CLINICAL REVIEW Abuse of Prescription and Over-the-Counter

The nonmedical use of prescription or over-the-counter (OTC) medications implies that the user is us-ing them for reasons other than those indicated in the prescribing literature or on the box label. The abuse of these medications is a national issue. Intentional drug abuse of prescribed and OTC medicines has climbed steadily. Data from the 2005 National Survey on Drug Use and Health demonstrated that 6.4 million (2.6%) people aged 12 or older had used prescription drugs for nonmedical reasons during the past month. Of these, 4.7 million used pain relievers, 1.8 million used tranquilizers, and 1.1 million used stimulants. The nonmedical use of prescription drugs in the past month among young adults aged 18 to 25 increased from 5.4 % in 2002 to 6.3 % in 2005, primarily because of an increase in the abusive use of pain relievers. Physicians need to watch for prescription and OTC medication abuse. Treatment strategies include (1) inquiring about prescription, OTC, and herbal drug use at the initial examination (even though many individuals are drug-abuse savvy, some are naı̈ve and do not realize that OTC medications can be problematic); (2) inquiring about drug use during office visits; (3) providing disposal containers that patients can use to dispose of their unused or unneeded prescription or OTC medications; (4) treating pain aggressively and appropriately; (5) practicing careful record keeping of prescription refills and controls over prescription blanks; (6) referring patients who are addicted to medications to 12-step programs such as Alcoholic Anonymous, Narcotics Anonymous, and Pills Anonymous; and (7) consider-ing detoxification. (J Am Board Fam Med 2008;21:45–54.) The nonmedical use of a prescription or over-the-counter (OTC) medication implies that the user is using it for reasons other than those indicated in the prescribing literature or on the box label.1 The abuse of these medications is a national issue. Pre-scription medications are those pharmaceuticals dispensed by a pharmacist on the presentation of a prescription written by a physician, dentist, or other health care provider who is legally authorized to write prescriptions. OTC medications are phar-maceuticals that do not require a prescription and are sold on the shelves of markets, stores, and pharmacies.