Drug policy in America tends to focus on illicit drugs, such as heroin, cocaine, marijuana, methamphetamine, etc.  However, of these illicit drugs, only marijuana is abused more than another class of narcotic: prescription drugs.

Three categories of prescription drugs are abused: painkillers, stimulants, and sedatives & tranquilizers.   Prescription drug abuse is widespread, and is hardly new.  According to SAMHSA, in 2007 over 16 million Americans over the age of 12 had taken a prescription painkiller or stimulant for nonmedical purposes.  Among the most abused brands are Vicodin, OxyContin, and Valium.  Even Xanax and Ritalin are abused for the highs they produce when taken in unintended quantities.  According to the National Institute on Drug Abuse (NIDA) long-term use of opioids or central nervous system depressants can lead to physical dependence and addiction. Taken in high doses, stimulants can lead to compulsive use, paranoia, dangerously high body temperatures, and irregular heartbeat.

Monitoring the Future is a longitudinal study funded by the NIDA and every year releases its findings on drug use and perceptions of abuse by junior high school and high school students. It is conducted by Dr. Lloyd Johnston at the University of Michigan.  According to MTF, while use of illicit drugs in teenagers is declining, abuse of vicodin and OxyContin is for the most part steady.

It is a problem that extends into the populace beyond teenagers. An estimated 48 million people (ages 12 and older) have used prescription drugs for nonmedical reasons in their lifetimes. This represents approximately 20 percent of the U.S. population.  In 2002, only 4.1 percent of the population aged 18 to 25 reported abusing pain relievers, but that percentage jumped to 4.9 percent in 2006. Nonmedical use of tranquilizers also increased since 2002, from 1.6 percent to 2 percent for the same age group.

Legislation

While scores of legislation has been introduced in recent decades to combat illicit drug use, including legislation aimed at specific drugs such as methamphetamine (its manufacturing and its distribution,) only recently has Congress stuck its toe in the water of prescription drug abuse.

HR1298/S525 is the Pharmaceutical Market Access and Drug Safety Act of 2009, and seeks to amend the Federal Food, Drug, and Cosmetic Act (FFDCA) to revise provisions governing the importation of prescription drugs. It would prohibit the importation of a qualifying drug, unless such drug is imported by a registered importer. It would also establish registration conditions for importers and exporters. The Secretary of Health and Human Services would be required to inspect places of business, verify chains of custody, inspect facilities, and determine compliance with registration conditions.

As for manufacturers, it would prohibit them from: (1) discriminating against registered exporters or importers; (2) causing there to be a difference in a prescription drug distributed in the United States and one distributed in a permitted country; (3) engaging in actions to restrict, prohibit, or delay the importation of a qualifying drug; or (4) engaging in any action that the Federal Trade Commission (FTC) determines discriminates against a person that engages or attempts to engage in the importation of a qualifying drug. There is also a clause in the legislation that requires the Secretary’s office to educate consumers regarding prescription drug importation.  Perhaps most importantly, it would set forth provisions governing the sale of prescription drugs through an internet site.

Rep. Mary Bono-Mack (R-CA) is one member of Congress who takes the issue of prescription drug abuse very seriously.  She and her son Chesare have been very willing to share their story with the public, one that includes Chesare’s addiction to Oxycontin.  “We both felt that it was very important to raise awareness about prescription drug abuse in children,” Bono Mack said  in an interview with CBS news. “My son saw it happen in his friends. He wanted to make sure that other kids knew as well to stay away from prescription drugs.” Bono Mack was a co-sponsor of HR 1259, as well as legislation that officially recognizes September as Addiction Recovery Month.

Legislation that seeks to regulate non-illicit narcotics is not limited to prescription medications.  Cough syrup is widely abused, and has been for decades, because of its active ingredient, dextromethorphan, or DXM.  Based on SAMHSA’s National Survey on Drug Use and Health, in 2006 about 3.1 million persons aged 12 to 25 (5.3%) had ever used an over-the-counter cough and cold medication to get high.  According to research conducted by the Partnership for a Drug-Free America, one in 10 teenagers (10 percent), or 2.4 million young people, have intentionally abused cough medication to get high. This form of abuse involves taking extreme amounts of cough medicine to get high. It is not possible to accidentally abuse dextromethorphan; it takes vast amounts that are far beyond the recommended dosage.  The raw form of dextromethorphan can be purchased over the Internet in unfinished form and is very dangerous when abused.  High doses can cause problems with the senses (especially vision and hearing) and can lead to confusion, stomach pain, numbness, and hallucinations. DXM is found in more than 140 over-the-counter (OTC) cough and cold medications.

HR 1259, the Dextromethorphan Distribution Act of 2009, seeks to curb the abuse of this product, and similar legislation has been introduced in past sessions of Congress (In 2007, the senator responsible for introducing legislation that sought to regulate DXM was Vice President Joe Biden.)  Passed on March 31, 2009, it seeks to amend the Federal Food, Drug, and Cosmetic Act to prohibit a person from possessing or receiving unfinished dextromethorphan unless the person is registered with the Secretary of Health and Human Services as a producer of a drug or device or otherwise registered, licensed, or approved pursuant to federal or state law to engage in the practice of pharmacy, pharmaceutical production, or manufacture or distribution of drug ingredients; or distributing unfinished dextromethorphan to any person other than a registered or otherwise authorized person.

Research and Services

Outside of Congress, prescription drug abuse has long been a concern for agencies such as NIDA and SAMHSA.  “The rising wave of prescription drug abuse—particularly of stimulants and opioid pain medications—among both adolescents and adults is an urgent public health issue that NIDA is addressing on multiple fronts,” says NIDA Deputy Director Dr. Tim Condon.  “Our efforts include educating physicians and the general public about prescription drug risks, pursuing medications with reduced addiction liability, providing screening tools to physicians, and conducting epidemiological studies to learn more about who abuses these drugs and why.  Above all, we must tackle the issue of balance, so that people suffering from chronic pain, ADHD, or anxiety can get the relief they need while minimizing the potential for abuse.”