The diversion of nonscheduled psychoactive prescription medications in the United States, 2002 to 2017

Abstract

Purpose Systematic studies of the diversion of nonscheduled drugs, except for gabapentin, are not apparent. We searched diversion case reports of all other nonscheduled psychoactive prescription drugs in the Researched Abuse, Diversion, and Addiction‐Related Surveillance (RADARS) System. Methods Case report data are drawn from a quarterly survey of prescription drug diversion completed by a national sample of law enforcement and regulatory agencies. Rates of diversion per 100 000 population were calculated for each year from 2002 to 2017 for prescription medications with greater than 400 reported cases during the period. Results Cyclobenzaprine, quetiapine, and trazodone met criteria for analysis. We found a significant and steady increase in the diversion of each drug over the period. The 2017 annual rates of diversion per 100 000 population for the three medications range from 0.0428 to 0.0726. Although these rates of diversion are much lower than the rate for total opioid analgesics, they are all more than five times higher in 2017 compared with 2002. While diversion rates for opioids have decreased in recent years, rates for cyclobenzaprine, quetiapine, and trazodone have continued to increase. Conclusions A common attribute of the three nonscheduled drugs studied here is that all are used for the treatment and/or self‐treatment of opioid withdrawal symptoms, and the increasing diversion of these drugs may be related to the ongoing opioid epidemic and to increasing levels of control over pharmaceutical opioid availability in the United States. Prescribers need to be aware of illicit markets for these medications and prescribe to their patients with appropriate caution.

A Focus on Abuse/Misuse and Withdrawal Issues with Selective Serotonin Reuptake Inhibitors (SSRIs): Analysis of Both the European EMA and the US FAERS Pharmacovigilance Databases

“…From both datasets, the abuse-related signals were here mostly recorded in association with citalopram and fluoxetine, and to a lesser extent with sertraline. This finding is consistent with data from the US Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System, suggesting that the most common non-scheduled psychoactive prescription drugs diverted over a 16-year period included sertraline, fluoxetine, and citalopram, along with other psychotropics [ 56 ]. Despite being generally considered a safe class [ 57 ], there is a growing, albeit relatively small, literature reporting the misuse and abuse of SSRIs; many of these reports involved fluoxetine, ingested in idiosyncratic ways (e.g., intravenously) and/or at mega-dosages (e.g., up to 120 mg), for either appetite suppression/weight loss or for stimulant-like effects in patients with a substance use history [ 1 ].…”

Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability

“…And although individuals may misuse gabapentinoids prescribed to them, reports of obtaining gabapentinoids from friends or family, on the internet, or from street dealers are also common 15,19–23 . These qualitative findings coincide with recent reports of increasing nonprescribed gabapentinoid obtainment 24,25 …”

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

“…Fatal arrhythmias can occur with trazodone overdose [ 44 ]. It has been noticed that trazodone—along with cyclobenzaprine and quetiapine—can be used for the treatment and/or self-treatment of opioid withdrawal symptoms, so clinicians need to prescribe these medications to their patients with appropriate caution [ 45 ].…”