Prescription Drug Misuse: Issues for Primary Care. Final Report of Findings
(2008; 146 pages)

Prescription drug misuse (PDM) or abuse is a worldwide problem. In the US, prescription medicines are the second most misused class of drugs after cannabis, and it has been predicted that misuse of these substances will soon exceed illicit drug use. PDM has been associated with a wide range of social and health harms, including medical emergencies, drug-related deaths, emotional or mental health problems, and problematic poly drug use. However, although PDM is internationally recognised as a problem, it is often one which is overlooked by policy makers and treatment and harm reduction intervention providers, and is often misunderstood within the community. Indeed, a recent Australian report noted: ―it can hardly be said that this area [prescription drug misuse] is one that is in fact conceptualised as a drug problem when compared to illicit drugs such as heroin or amphetamine or even licit drugs such as alcohol. Such indifference or lack of knowledge may even extend to the health professions and particularly general practitioners (p.8). Indeed, the report goes on to comment on how, at a community level, there is often a lack of understanding of the risks associated with PDM, and the seriousness of dependence on them. In New Zealand, it is noted in the National Drug Policy (2007-2012) document that: ―due to New Zealand‘s geographic isolation, it is not easy to import heroin and raw opium in bulk; thus the majority of opioids abused in New Zealand have been prescription medicines (e.g. morphine sulphate tablets, methadone), poppies and home bake (p.31). The most recent national household data of 13-65 year olds indicate that 0.7% had ever tried morphine, and 1.7% ever having used tranquillisers. Problematic use is also an issue. For example the use of tranquillisers such as benzodiazepines has been highlighted as a significant problem amongst people in drug and alcohol treatment services, and in a recent study 14% were diagnosed with sedative dependence. Frequent drug users interviewed as part of the 2006 Illicit Drug Monitoring System (IDMS) reported that availability of opiates was "easy/very easy", and 50% of the intravenous drug users who took part in the study indicated that opiates were the drug most responsible for their drug-related work/study problems.

PDM poses issues at many levels. One key factor is the fine line between appropriate and inappropriate use of prescription drugs, and whether someone who misuses as a result of iatrogenic dependence poses the same problems as someone who obtains prescription drugs for recreational use, or to feed an illicit drug habit. The misuse or inappropriate use of prescription medicines has cost implications which may include dealing with adverse outcomes such as dependence, injecting-related harms, overdose and the broader social consequences of drug misuse. The treatment of PDM, including harm reduction interventions, poses complex problems in that not everyone who misuses these medicines is linked into the highly stigmatised illicit drug scene. Thus, services set up for illicit drug misusers may been seen by health professionals and patients alike as not an appropriate place for the management of iatrogenic dependence, even though this is where the expertise often lies. Furthermore, the issue of prevention of PDM needs to be carefully thought through, as simply preventing access through regulation can have negative impacts on legitimate patients as well as those who rely on prescription drugs to support their drug dependence. All these are issues which will be considered within this research, and resulting recommendations will take these into account. Although not considered as part of this research, any changes which alter the availability of prescription drugs may cause current misusers to move towards using illicit drugs, which in turn may result in more unknown and more harmful consequences. We can hypothesise that a significant proportion of the prescription medicines obtained for non-medical purposes in New Zealand will be accessed via primary healthcare, although not all prescription drugs available for misuse are in this way and some may also be diverted from secondary care, come from thefts from wholesalers, and nowadays also via the internet...

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