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

Clinical Implications

Anyone doubting the reality of noncontrolled medication abuse need only visit the plethora of Internet forums that exist for various medications. Such Web sites may be found using a Google search of a given drug name and cite headings such as "Gabapentin Recreational Use Drug Forum." Sites of this type often contain self-disclosures of medication abuse, detailed advice, and sometimes frank encouragement of illicit use.[90]

In a sense, any medication that has psychoactive effects can be misused if taken in doses or by means that result in high serum or cerebrospinal fluid levels. As Paracelsus noted, "All things are poisons, for there is nothing without poisonous qualities. It is only the dose which makes a thing a poison."[10] As such, the sometimes inventive abuse of medications becomes a significant problem. Although individuals with a history of drug abuse are more vulnerable to addiction when treated with medications that are easily abused, less is known about the risk for those who have not abused drugs. Predictors of risk for prescription medication abuse appear to include female sex, white race, poor health, rural residence, social isolation, substance use or psychiatric disorders, and age-related factors.[91] Further research leading to procedures for early identification of prescription drug abuse will help clinicians detect addictive behavior sooner.

It should be noted that much of the evidence presented in this review is anecdotal case information and does not in and of itself provide conclusive evidence of a widespread abuse problem. Although abuse of noncontrolled and OTC medications may in the cases of certain individuals be a problem, the authors certainly do not wish to discourage the use of such medications. The valid use of medications is a mainstay of treatment, and the vast majority of noncontrolled prescription and OTC medications are taken appropriately. It is not being suggested that additional drugs be placed on a controlled substances schedule, but we wish to point out that a minority of patients may abuse certain noncontrolled medications and clinicians should be aware of the abuse potential of these medications.[92] Our aim was to present evidence of abuse of medications that clinicians would often not suspect of having any abuse potential and to raise questions about the use of certain noncontrolled medications by patients who are likely to be at risk for problems with iatrogenic addiction. Changes of current policies regarding use of such medications based on a better understanding of pharmacological variables that minimize their reinforcing effects could decrease the risk of their abuse.[10]

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