The past decade has seen a rapid increase in global prescription drug abuse. The US has been going through an opioid epidemic, which has resulted in a recent surge in several counties in different states filing lawsuits against opioid-manufacturing pharmaceutical companies. The Australian and British governments have also made efforts to combat their own growing opioid issues, as the Australian government has made codeine-based medication only available to those with prescriptions, while the English government has ordered an investigation into the growing problem of addiction to prescription drugs such as painkillers, and medicines to treat anxiety and insomnia.
Mayo Clinic defines prescription drug abuse as “the use of a prescription medication in a way not intended by the prescribing doctor”, these include taking a friend’s prescription painkillers for pain, and snorting, or injecting medication to get high. The most commonly abused prescription drugs include opioid painkillers, such as Oxycotin and Vicodin; anti-anxiety medication, such as Urbanol and Xanax; and stimulants, such as Concerta and Ritalin. Mayo clinic also says that those who abuse prescription medication may develop a tolerance to the medication, as their bodies become physically dependent on the drug and will require higher doses to experience the same effects. This dependence could lead to withdrawal symptoms if dosage is decreased or if drug use is stopped. Prescription medication abuse has also been a problem in South Africa. According to The South African Community Epidemiology Network on Drugs (Sacendu), the abuse of over-the-counter and prescription medication such as slimming tablets, analgesics and benzodiazepines has become more prevalent in South Africa. According to statistics compiled by Sacendu between January and June 2016‚ admissions to its centres for over-the-counter and prescription medication as a primary or secondary drug of abuse were 0.7% for Mpumalanga‚ 7.2% in the Eastern Cape‚ 1.7% for Gauteng‚ 1.5% in KwaZulu- Natal and 1.1% for the Free State‚ North West and Northern Cape. Sancedu also noted that during the same time period, 2.4% of patients across all their treatment centres reported having used codeine for non-medical purposes, with the majority coming from Gauteng.
According to Dr Bhoora of the UP Department of Family Medicine and the Community Oriented Substance Use Programme (COSUP), prescription drug abuse has been on the rise because people are now more aware of what drugs there are, as well as what they can do. Dr Bhoora further said “life stressors and the fast-paced society we live in also adds to the daily pressure. Once someone has used a drug that works, those factors make it easier to need more. It is also possible that the problem has always been around but we are only realizing the actual impact now.” Dr Bhoora believes that there are several reasons as to why people initially start using or abusing prescription drugs, such as it being more acceptable to use prescription drugs than street drugs in society, they can be covered by medical schemes, there is no real bodily danger in terms of accessing, compared to street drugs sold by dangerous dealers. Dr Bhoora also says that “a lot of people use prescription drugs for a real problem, for example after an injury, and become dependent as a result of this […] Not everybody gets hooked, but there could be underlying issues.”
The South African National Council on Alcoholism and Drug Dependence (Sanca) has been trying to deal with issues of overdose, but have been finding it to be difficult as there is “minimal information on overdose in South Africa”. Sanca spokesperson Adrie Vermeulen says that the scarcity of statistics is because of stigma and a lack of reporting on drug-related deaths. Speaking on overdose, Vermeulen says that “many people will assume that it’s only relevant to illegal drugs like heroin and cocaine‚ but people can overdose using prescription drugs or over-the-counter medication”. Over-the-counter drugs, which are classified under schedule 0‚1 and 2 under the Medicine Control Act 101 of 1965, can be easily bought from “a pharmacy or even a supermarket without a prescription from a medical doctor‚” says Vermeulen. “These medications are designed for the short-term treatment of headaches‚ allergies‚ skin irritations‚ coughs‚ cold and flu‚ constipation‚ weight loss‚ nausea‚ indigestion and many more‚” she said. Vermeulen further said that most people who abuse over-the-counter drugs don’t realise that “most painkillers‚ cold and cough medication contain codeine‚ which is from the opioid family like heroin and morphine”. Vermeulen says that addiction to prescription and over-the-counter drugs can be very easy to hide from friends and family, because we “live in a chemically oriented society that finds it socially acceptable to use these legal medications”.
A lot of the blame has been laid on pharmaceutical companies for not accepting enough responsibility for the damage their drugs have been causing, while some believe that medical practitioners such as psychiatrists are to blame, as they are the ones actually prescribing the medication. Dr Bhoora thinks that it isn’t that easy to assign blame to either, because pharmaceutical companies “have a motive for selling their product”, and without these companies “there would be a lot of sick people”. Dr Bhoora says that it is impossible for psychiatrists to know who will or won’t become addicted to prescription medication, as they only prescribe the medication according to their patients’ needs.
Tertiary education institutions have become a hot bed for prescription drug abuse, as the drugs are widely available to students from other students who might actually use the medication for their intended purpose. According to a study conducted by the Ohio State Center for the Study of Student Life and the Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery, the “majority of students who use prescription drugs for non-medical reasons report that they typically obtain prescription drugs from friends”, with the most common reasons for taking medication being for pain relief, getting high, taking sedatives to sleep, anxiety relief, and to help with studying. Dr Bhoora says that university students are in a stressful environment, and the pressure they feel can be immense. Using medicine as a example for a high stress field of study he said, “not only do you have to study but you work in hospitals as well. Exhaustion is real”.
Dr Bhoora spoke of the work that COSUP does, saying: “What COSUP has done is to assist people who use substances. We are trying to break the stigma around substances. We offer opioid substitution therapy amongst other services. This allows people to reclaim their lives and function normally within society.”
Image: Lanna Matthews