin, was the first to add an ‘abuse deterrent formulation’ to its pills in 2010.The new pills are harder, so they can no longer be ground into a fine powder that can be snorted, and include a polymer that turns to gel when mixed with water, so they cannot be drawn into a syringe.These include depressants — for example, benzodiazepines such as diazepam (Valium) and alprazolam (Xanax), used to treat anxiety — and stimulants — for example, the combination of amphetamine and dextroamphetamine (Adderall), and methylphenidate (Ritalin or Concerta), prescribed for attention deficit hyperactivity disorder.But by far the most widely abused, and dangerous, drugs are opioid painkillers, such as hydrocodone (Vicodin) and oxycodone (Roxicodone).The annual prevalence of abuse of opioid painkillers in the population is greater than 5% in the United States and more than 3% in Australia; across most of Europe it is well below 1%.Although there are indications that opioids are also being abused in Asia and Africa, Niaz adds, there is not yet any good data on the prevalence.“The extent of misuse of prescription opioids in Europe is not in any way comparable to North America,” says Niaz.Weaker regulatory restrictions, higher patient demand for ‘effective treatment’, and a more pronounced for-profit organisation of healthcare in North America, particularly the United States, may have exacerbated the problem in this region.In contrast, tighter control and surveillance over prescriptions in the UK’s NHS has probably kept the problem from reaching the same level, says Stannard.