Meperidine: Usage trends

Last modified: Sunday, 31. May 2009 - 5:18 pm

A study published in the Journal of the American Medical Association in 2000, obtained Drug Enforcement Administration (DEA) data on trends in legitimate medical use of several opioid medications, including meperidine, for the period of 1990 to 1996. In that seven-year span, meperidine use in the United States decreased by 35% (5,200 kg to 3,400 kg).
In the early 1980s, approximately 15,400 kg of meperidine were consumed worldwide each year. By 1999, that figure decreased to 12,200 kg, a 20% drop. Most of the decrease in the use of meperidine may be due to the ongoing development of other safer, longer lasting Schedule II opioids.
Scope and severity
One method of analyzing the issue of drug abuse is to compare and contrast the abuse of illegal drugs (marijuana, cocaine, etc.) with that of legal drugs (OTC and prescription medications). The majority of national and international attention and resources go toward illicit drug abuse. However, prescription drug abuse is a large and growing proportion of the complete drug abuse picture.
Each year, the National Household Survey on Drug Abuse (NHSDA) — the United States Department of Health and Human Services — collects statistical data on five drug groups: marijuana and hashish; psychotherapeutic drugs; cocaine and crack; hallucinogens; and inhalants. Psychotherapeutic drugs include stimulants, sedatives, tranquilizers, and pain relievers. Meperidine and other opioids constitute the majority of the pain relievers in that group.
In 2000, the NHSDA found 1.7% of all people 12 years and older reported nonmedical use of any psychotherapeutic medication during the previous month. More than nine million Americans over age 12 reported use at any time during the year. Those in the 18 to 25-year-old age group have the highest rates of drug abuse. In 2000, 3.6% of individuals in that age group reported nonmedical use of prescription drugs in the month prior to the date on which they were surveyed, but less than half that many, 1.6%, reported the same type of drug abuse in 1994. An estimated 1.6 million Americans used prescription pain relievers nonmedically for the first time in 1998. During the 1980s, there were generally fewer than 500,000 first-time users per year.
The study in the Journal of the American Medical Association mentioned previously also analyzed data from The Drug Abuse Warning Network (DAWN). As mentioned, the study showed a 35% decrease in the medical use of meperidine. However, use of the other four opioid drugs studied (morphine, fentanyl, oxycodone, and hydromorphone) increased, such that the group as a whole showed a cumulative increase of nearly 250%. Data collected from DAWN for the same time-period showed a 7% increase in emergency room mentions of abuse of these drugs. By comparison, the reports of abuse of illicit drugs increased 110%. Admittedly, the data collected by DAWN evaluates only one facet of the drug abuse problem — drug abuse that contributes to emergency room visits. However, from these data at least, it does not appear that a significant increase in medical use of opioid drugs resulted in a proportionate increase in abuse. Further studies looking at a broader picture of opioid analgesic abuse are needed.
Age, ethnic, and gender trends
Between 1990 and 1998, abuse of some illegal drugs among teens and young adults leveled off or decreased slightly. However, increases in new users of prescription pain relievers were reported in young teens, age 12-17, as well as in young adults age 18-25. In 2000, the NHSDA found that the youngest teens, age 12-14, reported psychotherapeutic medications as the most frequent drugs of abuse, making up 53% of the total of all drug abuse reports. Teens and young adults in the 18-25 age group reported prescription drug abuse at a rate of 36%, while 28% of those over age 26 reported that type of abuse. Most teenagers begin prescription drug abuse by taking another person’s medication, usually someone from their family. Teens are also more likely than adults to be acquainted with someone illegally who sells prescription drugs like meperidine.
On the other end of the age spectrum, prescription drug abuse among older adults is also a growing concern. Persons 65 and older comprise 13% of the United States population, but consume about 33% of all prescription drugs. A study of 1,500 elderly patients found that 3% were abusing prescription drugs. Unlike people in younger age groups, however, the elderly are more likely to misuse prescription drugs than abuse them. If abuse does occur, it may begin with misuse due to inappropriate prescribing or the patient not following instructions correctly.
The NHSDA study showed that boys in the youngest age group (12-17) are more likely to experiment with illegal drugs, but girls of that age have a 20% higher rate of prescription drug abuse. In addition, for all teens of that age who abuse prescription drugs, girls are twice as likely to become addicted as boys are. Women are also more likely to abuse and become addicted to prescription drugs in the young- and middle-adult age groups. Part of this may be that women are prescribed potential drugs of abuse more often than men are. Finally, a survey of elderly persons admitted to a treatment program found that 70% were female. Of the various drugs of abuse in that group, 70% were opioids. At all age groups, whites are more likely than other racial or ethnic groups to abuse prescription drugs.
Health professionals (doctors, nurses, dentists, veterinarians, etc.) and their staff may be at risk for meperidine abuse because of their ready access to the drug. Several highly publicized cases involving health care workers who removed injectable meperidine from vials for their own use — and replaced it with some other (harmless) liquid to give to the patient — would seem to lend credence to that argument. On the other hand, one would expect health care workers to be at lesser risk due to their training and knowledge of the effects of drug abuse. In fact, the publicized cases of meperidine theft present an unbalanced picture, since health care workers do not appear to have rates of meperidine or other opioid abuse much different from the rest of the population.

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