Of course, nobody knows for sure the extent of abuse that pharmaceuticals will see over the next decade and beyond, but perhaps an educated guess can be made based on the history of substance abuse over the past 40 to 50 years. I have been around about that length of time in law enforcement, and unfortunately I have seen some remarkable events unfold.
There is no question in my mind that alcohol abuse far outweighs all of the other substances of abuse, and of course, alcohol is a legal drug. When President Obama indicated that marijuana was no worse than alcohol, I wondered if he really knew what he was saying! That shouldn’t have made the case for marijuana legalization, but should give pause as to the meager job we have done controlling alcoholism and alcohol abuse by our youth.
In the late 1960s and into the 1970s, heroin was the top illicit drug of abuse on the nation’s streets. Although most were not aware, pharmaceuticals were in second place, with oxycodone, hydromorphone, diazepam, and good old pentazocine being mixed with other prescription medications. Quaaludes were also popular for a short time until they were banned from the legitimate marketplace.
As we moved through the 1980s and into the 1990s, cocaine and “crack” cocaine became prominent on the drug scene, with prescription drugs once again staying strong in second place. We began Cincinnati’s Pharmaceutical Diversion Squad in 1990 through a grant as we realized that this prescription drug problem apparently was not going away. By the end of the century, prescription analgesics were being prescribed in record numbers, with corresponding percentages of the products being diverted for illicit use.
We then moved into the first decade of the 21st century, with pharmaceuticals taking the #1 spot on the abused substances list. With the reformulation of OxyContin in 2010, Mexican cartels realized that there was a marketing opportunity, and we saw cheap, potent heroin rapidly flood the United States. This flood continues today as heroin has once again achieved #1 status, as it had in the late 1960s and early 1970s. This heroin, however, is much more powerful and devastating, with overdose deaths commonplace in virtually all communities in our country.
Pharmaceuticals remain a strong #2 contender, as they have for many decades over the past 45 years. I am glad to say that much more emphasis and notoriety has been placed on pharmaceuticals in the past 15 years than ever before. This has encouraged law enforcement and regulators, along with rehabilitation and education folks, to try to combat this largely prescription opiate problem.
I see the future belonging to abuse-resistant formulations after seeing the success that OxyContin enjoyed in deeply reducing the abuse and diversion of this product. A few others have followed, and several have these formulations in the pipeline. Zogenix Pharmaceuticals announced that its new hydrocodone product, Zohydro ER, will also have an abuse-resistant formulation in the future. When these reformulations work—and they still provide the same adequate pain relief to legitimate patients—it is a win-win for all of us involved.
The future is unclear when you think about all of the generic drugs that have had little, if any, regulation placed on them, except for the FDA’s rejection of a generic oxycodone ER without abuse-resistant properties. I suspect the short-acting generic drugs, designed primarily for acute pain, will still exist without change and will represent the bulk of the controlled substance pain medication abuse in the United States for many years to come.
Electronic prescriptions, if ever fully implemented, may provide some safeguard against forged and altered prescriptions, but will do little to combat doctor shopping offenses or unscrupulous prescribers and dispensers of pharmaceuticals. Old-fashioned law enforcement techniques will still need to be utilized in an attempt to reduce the criminal offenses.
If history is any indication, the heroin epidemic will end at some point, but cocaine or pharmaceuticals will likely take heroin’s place at the top of the heap; or worse yet, some diabolical new drug, even more devastating than opiates, will come forward. America has long been a consumer of abused substances of all kinds. My guess is that alcohol will remain #1 as a substance that causes more death and damage than all of the rest combined.
Some new drugs on the market that seem to work toward many kinds of addiction, including alcohol, are a possible light at the end of the tunnel. I sincerely hope this is part of the solution, but unfortunately I wouldn’t count on this complex problem being solved anytime soon.