Abuse of Medications That Theoretically Are Without Abuse Potential

Roy R. Reeves, DO, PhD; Mark E. Ladner, MD; Candace L. Perry, MD; Randy S. Burke, PhD; Janet T. Laizer, MD

Disclosures

South Med J. 2015;108(3):151-157. 

In This Article

Abstract and Introduction

Abstract

The potential for abuse of medications that are controlled substances is well known. Abuse of certain noncontrolled prescription drugs and over-the-counter medications also may occur. To some degree, any medication that exerts psychoactive effects may be abused if taken in high enough doses or by means that result in high serum or cerebrospinal fluid levels. Many clinicians may be unaware of the potential for abuse of these medications. This review examines evidence of the possibility of abuse of several common medications that theoretically do not have abuse potential, including cough and cold preparations, antihistamines, anticholinergics, antipsychotics, antidepressants, anticonvulsants, skeletal muscle relaxants, and antiemetics. Means by which such medications may be abused and biochemical and physiological mechanisms fostering their abuse also are discussed.

Introduction

The potential for abuse of controlled substances such as narcotics is well known. Most clinicians exercise caution when prescribing these medications; however abuse of certain noncontrolled prescription drugs and over-the-counter (OTC) medications may be a problem that is not receiving adequate attention. Many medications not classified as controlled substances appear to have abuse potential in certain individuals.[1–3]

There are medications that were prescribed for years without restrictions, but later, because of abuse, had to be classified as controlled substances. Available since 1959, carisoprodol (Soma) was frequently abused.[4] The Drug Abuse Warning Network (DAWN) data showed significant increases of carisoprodol-related ED visits.[5] DAWN is a public surveillance system that monitors drug-related visits to hospital emergency departments (EDs) and drug-related deaths investigated by medical examiners with information collected through retrospective review of patient medical records and decedent case files. Seventeen states classified carisoprodol as a controlled substance and researchers argued for federal classification;[6] however, the US Food and Drug Administration denied this request in 1996. Carisoprodol was classified as a controlled substance at the federal level in January 2012,[4] meaning that from 1959 to 2012, carisoprodol was available in 33 US states as a noncontrolled drug, although it actually had significant abuse potential.

This review examines noncontrolled prescription and OTC medications that have demonstrated potential for abuse. In the literature, "abuse" generally involves ingesting a drug for nonmedical or pleasurable purposes.[2]

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