Medicine Misuse: Inhibiting Causes and Effects

Megha Sevalia
2/8/17

Independent Research I G/T

Dr. Melissa Kiehl

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 Twenty-two year old patient A survived a car accident and was prescribed strong

painkillers, to which she developed a dependency. She returned to the hospital within a year with

liver failure. Thirty year old patient B suffers from headaches frequently so he takes medicine

daily to prevent them. He now suffers from a medicine overuse headache when he takes

medicine as well. Both of these people led fairly normal lives but now have developed an

addiction that will need to be treated the same way that drug abuse addictions are treated, as well

as internal injuries that they could have avoided. They both feel that they did not consciously

choose to do drugs, and do not understand how this situation occurred for them, as well as for

many others around the world. Medicine misuse has roots in a variety of situations, from injury

to ignorance. Adding onto the long list of causes are a number of factors which can make a

person more susceptible to misuse, and more likely to end up in an alarming situation. Medicine

misuse, impacted by a variety of factors, occurs at a dangerous rate and creates many harmful

consequences, but can be prevented through a combination of people receiving more information

on the topic, and taking precautions with medicine intake. In order to begin this process, this

paper will categorize factors contributing to medicine misuse, inform readers about the severity

of related internal injuries, and explain a prevention mechanism that can be used to evade this

problem.

Medicine misuse is a subsection of overall drug abuse. While drug abuse covers the

recreational, careless, and addiction-based misuse of a chemical substance with physiological

effects on the body, medicine misuse focuses around the specific situations where the drug

misuse leads from purposes originally intended to benefit ones health. A simpler differentiation

can be made by stating that medicine misuse is an unfortunate consequence of carelessly using

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medicines, even if the original purpose was meant to heal a person. Due to the nature of this

problem, a variety of factors arise which could influence how susceptible a person is to misusing

medicine. After all, not everybody in society who uses medicine ends up misusing it. However, a

significant portion of people who use medicine do at some point misuse it. Nearly 1.3 million

Americans aged 12 years and older experience problem use of prescription drugs, signifying

physiological dependence or heavy daily use, report Simoni-Wastila & Strickler (n.d.).

Medicine misuse generally arises from one of the following situations. One would be if a person

is involved in a major accident after which they are put on multiple medicines to help them heal.

This type of high level of dependency can create a tolerance and addiction to the medicines.

Often times, a person can find themselves craving the effects after they leave intensive care and

run out of prescriptions. Another common situation that can arise is when a person repeatedly

uses small doses of a medicine to rid themselves of a minor ailment, such as a common headache

or back pain. When a person frequently uses this medicine, the physiological effects will not

only relieve them of the ailment, but will also cause addicting side effects on other parts of the

body as well (Harsanyi, 2016). This can cause a person to start wanting the drug all of the time

and start imagining the pain to a higher degree, ultimately also leading to misuse. High

dependency on medicines also can lead to other situations such as doctor shopping, which

occurs frequently when a doctor stops prescribing medication to a patient, but in needing the

effects of the medicine, the patient visits a large number of doctors to try and procure multiple

prescriptions for the drug (Doctor shopping for narcotics common after trauma surgery, 2014).

While there are systems in place to track medication distribution, many misusers are still

successful in obtaining the medicines. If the medication is an over-the-counter drug, then they

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generally face virtually no limits. Even if it is prescription based, a large number of misusers turn

to black markets, where there are even less barriers. There are various other situations similar to

these, but regardless of the situation or the other contributing factors, some misuse trends remain

the same, such as types of medications misused.

There are a number of common medicines that are the mostly commonly misused, as

listed here: Acetaminophen, Opioids, Stimulants, and Depressants (Prescription drug abuse: Risk

factors, n.d.). Acetaminophen is the primary ingredient in most pain relievers. This type of

medicine can be used by people searching for any type of pain relief, as its effects spread among

the whole body, not just the intended location of pain. Due to this, a person can often grow to

become dependent on the medicine for pain relief, and over time the amount of the drug that they

need will exponentially increase. Opioids are also common pain relievers that people misuse.

The overall process of how they become misused is pretty similar to that of Acetaminophen,

except Opioids have been in circulation for much longer than many other drugs (Prescription

drug abuse: Risk factors, n.d.). They have been used recreationally as well, and the general

amount people need has always been higher, and dependency rises to that high level. Stimulants

are medicines that help people pay attention. These often are introduced to a person when they

are coming out of an illness and are not feeling aware enough to operate through many daily

tasks. Stimulants used during this time can be very beneficial for a person, but at a heightened

awareness a person may feel more competent and continue using the medicines when it is not

needed. Depressants are another type of common medicines. These ingredients are often found in

anti-anxiety medication or night time medicines as they help the body relax, grow less anxious,

or ultimately get drowsy (Prescription drug abuse: Risk factors, n.d.). These medicines are often

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misused by people who realize that they are more comfortable at reduced anxiety levels or

insomniacs who like the sleep aid. Altogether, all of these medicines end up harming the body

because of the high number of physiological effects they can produce (Myers, n.d.). When

produced at high frequencies, they can cause damage to the body, often irreversible. However,

this generally only happens if a person does excessively misuse a medicine, which is largely

dependent on the prevalence of a number of factors on a persons life.

A number of factors have been examined and linked to medicinal misuse, many of which

seem completely unrelated. One major influence category was a persons nature, referring to

innate qualities, such as gender (Khan Academy, 2015). In fact, females have been found to be

more prone to medicine misuse, with up to 43% increased odds (Simoli-Wastila, L., Ritter, G.,

& Strickler, G., 2004). Race is also a factor that was examined, but the only difference found was

that people of the white race misuse more often than people of any other nonwhite race

(Simoli-Wastila, L., Ritter, G., & Strickler, G., 2004). However, injury does not discriminate

among races, and subsequently misuse patients were found internationally and at in similar

amounts. Age was studied as well, although this factor had questionable elements. For example,

young children are automatically discounted because they are given medicine by their parents. In

addition, elderly people generally take more medicines due to exhibiting more ailments, adding

additional confounding variables. However, studies did correlate being a young adult to having a

higher probability of misusing, just in that the number of overall drug addicts traditionally are

younger, and purposeful misuse also ranged higher in this age group (Prescription drug abuse:

Risk factors, n.d.). Another factor discussed is genetics. Different genes can make a person more

susceptible to addiction, and carriers of the gene are more likely to misuse (Prescription drug

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abuse: Risk factors, n.d.). The A1 allele of the dopamine receptor gene DRD2 is one of these

genes that misusers often carry (Prescription drug abuse: Risk factors, n.d.). Family history is

also a major part of whether a person might misuse, but this category overlaps into the other big

influence, which is a persons nurturing. If a person witnessed parents or other family members

misuse medicines, or show addictive behaviors, then they often will be more likely to misuse in

the future (Khan Academy, 2015). Similarly, social influences among friends can create a similar

influence as the reality of medicine effects are often blurred when it seems as if everybody is

taking them regularly (Khan Academy, 2015). In terms of income, people in lower social classes

misused medicine more, but this can be attributed clearly to lifestyle. People with lower incomes

often do not receive the same optimal treatment as upper income people, leading to them relying

on medicines well past the injury for pain relief (Simoni-Wastila, 2004). In addition, people with

lower incomes often work more frequently and do more physically demanding labor, which can

lead to various ailments. Conversely, people with higher incomes are reported to recreationally

use prescription drugs more. Marital status is another significant influence, and single people are

more likely to misuse than those who are married or in a committed relationship. Finally,

education also plays a large role in a persons likeliness to misuse, as people with less education

often misuse more often, which can be supported by the likeliness that they do not understand

the true nature of the medicines they are using and cannot foresee any future negative

consequences (Simoni Wastila, n.d.).

The significance of medicine misuse stems from the fact that some of the problems that

could be caused from it are often major and generally irreversible. Many of the short term effects

resemble the outcomes of general drug abuse. The misuser develops a dependence, from which

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an addiction stems. Without the medicine in their system, the person feels a physical weakness,

possible headaches, and stomachaches (Diener & Limmroth, 2004). With many strong

prescription drugs it does not take long for an addiction to develop, meaning that these symptoms

can occur at a faster rate than if they were frequently using many recreational drugs (Leise,

2014). Long term effects include teeth, nail, hair, and bone problems, which can include frailty

or discoloration. Strong medications often accumulate in the liver, where toxins are meant to be

filtered out, which can lead to liver hepatotoxicity (poisoning) (Mckay, 2001). From this injury

onwards, the outcomes become dangerous and irreversible. Dr. William M. Lee of the University

of Texas Southwestern Medical Center in Dallas states that, drugs cause about 55 percent of the

liver failure cases evaluated at liver transplant centers (Tarkan, L.,2001). Liver toxicity can

sometimes be cured with hospital care, but often leads to the need for a liver transplant (Mckay,

2001). The consequences become potentially fatal if liver failure is reached, as liver failure can

spark other organ failure if the liver is not replaced (Frei, 2010). In addition, there are a number

of indirectly related effects that can eventually create a harmful effect, which is that many

illnesses and diseases have become resistant to common medications. These illnesses range from

simple infections to Tuberculosis and even Human Immunodeficiency Virus (HIV) (The global

epidemic of drug resistance: misuse of medicines is making diseases harder to fight, 2002). As

these medications become stronger, the chances of them creating more severe symptoms and

being harder to fight increase strongly. Many misuse patients in turn have developed such a high

tolerance for various medications that if they acquire any of these illnesses they require

significantly stronger medications to fight off the sickness. The severity of all of these effects

make medicine misuse prevention exceptionally important.

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 Medicine misuse prevention can generally be combatted with a general drug abuse

prevention program, coupled with information about medicine misuse. A large portion of todays

children will receive general drug prevention instruction through an education, or special interest

group. However, the variety of different types that exist make it difficult to measure if everyone

is receiving the most effective lessons. One difference include whether everyone participating

are receiving the same education, or if a target group is receiving supplemental instruction. In

one study, researchers found that, only 11 out of 136 treatment-control contrasts... involved

target populations that were at elevated risk for substance use or other problem behaviors

(Gottfredson, D. C., & Wilson, D. B., 2003). Other researchers have supported that having

specific target group instruction for higher risk students in addition to a general discussion is

more successful in prevention (Hawkins, J. D., Catalano, R. F., & Miller, J. Y., n.d.). Another

major factor is the age of the children when they are hearing this information. While medicine

misuse peaks during the late teenage and young adult years, the most effective prevention

programs targeted middle school aged children as opposed to elementary school or high school

aged ones. Furthermore the length of the program can make a difference in effectiveness.

Programs generally range from a one time assembly-style presentation, to a couple month long

duration, to even longer extended ones. While it might seem reasonable that the longest ones

would be best as they have the ability to check back on the same students and measure their

progress in terms of how they view drugs, research has shown that mid-range, brief programs of

less than 4.5 months are generally as effective as those of longer duration (Gottfredson, D. C.,

& Wilson, D. B., 2003). This is an important factor to consider because many schools or interest

groups that do not have special programs are often influenced by the high cost of many.

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However, it is supported that an effective program does not have to be the longest, most

expensive one. Lastly, another important factor in prevention program success is the role of the

person delivering the preventive intervention (Gottfredson, D. C., & Wilson, D. B., 2003).

There is not a major difference in who is giving the information, but studies have shown that

peer involvement in giving the information is the most effective. Regardless of many of these

differences, it is considerably more important to have one in general. Even though they address

general drug abuse, the curriculum generally briefly also covers medicine misuse, and generating

awareness about the problem is the greatest prevention mechanism that can be used.

Altogether, medicine misuse is an expansive problem with many different angles which

will be a difficult problem to solve. The research supports that the majority of medicine misuse

factors are not more or less important in contributing to the misuse; rather, the prevalence of

contributing factors intensifies the susceptibility to misuse, along with the type of root situation

from which it arises. Since this makes the possibility of misuse greater, it is important to

understand the effects of medicine misuse, which can be observed through the internal injuries

that result from them. The short term effects resemble many of the effects of recreational drug

abuse, but the long term effects are generally much more serious due to patients not even

considering that they are harming themselves. Many patients think they are treating themselves,

but will end up causing great harm to their organs, which can even lead to death. Although

prevention program vary greatly, there has been a notable amount of success with a few. It is

important to further develop many of these programs and include more information specifically

about medicine misuse, a topic many students do not consider at all. With more education on it,

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there is a definite chance that the future will see less devastating injuries cause by something that

should be doing good.

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