Well-meaning friends fuel pain-drug misuse

In a comprehensive study of prescription drug misuse, SAMHSA found that friends and family are the most common sources supplying pain drugs to those who misuse them. It’s a clear wakeup call for behavioral health professionals and advocates for prevention.

The National Survey on Drug Use and Health released Thursday collected data on misuse of prescription psychotherapeutic drugs in 2015 and found that 53.7% of those who reported misuse of pain drugs, such as oxycodone and hydrocodone products, said they got them from a friend or relative. When drilling down into that data point, perhaps even more significant is that the pain drugs obtained from the friend or relative typically (40.5%) were shared for free. Another 9.4% of those responding said they paid friends and family for them, and 3.8% reported stealing them from friends or family.

“People even offer me their medication, even knowing the work I do,” Kimberly Johnson, PhD, director of Center for Substance Abuse Treatment (CSAT) within SAMHSA, tells Behavioral Healthcare.

Johnson says it’s common for consumers to share their medications, and there is a serious opportunity for enhanced education about the dangers of well-meaning friends and family offering their pain drugs to others. Interestingly, many prevention programs tied to today’s opioid crisis are focused on changing prescribing patterns of medical professionals, yet the survey found that medical providers are the source of pain medications in 36.4% of misuse responses, compared to the 53.7% of responses attributing friends and family as the source.

The call to action is rather urgent considering that an estimated 119 million people, or 44.5 of the U.S. population, used some type of prescription psychotherapeutic drug in 2015. SAMSHA notes that more than 84% of those who have such prescriptions do not misuse them, however. The category includes pain drugs as well as stimulants, tranquilizers and sedatives.

“For providers, if you’re working with family members of people who have substance use disorders, have those conversations about what to do with medications to ensure they are not available to the person with the disorder,” Johnson says.

Diversion identified

Also of note, for the first time, the national study breaks down pain drugs by subtype and estimates the number of Americans misusing each.

Buprenorphine products were misused by an estimated 688,000 people, while methadone was misused by an estimated 502,000. While these two drug types pale in comparison to hydrocodone products—misused by 7.1 million—and oxycodone products—misused by 4.2 million—they represent a significant narrative in context.

“We do know that there is some diversion of these medications from treatment programs, so that’s why this question was included in the survey,” Johnson says. “When providers are using agonists to treat opioid use disorder, they need to have a diversion control strategy in place so they can pay attention to what happens with that medication and make sure the patient is using it appropriately.”

More treatment needed

SAMHSA has long pointed out that only a fraction of those who would benefit from behavioral health treatment seek and receive it. In the companion study also released this week, agency officials note that nation still faces a public health crisis of untreated mental and substance use disorders. In 2015, one out of five adults in America met criteria for a mental illness or substance use disorder, yet only 39% of them received services.

In terms of access, Johnson says providers of addiction treatment programs only serve about 10% of those who need the services, and every stakeholder needs to innovate ways to address the insufficiency.

“We have to think about the variety of options for treatment,” she says. “You might do bio-psycho-social but find out that the patient needs residential treatment, and you have a waiting list for it. Consider what else you can give to the person because it’s the magic moment and they need something now.”

She suggests that everyone, from federal health leaders to individual clinicians, needs to adjust what they’re doing to find ways to serve people immediately—even if the interim services are not ideal—because it will translate to long-term improved health outcomes and a reduction in overdoses.