Editing Substance abuse (section)

===Drug misuse===
Drug misuse is a term used commonly when [[prescription medication]] with [[sedative]], [[anxiolytic]], [[analgesic]], or [[stimulant]] properties is used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. It sometimes involves [[drug diversion]] from the individual for whom it was prescribed.

Prescription misuse has been defined differently and rather inconsistently based on the status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with [[alcohol (drug)|alcohol]], and the presence or absence of [[Substance dependence|dependence]] symptoms.<ref name=misuse>{{Cite journal |vauthors=Barrett SP, Meisner JR, Stewart SH |title=What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations |journal=Curr Drug Abuse Rev |volume=1 |issue=3 |pages=255–62 |date=November 2008 |pmid=19630724 |doi=10.2174/1874473710801030255 |url=http://www.bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf |url-status=dead |archive-url=https://web.archive.org/web/20100615214225/http://bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf |archive-date=2010-06-15 }}</ref><ref>{{Cite journal|vauthors=McCabe SE, Boyd CJ, Teter CJ |title=Subtypes of nonmedical prescription drug misuse |journal=Drug Alcohol Depend |volume=102 |issue=1–3 |pages=63–70 |date=June 2009 |pmid=19278795|pmc=2975029 |doi=10.1016/j.drugalcdep.2009.01.007 }}</ref> Chronic use of certain substances leads to a change in the central nervous system known as a "tolerance" to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur,<ref>{{Cite book |last=Antai-Otong |first=D. |url=https://www.worldcat.org/oclc/173182624 |title=Psychiatric Nursing : Biological & Behavioral Concepts |date=2008 |publisher=Thomson Delmar Learning |isbn=978-1-4180-3872-4 |edition=2nd |location=Clifton Park, NY |oclc=173182624}}</ref> but this is highly dependent on the specific substance in question.

The rate of prescription drug misuse is fast overtaking illegal drug use in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, nonmedical prescription drug use is now second only to [[cannabis (drug)|cannabis]].<ref>{{cite web|publisher=PDMP Center of Excellence|title=The Prescription Drug Abuse Epidemic|url=http://www.pdmpexcellence.org/node/10|date=2010–2013}}</ref> In 2011, "Nearly 1 in 12 high school seniors reported nonmedical use of [[Hydrocodone/paracetamol|Vicodin]]; 1 in 20 reported such use of [[Oxycodone|OxyContin]]."<ref>{{Cite web |date=December 2011 |title=Topics in Brief: Prescription Drug Abuse |url=http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse |url-status=dead |archive-url=https://web.archive.org/web/20140924064448/http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse |archive-date=24 September 2014 |website=[[National Institute on Drug Abuse]]}}</ref> Both of these drugs contain [[opioids]]. Fentanyl is an opioid that is 100 times more potent than morphine, and 50 times more potent than heroin.<ref>{{Cite journal |last=宋 |first=建燮 |date=2020-05-30 |title=A Study on the Communication Index and Efficiency Evaluation of Regional Governments: Application of DEA, SEM, Super-SBM Models |url=http://dx.doi.org/10.38134/klgr.2020.22.1.021 |journal=National Association of Korean Local Government Studies |volume=22 |issue=1 |pages=21–49 |doi=10.38134/klgr.2020.22.1.021 |s2cid=225870603 |issn=1598-0960}}</ref> A 2017 survey of 12th graders in the United States, found misuse of OxyContin of 2.7 percent, compared to 5.5 percent at its peak in 2005.<ref name=NIDA2017>{{cite web |title=Vaping popular among teens; opioid misuse at historic lows |url=https://www.drugabuse.gov/news-events/news-releases/2017/12/vaping-popular-among-teens-opioid-misuse-historic-lows |website=National Institute on Drug Abuse |access-date=10 April 2019 |language=en |date=14 December 2017 |archive-date=29 May 2020 |archive-url=https://web.archive.org/web/20200529174445/https://www.drugabuse.gov/news-events/news-releases/2017/12/vaping-popular-among-teens-opioid-misuse-historic-lows |url-status=dead }}</ref> Misuse of the combination [[hydrocodone/paracetamol]] was at its lowest since a peak of 10.5 percent in 2003.<ref name=NIDA2017/> This decrease may be related to public health initiatives and decreased availability.<ref name=NIDA2017/>

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often "[[doctor shopping]]" to find multiple physicians to prescribe the same medication, without the knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract". Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.<ref>{{Cite web |last=Westgate |first=Aubrey |date=22 May 2012 |title=Combating Prescription Drug Abuse in Your Practice |url=http://www.physicianspractice.com/difficult-patients/content/article/1462168/2074772 |url-status=dead |archive-url=https://web.archive.org/web/20120618014634/http://www.physicianspractice.com/difficult-patients/content/article/1462168/2074772 |archive-date=18 June 2012 |website=Physicians Practice}}</ref>