Authored by Siavash Jafari*
Abstract
Background: Non-medical use of prescription medications is a public health concern. Individuals who suffer from substance dependence utilize a variety of aberrant behaviors to obtain prescription medications. They share their methods and experiences with others in social media and online platforms and educate each other on how to manipulate the providers, so that they can successfully obtain their medications of choice.
Objectives: The main objective of this qualitative study was to review the content of webpages, blogs, and forums to explore the most common approaches shared by individuals with prescription medication dependence to obtain such medications.
Methods: We used a combination of keywords to search five main search engines: Google, Yahoo, Bing, MSN and AOL. Our search strategy focused on two categories of medications: opioid painkillers and stimulants. The following keywords were used for the purpose of this search: Tylenol 3, Tylenol #3, T3, Morphine, Hydrompohone, Dilaudid, Dexedrine, Ritalin/Adderall, and Pain Medications.
Results: Qualitative analysis of the verbatim revealed 5 themes and 34 sub-themes. Over-reporting the side effects of undesired alternatives, under-reporting of the therapeutic effects of the medication of choice, knowing the symptoms of the illness in advance of a visit, and threatening doctors about making complaints against them were among the most common aberrant behaviors recommended online.
Conclusion: Individuals with prescription medication dependence use a variety of aberrant medication seeking behaviors to obtain their medications of choice. They use online discussion to share these approaches with other patients. Prevention of prescription medication abuse requires a multidisciplinary approach and engagement of all stakeholders.
Introduction
Introduction
Prescription medications, after cannabis, are the second most commonly used drugs in all age groups in the United States. Evidence indicates prescription medication abuse has been associated with significant morbidity and mortality and imposes a serious burden to the health care system [1].
It is estimated that about half of all emergency department visits for drug misuse were attributed to prescription medication abuse [2]. From 1999 to 2016, more than 200,000 people died in the United States from overdoses related to prescription opioids. This number was five times higher in 2016 than in 1999 [3].
According to the Drug Abuse Warning Network of the United States, [4] over 1.2 million emergency department (ED) visits involved nonmedical use of prescription medicines, over-thecounter drugs, or other types of pharmaceuticals in 2011. Pain relievers were the most common type of drugs involved in medical emergencies and narcotic pain relievers were involved in 29 percent. According to this study, the overall medical emergencies related to nonmedical use of pharmaceuticals increased 132 percent in the period from 2004 to 2011, with opiate/opioid involvement rising 183 percent. Central nervous system (CNS) stimulants (e.g., ADHD drugs) have experienced an 85% increase in the short-term, a similar short-term rise observed for involvement of illicit stimulants (amphetamines/methamphetamine) (71%).
In the US, according to the 2014 National Survey on Drug Use and Health, past year nonmedical use of prescription drugs (opioids Citation: Siavash Jafari, Ashkan Nasr, Nazila Hassanabadi. Aberrant Prescription Medication Seeking Behavior Used by Prescription Drug Users to Obtain Prescription Medications from Physicians: A Qualitative Review of Webpages, Blogs and Forums. Open Access J Addict & Psychol. 3(1): 2019. OAJAP.MS.ID.000555. DOI: 10.33552/OAJAP.2019.03.000555. Page 2 of 6 stimulants, tranquilizers and sedatives) was reported by 6.2% of 12-17 year-olds and 11.8% of 18-25 year-olds, mainly driven by nonmedical use of prescription opioids, which has remained stable in the past decade despite rising trend since the late 1990’s [5].
Americans constitute less than 5% of the world’s population; however, they consume 80% of the global opioid supply and 99% of the global hydrocodone supply [6]. From 1997 to 2007, retail sales of commonly used opioid medications (including methadone, oxycodone, fentanyl base, hydromorphone, hydrocodone, morphine, meperidine, and codeine) have increased from a total of 50.7 million grams in 1997 to 126.5 million grams in 2007 [7]. This is an overall increase of 149% with increases ranging from 222% for morphine, 280% for hydrocodone, 319% for hydromorphone, 525% for fentanyl base, 866% for oxycodone, to 1293% for methadone.
The Canadian Alcohol and Drug Use Monitoring Survey 2013 found that opioid pain relievers were used by 4.3 million (15% of Canadians aged 15 years and older) [8]. Of these users, 99,000 (2%) of all self-reported abusing their opioid painkillers. This number was 6% among youth aged 15 to 19. United States, in 2002, abuse of prescription drugs cost nearly $181 billion [9].
One US study found that depressive symptoms and suicidality were significantly associated with greater odds of any non-medical prescription drug use (NMPDU), with painkiller use representing the greatest correlate among college students [10]. Other studies indicate that early onset of NMPDU was a significant predictor of prescription drug dependence. These findings reinforce the importance of developing prevention efforts to reduce NMPDU and diversion of prescription drugs among children and adolescents [11].
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