Controlled substances are essential for the effective treatment of a wide range of serious medical conditions. For many patients, the availability of these drugs often means the difference between a life of relative normalcy and one of unbearable pain and suffering. Over the past two decades, the recognition that pain itself, and in particular chronic, unrelenting pain, can have severely detrimental effects on the health and welfare of patients has led to greater clinical use of controlled substances in an attempt to effectively treat a variety of painful conditions. Between 1997 and 2007, the use of prescription opioids in the U.S. increased from 74 mg/person to 369 mg/person, an increase of 402%.
However, paralleling the increased availability of many types of controlled substances has been a growing epidemic of non-medical use and abuse. Prescription drug abuse is now widely considered to be the fastest growing drug abuse epidemic in the nation and a major contributor to the current record level of drug overdose deaths in the United States. The Centers for Disease Control and Prevention estimates that, in 2009, unintentional drug overdose surpassed motor vehicle crashes as the leading cause of unintentional injury death in the country. The number of fatal overdoses related to opioid analgesics, a commonly abused class of prescription drugs, tripled between 1999 and 2006, accounting for at least 37% of all overdose deaths in 2006. By 2007, there were more fatal prescription opioid analgesic-related overdoses than those involving cocaine and heroin combined.
State-level data indicate that Maryland has not been immune from this epidemic. Between 2007 and 2010, the percentage of prescription drug-related admissions to Maryland Alcohol and Drug-Abuse Administration-funded treatment programs nearly doubled, accounting for about 1 in 5 admissions in 2010. Prescription opioid analgesic-related admissions increased 106% from 2007 to 2010, and by 139% as the primary reported substance-of-abuse. Benzodiazepine-related admissions increased by 94% over these four years. Telephone calls to the Maryland Poison Center regarding human exposure to opiates other than heroin and reported as intentional abuse or intentional misuse increased by 69% from FY2007 to FY2010. Calls about oxycodone specifically rose by over 250%, making up a third of the non-heroin FY2010 calls. According to the Office of the Chief Medical Examiner, overdose deaths involving prescription opioids other than methadone increased by more than a third from 2007 to 2009, going from 20% to 30% of all intoxication deaths. In 2010, 55% of all intoxication deaths occurring in Maryland involved a prescription opioid.
When compared with demographic data on illicit drug-related treatment admissions, prescription drug abuse appears to be having a disproportionate impact on young people, women, whites, and those living in rural areas. In 2010, 42% of benzodiazepine-related and 45% of opioid-related treatment admissions were for people in their twenties, compared to 29% overall. Ninety percent of benzodiazepine-related and 86% of opioid analgesic-related admissions were white, compared to just over half of total admissions. Just under a third of total treatment admissions were female compared to 41% of opioid analgesic-related and half of benzodiazepine-related admissions. Maryland’s more rural counties were clearly the leaders in opioid analgesic-related treatment admissions. For the state population over age 14, the FY2010 rate of opioid analgesic-related admissions per 10,000 was 13.8; the highest rates by subdivision occurred among residents of Calvert (61.8), Queen Anne’s (39.5), Allegany (39.3), Cecil (32.1), Kent (31.7), St. Mary’s (31.6) Worcester (29.5) and Garrett (29.4) counties. The counties with the highest percentage increases in opioid analgesic-related admissions from FY2007 to FY2010 were Frederick (275%), Worcester (262%), Caroline (240%), Wicomico (223%), Charles (197%), and Queen Anne’s (183%).
This project was supported by Grant No. 2011-PM-BX-0011 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, the Community Capacity Development Office, and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.