Licit drug abuse – overshadowing the illegal drug trade

Licit drugs are also known as legal drugs. Licit drugs usually means that a drug is used legally (e.g., alcohol, tobacco, and caffeine). “Legal” use of drugs includes medicines used for illness or over-the-counter drugs used as directed by the pharmacist or medicine purchased from a retail outlet for self-medication.

“Legal drug” abuse (not for its intended purpose) is a far greater problem than illegal drug abuse.

How big is the problem? The US National Institute of Health (NIH) reported that the number of people in their 50’s who are abusing licit or prescription drugs more than doubled from 2002 to 2010, going from 2.7 to 5.8 percent in this population. Among those 65 and older, 414,000 used such drugs in 2010. At the other end of the spectrum, one in four teens has misused a prescription drug at least once in their lifetime, according to survey results from the partnership at Drugfree.org and the MetLife Foundation.

Americans abusing Rx drugs jumped 94% over a 10-year period to twice the increase of marijuana, five times the number abusing cocaine and sixty times the number abusing heroine. Abuse can progress into addiction. Prescription drugs can be the gateway to other substances of abuse.

Possible reasons for that are that prescription drugs don’t hold the same stigma as illegal recreational drugs, even though they can be just as deadly, leading people to regard the former as a “safe” way to get high. Legal drug addiction is tricky because it often starts out with a prescription obtained from a doctor for a clinically diagnosed condition. Many people find themselves addicted to painkillers before they even realise what’s happened, often after taking the drugs to recover from surgery or for treating chronic back- or other pain.

How is addiction defined?
Addiction is classified as a chronic, primary, progressive, and fatal mental disease characterised by the compulsion to use drugs, with an associated loss of control over drug use, and continued use of drugs despite known problems. Addiction is a brain disease complicated by co-occurrence of mental illness and often doctors find it difficult to treat when these two conditions co-exist.

Dependence is often seen when someone uses a drug regularly but does not feel the compulsion to increase the dose or use a “stronger” drug to obtain the same effect.

There are generally four steps that takes place for a person to become addicted. The experimental stage. The recreational phase – you don’t actively try to acquire the drug, but partake when your friends offer it to you, the regular-use stage – you obtain the drug yourself and make sure you always have stock. You use drugs once or twice a week and then finally, the dependency phase or addiction. At this stage drugs will be the most important thing in your life and any attempt to separate you from the drug will be met with fierce resistance.

Some tell-tale signs of addiction are memory trouble after taking medicine, loss of coordination, changes in sleeping habits, unexplained bruises, being unsure, irritability, sadness, depression, and sometimes unexplained chronic pain.

How do drugs work in the brain to produce pleasure?
Drugs of abuse directly or indirectly target the brain’s reward system. It floods the circuit with a brain messenger called “dopamine”. It rewards our natural behaviours. It produces the euphoric effects. It teaches the abuser to repeat the behaviour.

How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?
Our brains ensure we repeat life-sustaining activities which is associated with pleasure or reward so that when the reward circuit activated – the brain remembers and teaches us to do it again and again without thinking. We learn to abuse drugs in the same way.

What happens to your brain if you keep taking drugs?
The brain adjusts to surges in dopamine (and other neurotransmitters) by producing less dopamine, reducing the number of receptors that can receive and transmit signals. Dopamine’s impact on the reward circuit becomes low and the experience of pleasure reduced, the abuser feels flat, lifeless, and depressed and they need to take drugs to bring their dopamine function back to normal. They also need to take larger amounts of the drug – called “tolerance”.

The newest trends noticed in drug abuse are that young people start experimenting earlier. They construct a wall of denial, they have a perception twisted into belief that drug use is a result of misfortune and sequelae are disrupted interpersonal relationships, low self-esteem, ill health and poor job performance.

What is being done about this problem? Parents and friends are well positioned to respond to the crisis. We tend to isolate ourselves and limit our involvement as it is “not our problem”. We avoid assuming preventive roles. We should embrace our responsibility. Move from the “self-caring only” attitude of the modern community. There are Drug awareness programs by pharmacists, social involvement groups, teachers, the role the SAPS plays, and most importantly, support from parents.  Restricting access to licit medicines by SAHPRA by requiring a prescription for potentially addictive substances as well as having the SAPS enforce legislation. Social support to the addicted person as well as the family and supporting rehabilitation institutions plays a very important role in prevention and rehabilitation of the individual.

The most important part in preventing drug abuse is: Sharing of information… Sharing of information…. Sharing of information…. Sharing of information….

Johann Kruger M.Pharm., M.Phil., PhD., FPS is a Director at Medwell SA – The Home Health Care Specialists and the Head of EDNA Medical Distributors, an incorporated company at Medwell SA.  For more information visit www.edna.co.za or www.medwell.co.za