With all prescription drugs, the potential for misuse or abuse must be carefully assessed during and after clinical trials. Once the drug is on the market, doctors shoulder the burden of weighing the likelihood of abuse versus therapeutic value for any given prescription. Patient history definitely plays a role in determining appropriate prescriptions and dosages. However, some drugs by their very nature are more prone to misuse, even among patients with no warning signs in their past. Clinical trials are very effective for demonstrating the safety or effectiveness of a drug but less so for highlighting the propensity for abuse. The strictly controlled procedures and selection of participants naturally leads to blind spots in safety assessment. For example, experience has demonstrated that the class of drugs known as benzodiazepines has a significant potential for misuse, a discovery not obvious during the testing phases of these drugs. A recent survey of an insurance claims database in France revealed just how rampant benzodiazepine abuse has become.
One of the most common methods for acquiring benzodiazepines illicitly is through “doctor shopping.” With doctor shopping, a patient obtains legitimate prescriptions from several doctors in an overlapping fashion. This surplus of drugs can be hoarded for oneself or distributed on the black market. The study authors examined a French insurance claims database of over 1 million citizens, of which 12% had received at least one prescription for a benzodiazepine during the calendar year of 2003. Of the total quantity of dispensed drugs, 3.6% were acquired through the practice of doctor shopping. In terms of sheer volume, that’s an enormous amount of prescription medication that should never have been prescribed.
Rohypnol (flunitrazepam) showed by far the highest abuse potential, both in terms of volume and likelihood for doctor-shopping activities. Other drugs ranking high on the list were Xanax (alprazolam), Valium (diazepam), and Gen-Xene (clorazepate). There’s no way to know whether these illicit “extra” prescriptions were intended for resale or hoarding. According to the researchers, not all abuse falls under the heading of “recreational.” Sometimes patients discover that the therapeutic value of a legitimate prescription is not what they expected, and they commence doctor shopping to acquire higher doses. Of course, abuse is still abuse and will always have negative outcomes in the long run.
The French study authors demonstrated that analysis of doctor-shopping statistics is a powerful indicator of a drug’s abuse potential. With this information in hand, doctors can be more discriminating in their prescriptions, while drug companies can target their research towards alternative medications without the unwanted, addictive qualities.
- Pradel, V., Delga, C., Rouby, F., Micallef, J., Lapeyre-Mestre, M. (2010). Assessment of abuse potential of benzodiazepines from a prescription database using ‘doctor shopping’ as an indicator. CNS Drugs, 24(7), 611-620.
- MedlinePlus Drug Information. (n.d.). Bethesda (MD): National Library of Medicine. Alprazolam. Retrieved February 27, 2012, from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684001.html
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