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April 29, 2019

Non-prescribed use of pharmaceutical drugs

Non-prescribed pharmaceutical use

Use of pharmaceuticals is a major public health concern in Australia, with widespread non-prescribed use resulting in a range of harms.

What is non-prescribed use?

Non-prescribed use (NPU) of pharmaceutical drugs is the use of a prescription or over-the-counter drug for non-medicinal purposes or other than directed by a registered healthcare professional.1 This includes:

  • taking a higher dose or increased frequency of the medication than prescribed
  • using medication without a prescription or ongoing medical supervision
  • sharing prescription medication with others
  • combining drugs, including alcohol
  • using medication against medical advice, for example, while driving or using heavy machinery, working or supervising children.2

Non-prescription use can be accidental or deliberate. Sometimes people use pharmaceutical drugs to:

  • feel happy or relaxed
  • to increase the effects of alcohol and other drugs
  • to relieve pain or illness
  • to alleviate the symptoms of withdrawal from alcohol and other drugs
  • or to improve performance.3

There are many types of pharmaceuticals that are used in this way, including steroids, nonbenzodiazepines, some anti-psychotics and codeine.

Pharmaceutical drugs with the highest non-prescribed use in Australia are opioids and sedatives, specifically benzodiazepines.4 These drugs are listed as Essential Medicines by the World Health Organisation, and when used as advised by health professionals, can be effective and safe.5

The likelihood of developing a dependency on or tolerance of pharmaceutical drugs depends on the type of drug. Risk of harm, such as overdose or dependency, increases with length of use and dosage. Non-prescribed use of opioids in Australia, Canada, the United States and some parts of Europe exceeds use of all illicit drugs except for cannabis.4,6-8

What are the harms of non-prescribed use?

Many people underestimate the potential risks associated with non-prescription use of pharmaceutical drugs and believe them to be “safer” than illicit drugs.9 However, more people die from overdose of pharmaceuticals than all illicit drugs combined. Approximately 1 in 8 people (12.8%) will engage in non-prescribed use of a pharmaceutical drug over their lifetime.

Some people who use pharmaceuticals report feeling dependent or unable to reduce or eliminate their use. 10.7% of recent users of ‘painkillers/analgesics and opioids’ and 8.0% of recent users of tranquillizers/sleeping pills said that they could not stop or cut down their use, even if they wanted to.

Who is at risk?

Some people are at higher risk of non-prescribed use of pharmaceutical drugs, overdose and dependency. Individuals with complex health needs or mental health issues, an existing dependence on other drugs or alcohol, and people living in rural or remote areas may be at elevated risk of developing a dependency on pharmaceutical drugs.10

Use of pharmaceuticals is related to the availability and use of illicit drugs. The rise in non-prescription use of benzodiazepine and opioids is partly attributable to the decrease in availability of heroin.11,12 It’s also been shown that 39% of people who engaged in non-prescribed use of pharmaceuticals also used illicit drugs.4 Therefore, strategies to reduce the non-prescribed use of pharmaceuticals should be developed in conjunction with policies and interventions to reduce the potential harms associated with illicit drug use.

Harm reduction measures:

There are a number of harm reduction measures in place to reduce the risk of overdose, dependence and non-prescribed use of pharmaceuticals. For example, SafeScript was recently introduced to help doctors and pharmacists to identify when a patient may be at risk of non-prescribed use or receiving high-risk pharmaceuticals beyond medical need and prompt a discussion about alternative treatments with patients.13

Other strategies could include:

  • improving access to alternative pain management and mental health strategies to reduce the demand for drugs such as benzodiazepine and opioids
  • comprehensive education for health professionals on pain management, insomnia and mental health conditions
  • the promotion of alternative pharmacological treatment options such as serotonin-specific reuptake inhibitors (SSRIs) for the treatment of depression and anxiety
  • increasing access to non-pharmaceutical treatments such as cognitive behavioral therapy.15,16
    Improving people’s knowledge around pharmaceutical drugs may increase awareness of the risk of dependence and other harms associated with drugs such as benzodiazepine and opioids.19

More information

Australian Drug Information Network

DrugInfo or 1300 85 85 84

Interested to find out more?
Read this related article from the ADF Library.

References
  1. Larance B, Degenhardt L, Lintzeris N, Winstock A, Mattick R. Definitions related to the use of pharmaceutical opioids: Extramedical use, diversion, non‐adherence and aberrant medication‐related behaviours. Drug and alcohol review. 2011 May;30(3):236-45.
  2. Alcohol, tobacco & other drugs in Australia Web Report. Australia: Australian Institute of Health and Welfare; Date of publication [updated 2018 December 13; cited 2019 March 13].
  3. Rae J, O’Mara B, Munro G, Bajurny, L. Harmful use of pharmaceuticals. Prevention Research, Alcohol & Drug Foundation. September 2017.
  4. Australian Institute of Health and Welfare 2017. National Drug Strategy Household Survey 2016: detailed findings. Drug Statistics series no. 31.Cat. no. PHE 214. Canberra: AIHW.
  5. Essential medicines and health products. Geneva, Switzerland: World Health Organization; c2019 [cited 2019 March 13].
  6. Doyon S, Klein‐Schwartz W, Anderson BA, Welsh C. A novel approach to informing the public about the risks of overdose and nonmedical use of prescription medications. The American journal on addictions. 2013 Mar;22(2):108-12.
  7. Center for Behavioral Health Statistics and Quality : Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, 2015.
  8. Health Canada : Canadian Alcohol and Drug Use Monitoring Survey – Summary of Results for 2012.
  9. Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia. [Canberra], Australia: Australian Institute of Health and Welfare; [updated 2018 December 13; cited 2019 March 15].
  10. Alcohol and Drug Foundation 2017, Pharmaceutical misuse: Why should I care? factsheet, Alcohol and Drug Foundation, Melbourne, viewed 15 March 2019.
  11. Harris M, Forseth K, Rhodes T. “It’s Russian roulette”: Adulteration, adverse effects and drug use transitions during the 2010/2011 United Kingdom heroin shortage. International Journal of Drug Policy. 2015 Jan 1;26(1):51-8.
  12. Degenhardt L, Day C, Gilmour S, Hall W. The” lessons” of the Australian” heroin shortage”. Substance Abuse Treatment, Prevention, and Policy. 2006 Dec;1(1):11.
  13. SafeScript. Victoria, Australia: Department of Health & Human Services, State Government of Victoria; c2018 [cited 2019 March 13].
  14. The Pharmacy Guild of Australia. 2010. Project Stop website.
  15. Brijnath B, Xia T, Turner L, Mazza D. Trends in GP prescribing of psychotropic medications among young patients aged 16–24 years: a case study analysis. BMC psychiatry. 2017 December;17(1):214.
  16. Alcohol and Drug Foundation 2017, Pharmaceutical use: Management techniques, factsheet, Alcohol and Drug Foundation, Melbourne, viewed 14 March 2019.
  17. No Advertising Please About. Australia: No Advertising Please; 2014 [cited 2019 March 13].
  18. Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med 2010;7:e1000352 [CDM]
  19. Doyon S, Klein‐Schwartz W, Anderson BA, Welsh C. A novel approach to informing the public about the risks of overdose and nonmedical use of prescription medications. The American journal on addictions. 2013 Mar;22(2):108-12.
  20. Schulte B, Schmidt CS, Strada L, Götzke C, Hiller P, Fischer B, Reimer J. Non-prescribed use of opioid substitution medication: patterns and trends in sub-populations of opioid users in Germany. International Journal of Drug Policy. 2016 Mar 1;29:57-65.