Prescription Medication Misuse

Abstract

In the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pain, seizures, spasticity) where the prescriptions of medications with misuse potential are indicated. It is therefore imperative that neurologists understand which medications are liable to misuse and institute strategies to minimize the harm associated with these medications. The authors review the most common medications prescribed by neurologist with misuse potential, and briefly discuss the behaviors that are suggestive of medication misuse and tools for monitoring patients to minimize medication-related harm from misuse.

Keywords

prescription medication misuse - substance use disorder - neurological disorders

• References

• 1 Substance Abuse and Mental Health Services Administration. Prescription drug misuse and abuse. Available at: https://www.samhsa.gov/topics/prescription-drug-misuse-abuse . Accessed August 5, 2018
• 2 Zacny J, Bigelow G, Compton P, Foley K, Iguchi M, Sannerud C. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. Drug Alcohol Depend 2003; 69 (03) 215-232
• 3 Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM. ; Centers for Disease Control and Prevention (CDC). Controlled substance prescribing patterns–prescription behavior surveillance system, eight states, 2013. MMWR Surveill Summ 2015; 64 (09) 1-14
• 4 Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17–5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration;
• 5 Alford DP, German JS, Samet JH, Cheng DM, Lloyd-Travaglini CA, Saitz R. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med 2016; 31 (05) 486-491
• 6 Dart RC, Surratt HL, Cicero TJ. , et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372 (03) 241-248
• 7 Kelly BC, Vuolo M, Pawson M, Wells BE, Parsons JT. Chasing the bean: prescription drug smoking among socially active youth. J Adolesc Health 2015; 56 (06) 632-638
• 8 Walsh SL, Nuzzo PA, Lofwall MR, Holtman Jr JR. The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers. Drug Alcohol Depend 2008; 98 (03) 191-202
• 9 Leece P, Orkin AM, Kahan M. Tamper-resistant drugs cannot solve the opioid crisis. CMAJ 2015; 187 (10) 717-718
• 10 Cepeda MS, Coplan PM, Kopper NW, Maziere JY, Wedin GP, Wallace LE. ER/LA opioid analgesics REMS: overview of ongoing assessments of its progress and its impact on health outcomes. Pain Med 2017; 18 (01) 78-85
• 11 Miech RA, Johnston LD, O'Malley PM. , et al. (2018). Monitoring the future national survey results on drug use, 1975–2017: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, the University of Michigan.; Available at: http://monitoringthefuture.org/pubs.html#monographs . Accessed September 17, 2018
• 12 Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43 (13) 879-923
• 13 The Medical Letter. Tapentadol (Nucynta)--a new analgesic. Med Lett Drugs Ther 2009; 51 (1318): 61-62
• 14 Cicero TJ, Adams EH, Geller A. , et al. A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 1999; 57 (01) 7-22
• 15 Dart RC, Dasgupta N, Bailey JE, Spiller HA. Interpreting poison center call volume associated with tramadol. [Letter] Ann Pharmacother 2011; 45 (03) 424
• 16 Butler SF, McNaughton EC, Black RA. Tapentadol abuse potential: a postmarketing evaluation using a sample of individuals evaluated for substance abuse treatment. Pain Med 2015; 16 (01) 119-130
• 17 Vosburg SK, Severtson SG, Dart RC. , et al. Assessment of tapentadol API abuse liability with the researched abuse, diversion and addiction-related surveillance system. J Pain 2018; 19 (04) 439-453
• 18 Stoops WW, Glaser PE, Rush CR. Abuse potential of tapentadol compared to tramadol and hydromorphone in recreational opioid users. Drug Alcohol Depend 2014; 140: e217-218
• 19 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain–United States, 2016. MMWR Recomm Rep 2016; 65 (01) 1-49
• 20 Safer DJ. Recent trends in stimulant usage. J Atten Disord 2016; 20 (06) 471-477
• 21 Ashok AH, Mizuno Y, Volkow ND, Howes OD. Association of stimulant use with dopaminergic alterations in users of cocaine, amphetamine, or methamphetamine: a systematic review and meta-analysis. JAMA Psychiatry 2017; 74 (05) 511-519
• 22 Murillo-Rodríguez E, Barciela Veras A, Barbosa Rocha N, Budde H, Machado S. An overview of the clinical uses, pharmacology, and safety of modafinil. ACS Chem Neurosci 2018; 9 (02) 151-158
• 23 Parran Jr TV, Jasinski DR. Intravenous methylphenidate abuse. Prototype for prescription drug abuse. Arch Intern Med 1991; 151 (04) 781-783
• 24 Goodman DW. Lisdexamfetamine dimesylate (Vyvanse), a prodrug stimulant for attention-deficit/hyperactivity disorder. P&T 2010; 35 (05) 273-287
• 25 Jain R, Stark JG. Safety and efficacy considerations due to misuse of extended-release formulations of stimulant medications. Postgrad Med 2016; 128 (07) 672-681
• 26 Wilens TE, Adler LA, Adams J. , et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47 (01) 21-31
• 27 Krishnan R, Chary KV. A rare case modafinil dependence. J Pharmacol Pharmacother 2015; 6 (01) 49-50
• 28 Spiller HA, Borys D, Griffith JR. , et al. Toxicity from modafinil ingestion. Clin Toxicol (Phila) 2009; 47 (02) 153-156
• 29 Coupey SM. Barbiturates. Pediatr Rev 1997; 18 (08) 260-264 , quiz 265
• 30 Silberstein SD, McCrory DC. Butalbital in the treatment of headache: history, pharmacology, and efficacy. Headache 2001; 41 (10) 953-967
• 31 Centers for Medicare and Medicaid Services. Center for Program Integrity, US Department of Health and Human Services. 2019 Final Call Letter Improving Drug Utilization Review Controls (Opioids). Available at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html . Accessed August 5, 2018
• 32 Möhler H, Fritschy JM, Rudolph U. A new benzodiazepine pharmacology. J Pharmacol Exp Ther 2002; 300 (01) 2-8
• 33 Tan KR, Brown M, Labouèbe G. , et al. Neural bases for addictive properties of benzodiazepines. Nature 2010; 463 (7282): 769-774
• 34 Drug Enforcement Administration Office of Diversion Control Drug & Chemical Evaluation Section. Benzodiazepines (Street Names: Benzos, Downers, Nerve Pills, Tranks). Available at: https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf Published January 1, 2013 . Accessed August 5, 2018
• 35 Sheehan MF, Sheehan DV, Torres A, Coppola A, Francis E. Snorting benzodiazepines. Am J Drug Alcohol Abuse 1991; 17 (04) 457-468
• 36 Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012; 125 (1-2): 8-18
• 37 Ciraulo DA, Sands BF, Shader RI. Critical review of liability for benzodiazepine abuse among alcoholics. Am J Psychiatry 1988; 145 (12) 1501-1506
• 38 Bouvier BA, Waye KM, Elston B, Hadland SE, Green TC, Marshall BDL. Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically. Drug Alcohol Depend 2018; 183: 73-77
• 39 Roache JD, Meisch RA. Findings from self-administration research on the addiction potential of benzodiazepines. Psychiatr Ann 1995; 25 (03) 153-157
• 40 Reisfield GM, Goldberger BA, Bertholf RL. ‘False-positive’ and ‘false-negative’ test results in clinical urine drug testing. Bioanalysis 2009; 1 (05) 937-952
• 41 Sanger DJ, Morel E, Perrault G. Comparison of the pharmacological profiles of the hypnotic drugs, zaleplon and zolpidem. Eur J Pharmacol 1996; 313 (1-2): 35-42
• 42 Gunja N. The clinical and forensic toxicology of Z-drugs. J Med Toxicol 2013; 9 (02) 155-162
• 43 Victorri-Vigneau C, Gérardin M, Rousselet M, Guerlais M, Grall-Bronnec M, Jolliet P. An update on zolpidem abuse and dependence. J Addict Dis 2014; 33 (01) 15-23
• 44 Hajak G, Müller WE, Wittchen HU, Pittrow D, Kirch W. Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction 2003; 98 (10) 1371-1378
• 45 Licata SC, Rowlett JK. Abuse and dependence liability of benzodiazepine-type drugs: GABA(A) receptor modulation and beyond. Pharmacol Biochem Behav 2008; 90 (01) 74-89
• 46 Weaver MF. Prescription sedative misuse and abuse. Yale J Biol Med 2015; 88 (03) 247-256
• 47 Mack A. Examination of the evidence for off-label use of gabapentin. J Manag Care Pharm 2003; 9 (06) 559-568
• 48 Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med 2006; 166 (09) 1021-1026
• 49 Johansen ME. Gabapentinoid use in the United States 2002 through 2015. JAMA Intern Med 2018; 178 (02) 292-294
• 50 Micó JA, Prieto R. Elucidating the mechanism of action of pregabalin: α(2)δ as a therapeutic target in anxiety. CNS Drugs 2012; 26 (08) 637-648
• 51 Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs 2017; 77 (04) 403-426
• 52 Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol 2017; 27 (12) 1185-1215
• 53 Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern?. CNS Drugs 2014; 28 (06) 491-496
• 54 Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction 2016; 111 (07) 1160-1174
• 55 Liu J, Wang L. Baclofen for alcohol withdrawal. Cochrane Database Syst Rev 2011; (01) CD008502
• 56 Perry HE, Wright RO, Shannon MW, Woolf AD. Baclofen overdose: drug experimentation in a group of adolescents. Pediatrics 1998; 101 (06) 1045-1048
• 57 Zullino DF, Eskenasy AC, Beeson J. High-dose tizanidine abuse. Psychopharmacol Bull 2003; 37 (03) 5-6
• 58 Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila) 2017; 55 (10) 1072-1252
• 59 Gonzalez LA, Gatch MB, Forster MJ, Dillon GH. Abuse potential of Soma: the GABA(A) receptor as a target. Mol Cell Pharmacol 2009; 1 (04) 180-186
• 60 Bailey DN, Briggs JR. Carisoprodol: an unrecognized drug of abuse. Am J Clin Pathol 2002; 117 (03) 396-400
• 61 Sun C, Hollenbach KA, Cantrell FL. Trends in carisoprodol abuse and misuse after regulatory scheduling: a retrospective review of California poison control calls from 2008 to 2015. Clin Toxicol (Phila) 2018; 56 (07) 653-655
• 62 Cimolai N. Cyclobenzaprine: a new look at an old pharmacological agent. Expert Rev Clin Pharmacol 2009; 2 (03) 255-263
• 63 Harden RN, Argoff C. A review of three commonly prescribed skeletal muscle relaxants. J Back Musculoskeletal Rehabil 2000; 15 (02) 63-66
• 64 Dwoskin LP, Rauhut AS, King-Pospisil KA, Bardo MT. Review of the pharmacology and clinical profile of bupropion, an antidepressant and tobacco use cessation agent. CNS Drug Rev 2006; 12 (3-4): 178-207
• 65 McCormick J. Recreational bupropion abuse in a teenager. Br J Clin Pharmacol 2002; 53 (02) 214
• 66 Hilliard WT, Barloon L, Farley P, Penn JV, Koranek A. Bupropion diversion and misuse in the correctional facility. J Correct Health Care 2013; 19 (03) 211-217
• 67 Evans EA, Sullivan MA. Abuse and misuse of antidepressants. Subst Abuse Rehabil 2014; 5: 107-120
• 68 Baribeau D, Araki KF. Intravenous bupropion: a previously undocumented method of abuse of a commonly prescribed antidepressant agent. J Addict Med 2013; 7 (03) 216-217
• 69 Pettinger WA. Pharmacology of clonidine. J Cardiovasc Pharmacol 1980; 2 (Suppl. 01) S21-S28
• 70 Dy EC, Yates WR. Atypical drug abuse: a case report involving clonidine. Am Fam Physician 1996; 54 (03) 1035-1038
• 71 Capogna G, Celleno D, Zangrillo A, Costantino P, Foresta S. Addition of clonidine to epidural morphine enhances postoperative analgesia after cesarean delivery. Reg Anesth 1995; 20 (01) 57-61
• 72 Beuger M, Tommasello A, Schwartz R, Clinton M. Clonidine use and abuse among methadone program applicants and patients. J Subst Abuse Treat 1998; 15 (06) 589-593
• 73 Soeiro-DE-Souza MG, Dias VV, Missio G. , et al. Role of quetiapine beyond its clinical efficacy in bipolar disorder: from neuroprotection to the treatment of psychiatric disorders (review). Exp Ther Med 2015; 9 (03) 643-652
• 74 McLarnon ME, Fulton HG, MacIsaac C, Barrett SP. Characteristics of quetiapine misuse among clients of a community-based methadone maintenance program. J Clin Psychopharmacol 2012; 32 (05) 721-723
• 75 Malekshahi T, Tioleco N, Ahmed N, Campbell AN, Haller D. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. J Subst Abuse Treat 2015; 48 (01) 8-12
• 76 Fischer BA, Boggs DL. The role of antihistaminic effects in the misuse of quetiapine: a case report and review of the literature. Neurosci Biobehav Rev 2010; 34 (04) 555-558
• 77 Bogart GT. Abuse of second-generation antipsychotics: what prescribers need to know. Curr Psychiatr 2011; 10 (05) 77
• 78 Klein-Schwartz W, Schwartz EK, Anderson BD. Evaluation of quetiapine abuse and misuse reported to poison centers. J Addict Med 2014; 8 (03) 195-198
• 79 Harmon TJ, Benitez JG, Krenzelok EP, Cortes-Belen E. Loss of consciousness from acute quetiapine overdosage. J Toxicol Clin Toxicol 1998; 36 (06) 599-602
• 80 Adolph O, Köster S, Georgieff M, Georgieff EM, Moulig W, Föhr KJ. Promethazine inhibits NMDA-induced currents - new pharmacological aspects of an old drug. Neuropharmacology 2012; 63 (02) 280-291
• 81 Rumore MM, Schlichting DA. Analgesic effects of antihistaminics. Life Sci 1985; 36 (05) 403-416
• 82 Peters Jr RJ, Kelder SH, Markham CM, Yacoubian Jr GS, Peters LA, Ellis A. Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) onset and perceived addiction among urban Houstonian adolescents: an addiction trend in the city of lean. J Drug Educ 2003; 33 (04) 415-425
• 83 Peters Jr R, Yacoubian Jr GS, Rhodes W. , et al. Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) use and addiction among multi-ethnic college students. J Psychoactive Drugs 2007; 39 (03) 277-282
• 84 Shapiro BJ, Lynch KL, Toochinda T, Lutnick A, Cheng HY, Kral AH. Promethazine misuse among methadone maintenance patients and community-based injection drug users. J Addict Med 2013; 7 (02) 96-101
• 85 Tsay ME, Procopio G, Anderson BD, Klein-Schwartz W. Abuse and intentional misuse of promethazine reported to US poison centers: 2002 to 2012. J Addict Med 2015; 9 (03) 233-237