Substance Misuse: Medical, Economic, and Social Impacts

Introduction: The Scope of Substance Misuse

There are few nations, both developed and developing, that are not affected by some facet of substance misuse. Substance misuse represents a widespread medical, psychological, and human issue defined as the misuse of illicit and licit drugs (Stark & Payne-James, 2003). Drugs that are legally prescribed and illegally obtained, as well as alcohol, have the potential to be misused, create dependency, and cause addictive behaviors. Although substance misuse and addictive behavior have plagued societies for centuries, the development and distribution of prescription pain relievers within the last sixty years has marked a new era of substance misuse. In the United States alone, 120 million prescriptions were written between 2005 and 2006; Americans represent only 4.6% of the world population, yet they consume 80% of all opioids and 99% of all hydrocodone (Fishbain et al., 2010). While some individuals use drugs occasionally and for recreational purposes, others develop addictive and dependent behaviors toward their substance of choice. Substance misuse has the potential to negatively impact work, home, and school performance, as well as physical and mental health (Stark & Payne-James, 2003). The overuse of prescription drugs, alcohol, and illegal substances is relevant to almost every country due to its medical, economic, and societal implications.

The incidence of substance misuse raises several concerns for communities, societies, and the human population. When examining its prevalence, several questions arise concerning the increase in incidence, associated economic impacts, influences on the medical community, and effects on younger generations. The first question — why do individuals misuse drugs and substances? — speaks to both a psychological and medical need for drugs. The second question concerns economic implications: substance misuse is a source of economic wealth for pharmaceutical companies, but a financial burden on healthcare providers and patients. This economic concern connects to a third question: how has substance misuse affected the medical community? Substance misuse is not only a health concern for adults; youth and adolescents also present with problems associated with substance misuse. How has substance misuse impacted adolescents, and what implications does this have for society? Substance misuse carries interdisciplinary concerns that are complexly intertwined and influence one another. The growing incidence of substance abuse affects the economy, which influences healthcare providers, and its prevalence impacts society. The multifactorial nature of substance misuse creates a global health issue with multifaceted implications.

Why Individuals Misuse Drugs and Substances

The high prevalence of substance misuse raises the question: why do individuals misuse drugs and substances? Defining the logic behind substance misuse requires an interdisciplinary approach drawing from both historical and medical perspectives. Although the increasing use of drugs and substances has recently become a media mainstay, the misuse of drugs has been a common occurrence since ancient times. Historical evidence suggests that the use of drugs and psychoactive substances is part of the nature of human existence (Rassool, 1998). There seems to be an intrinsic human desire to engage with an altered state of consciousness. The consumption of tea, coffee, alcohol, opiates, marijuana, tobacco, and other substances has been practiced by cultures across the globe for centuries. The historical use of addictive substances has become part of the collective psychological and cultural consciousness of the human species (Rassool, 1998). Across a vast number of cultures, societies, and communities, individuals have used drugs and substances for personal benefit — whether to ward off sleepiness, for medicinal purposes, to reduce pain, or to experience an altered state of mind.

The historical perspective offers insight into the longstanding human need to experience an altered physiological state. This viewpoint, however, does not fully explain the increasing prevalence of substance abuse evolving in the 21st century. In the last sixty years, the development, distribution, and marketing of prescription pain medications made these drugs available in abundance unlike any previous period in medical history. Prescription pain medications have become standard in pain management therapy, and the overuse of these substances can lead to addictive behaviors. One of the most common reasons patients seek healthcare is to treat pain; in the United States, approximately 130 million people report experiencing chronic pain (Fishbain et al., 2010). Pain medicine specialists often provide opioid therapy — such as hydrocodone and oxycodone — as an essential element of treating patients with chronic pain (Fishbain et al., 2010). Within the last two decades, increases in opioid prescriptions have been accompanied by increasing reports of opioid misuse and abuse (Fishbain et al., 2010).

Opioid therapy is regarded as a customary pain management treatment, and the goal of the pain management plan is to provide appropriate pain relief for patients while simultaneously reducing drug-related addictive behavior (Fishbain et al., 2010). Individuals with legitimate chronic pain who receive opioid drugs often develop drug dependency as an unintended consequence. The direct relationship between increasing opioid prescriptions and increasing opioid misuse suggests that the greater incidence of substance misuse is, in part, due to overmedication (Fishbain et al., 2010). Understanding why individuals misuse substances is meaningful because it provides insights into the root of the problem. Substance abuse is a historical and enduring problem, with a long, complex history and a medically demanding present. The overmedication of patients with opioid therapy and other pain medications is a major contributor to the rising incidence of substance misuse.

Conclusion: A Multidisciplinary Perspective

A multidisciplinary approach is required to fully examine the multifactorial issue of substance misuse. Substance misuse is not only a medical issue; it encompasses lasting impacts on economies, healthcare resources, and societal structure. The very foundation of substance misuse is rooted in historical context: historians identify the use of drugs and substances as a fulfillment of the longstanding human need to experience altered consciousness and altered physiological states. This historical need intersects with contemporary medical relevance. The medical environment of the 21st century identifies pain management and unintended opioid dependency as significant contributors to the growing prevalence of substance misuse. With hundreds of millions of prescriptions written for pain management every year (Fishbain et al., 2010), the medical component of substance misuse necessarily carries economic implications. The combination of historical evidence, medical relevance, and economic significance raises profound concerns for societal structure — most notably, how the incidence of misuse among adolescents will influence multiple components of society. Substance misuse reveals a multitude of implications across several disciplines, which only adds to its diverse and complex nature.

The misuse of illicit and licit drugs has been affecting the human race for centuries. Although substance misuse has long influenced the global population, the development of prescription painkillers and their subsequent mass distribution over the last sixty years has significantly increased the rate of misuse. When asking why individuals misuse substances, both historical and medical perspectives are instructive. The historical viewpoint offers insight into the longstanding human desire to experience an altered physiological state, while the medical perspective explains the higher incidence of drug misuse as a consequence of overmedicating pain management patients with opioid therapy. The second area of concern examines who experiences the economic benefits and who bears the economic costs of substance misuse: pharmaceutical companies profit, while healthcare providers and patients carry the burden. The growing incidence of substance misuse also strains healthcare professionals through its high demand for medical resources — both to combat misuse and, inadvertently, to supply substances to those who are dependent. Finally, if the number of adolescent misusers continues to increase, a host of societal consequences may follow, ranging from greater demand for medical resources to reduced local economic activity due to unemployment. Substance misuse is a serious issue with implications that span and interconnect multiple disciplines. Fully addressing its complexities requires examination from medical, economic, and societal viewpoints simultaneously.

References

Crome, I. (2004). Young people and substance misuse. London, UK: Gaskell.

Fishbain, D., Johnson, S., Webster, L., Greene, L., & Faysal, J. (2010). Review of regulatory programs and new opioid technologies in chronic pain management: balancing the risk of medication abuse with medical need. Journal of Managed Care Pharmacy, 16(4), 276–287.

Rassool, G. (1998). Substance use and misuse: nature, context, and clinical interventions. Oxford, UK: Blackwell Publishing Company.

Stark, M., & Payne-James, J. (2003). Symptoms and signs of substance misuse (2nd ed.). San Francisco, CA: Greenwich Medical Media Limited.