When thinking of drug testing, most people immediately think of the illegal drugs we have been told about for so long (Marijuana, Cocaine, Amphetamines, Opiates (heroin) and PCP). Clearly there is a concern for abuse with these illegal substances. However, a growing concern in the general workforce and for companies developing health related policies should also be prescription drug abuse. Prescription drugs that are abused fall into 3 categories: Opiates (synthetic and non-synthetic), sedatives/ tranquilizers, and stimulants. Both the U.S. and Canada are facing drastic increases in prescription drug abuse and the complications this brings to the worksite.

U.S. Prescription Drug Abuse Statistics

The Drug Abuse Warning Network (DAWN), a division of the Substance Abuse and Mental Health Services Administration, compiles a report annually that shows the number of emergency department visits that occur because of substance abuse. The "National Estimates of Drug-Related Emergency Department Visits" report for 2011 indicated that 2.5 million visits to emergency rooms (nationwide) were connected in some way with drug misuse or abuse. In the long term, between 2004 and 2011, the annual overall number of ER visits that related to drug misuse or abuse has risen steadily each year for a total increase of 52 percent, or about 844,000 visits.

While visits involving illicit drugs alone, or underage drinking have not risen, ER visits related to the use of pharmaceuticals with no other drug involvement rose substantially (148%), as did the use of pharmaceuticals with illicit drugs (137%), pharmaceuticals with alcohol (84%), and pharmaceuticals combined with both illicit drugs and alcohol (93%). These increases reflect almost 500,000 more ER visits related to pharmaceuticals alone in 2011 compared with 2004.

The totals broke down to over 142,000 more visits related to pharmaceuticals and illicit drugs, almost 120,000 more visits related to pharmaceuticals and alcohol, and over 42,000 more visits related to all three types of substances.

Depressants, opioids, and antidepressants are responsible for more overdose deaths (45%) than cocaine, heroin, methamphetamine, and amphetamines (39%) combined. In the United States, the most deaths previously took place in inner cities in predominantly poor African-American neighborhoods, but they have now been overtaken by predominantly white rural communities. The same trend can be seen in the rates of hospitalization for substance abuse and emergency hospitalization for overdoses. Of the 1.4 million drug-related emergency room admissions in 2005, 598,542 were associated with abuse of pharmaceuticals alone or with other drugs.

Canadian Prescription Drug Abuse Statistics

Opiates

Prescription opioids are medications primarily used to treat acute and chronic pain. They can also be used to control a persistent cough or diarrhea. Another accepted medical use for prescription opioids is the treatment of opioid addiction, using methadone or buprenorphine-naloxone under the supervision of a trained healthcare practitioner to avoid withdrawal symptoms from the original opioid addiction.

The “misuse,” or “non-medical use,” of prescription opioids has traditionally been defined as use by people other than those to whom the medication is prescribed or use in a manner or for a purpose contrary to what is intended. Such misuse includes borrowing or stealing medications from friends or relatives, deliberately using higher than prescribed doses, hoarding medications, tampering with the medication or altering the route of delivery, and using opioids together with alcohol or other medications that have a sedating effect.

In 2013, 15% of the general population (15+ years old) used opioids for pain relief. Also, 2% of Canadians aged 15 and older reported non-medical prescription opioid use during the past year.

Sedatives and Tranquilizers

Prescription sedatives and tranquilizers are central nervous system depressants, meaning that they depress or slow down the body’s functions. These medications are mainly used to relieve anxiety and assist with sleep problems. Other medical uses include inducing sedation for surgical and other medical procedures, treatment of alcohol withdrawal, seizure control and relaxation of skeletal muscles. There are three different classes of sedatives and tranquilizers: benzodiazepines, non- benzodiazepine sleep medications, and barbiturates.

Prescription sedatives and tranquilizers are usually taken in pill form; however, some are available as suppositories or prepared as a solution for injection. Some people tamper with the medication to misuse it for the drug’s euphoric effects. Tampering involves changing the form of the medication or the route by which it is taken, or both.

The prevalence of the use of prescription sedatives and tranquilizers among the general population was 10% in 2013 and has remained relatively stable since 2008.

National data are lacking with regards to the prevalence of prescription sedatives and tranquilizers misuse among the adult and senior populations in Canada. However, it has been suggested that women are more likely than men to be prescribed tranquilizers for non-medical reasons, such as coping with stress and grief, or for adjusting to the natural life processes of childbirth and menopause.

Stimulants

The most common use of prescription stimulants is to treat individuals diagnosed with attention- deficit hyperactivity disorder (ADHD). Other medical uses include the treatment of narcolepsy and other sleep disorders. Prescription stimulants are normally taken in pill form, but some people who abuse them for the drug’s euphoric effects tamper with the medication. However, such tampering can cause complications because insoluble fillers in the tablets can block small blood vessels. While prescription stimulants are prescribed for therapeutic purposes, they have the potential to be misused because of their psychoactive properties.

The risk for psychological and physical dependence (addiction) is increased through accessibility, multiple opportunities for diversion along the supply chain, and perceptions of relative safety compared to other illicit drugs, among other factors. Stimulants are often misused for both cognitive enhancement and recreational purposes (i.e., to get high). For the former purpose, they increase wakefulness, alertness, focus and attention.

The prevalence of the use of prescription stimulants among the general population was 1% in 2013 and has decreased slightly from previous years.

There is little data on the prevalence of prescription stimulant misuse from other countries as their prevalence estimates generally include illicit drugs such as Ecstasy, in addition to prescription stimulants.

There is also little Canadian morbidity and mortality data related to prescription stimulant misuse.

Rehabilitation Admissions

It is hard to get an accurate idea of admissions into rehabilitation for prescription drug abuse in Canada as there is a mix of publicly and privately funded programs available and no current legislation for any of these facilities to provide statistics to a governing body like there is in the United States. The other problem that is encountered when looking for this is that the statistics in a research study are typically released 3 or 4 years after the data was collected.

In the literature, the number of admissions to drug rehabilitation programs vary from 48% of aboriginal clients admitted to a rehab facility to 30.6% for a Toronto-based rehabilitation facility in 2004.