Medicine misuse or drug abuse? A critical appraisal of current issues and research in the UK

Abstract

During the last decade consumption of licit medications and illicit drugs has risen substantially. It is estimated that the 100 000–200 000 severely dependent drug misusers in the UK generate social costs of 3–4 billion annually, while the cost of prescribed medicines for the entire population is currently 5 billion. Although attitudes and behaviours have been extensively researched, they remain complex and often contradictory. In particular, little is known of how perceptions of the benefits and risks of chemical substances influence behaviour. At an epidemiological level, new methods such as capture–recapture are being used to delineate forms of drug abuse which have previously not been detected in household surveys. There are few current data on the extent of inappropriate medicine prescribing, although there are various initiatives to promote rational and cost-effective prescribing. Reasons for inappropriate medicine use include patient expectations, prescribers' perceptions of patients and drug company marketing. Advances in basic science are revealing hitherto unsuspected consequences of both licit and illicit drug use. Examples include (1) the role of analgesics in causing severe headache and (2) suppression of immune functioning due to Ecstasy. One illustration of changing attitudes, as a result of public and medical pressure, is the growing call for the licensing of cannabis for medicinal use, particularly for intractable conditions such as multiple sclerosis. With the recently announced drug strategy promising a shift towards evidence-based decision-making, innovative research is required to improve the currently fragmentary view of the general population's attitudes and behaviour in relation to medicines and drugs.