It’s Alcohol Awareness Month! Alcohol Abuse Makes Prescription Drug Use More Likely

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April is Alcohol Awareness Month and it was first started by the NCADD in 1987 to create awareness about the use of alcohol and the serious consequences associated with its misuse. One of the many problems linked with the misuse of alcohol is the increased likelihood of a person abusing prescription drugs. In fact, people abusing alcohol are 18 times more likely to also be abusing prescription medications than people who are not abusing alcohol¹.

The effects of using alcohol and prescription drugs together can be extremely severe and even fatal. A body’s natural response to over drinking is to lose consciousness and pass out. However, drugs can stimulate the system to keep the inebriated individual awake and potentially, still drinking and using drugs – perhaps even different drugs than they would use sober. Some of the other side effects associated with combined prescription drug use and alcohol include vomiting, blackouts, loss of consciousness, respiratory depression and alcohol poisoning.

Another side effect of combining prescription drugs and alcohol is the increased likelihood of risky behaviors such as unprotected sex, unplanned sex and driving under the influence. It’s also more likely that the person will indulge in other drug use. When a person’s inhibitions are removed, their behavior becomes completely out of control. These risky behaviors are not just risky for the person drinking and using the drugs. These behaviors can also have deadly consequences for those around.

Nonmedical Use of Prescription Drugs (NMUPD)

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is sponsored by the National Institutes of Health (NIH). This group has defined non-medical use of prescription drugs as: “Using drugs that were not prescribed to you by a doctor, or using drugs in a manner not intended by the prescribing clinician (e.g., to get high). Nonmedical use does not include taking prescription medications as directed by a health practitioner or the use of over-the-counter medications”. This includes all methods and dosages that were not recommended by the patient’s doctor or pharmacist.

One study done in 2006¹ found that the four main types of prescription drugs used in a non-medical way included prescription opiates (such as Percocet and OxyContin), stimulant medications (such as Ritalin and Adderall), sedative and anxiety medications (such as Ativan and Valium) and sleeping medications (such as Ambien and Restoril). The class of drugs most misused is prescription opiates. OxyContin (Oxycodone) has been highly publicized for its misuse across the country as people have found themselves addicted to it after using it as a pain medication or using it recreationally.

Age Groups at Risk

In the last ten years, the rates of drinking and alcohol use disorders have remained steady in American youth aged 18 - 24. However, the nonmedical use of prescription drugs has risen significantly in young adults in the United States³. The increase of prescriptions overall, especially in the categories most likely to be abused, can account for some of the rise of nonmedical use of prescription drugs. Patients had prescriptions filled 3.7 billion times at pharmacies in 2010 – this number does not even include medications that were purchased online⁴. Online medications are not tracked in the same way as prescriptions that are purchased at pharmacies making the true number difficult to decipher.

The nonmedical use of any variety of prescription drugs was shown to be significantly higher in the 18-24 age range than in that of ages 25+⁵. This age group also had higher rates of binge drinking, alcohol use disorders and nonmedical prescription use. The 18-24 age range had nonmedical prescription drug use rates of 8% while the 25+ age group had a usage rate of 3%. It was also found that the people who were initiated into alcohol use at younger ages are even more likely to combine alcohol abuse with prescription drug abuse. This makes it even more important for adults to ensure that children are kept away from alcohol for as long as possible.

Drinking Severity

The nonmedical use of prescription drugs also increases significantly when the severity of drinking is taken into effect⁵.  The prescription drug use is the highest with individuals who reported binge drinking or alcohol use disorders. Those who qualified as alcohol dependent by the DSM-IV (Diagnostic and Statistical Manual Version 4) reported a 22.02% rate of having used prescription drugs for nonmedical uses within the past 12 months. In comparison, individuals diagnosed as alcohol abusers by the DSM-IV had a rate of 8.27%, binge drinkers had a rate of 4.01%, non-binge drinkers had a rate of 2.13% and those who abstained from alcohol in the last year had a rate of 1.26%.

These rates show that the more a person drinks in a year, the more likely they are to engage in nonmedical use of prescription drugs. These results came from a well-balanced study of more than 43,000 male and female respondents with representatives from various racial categories gathered from around the United States of America. The rates of an alcohol dependent respondent showed that they were 18 times more likely to engage in the nonmedical use of prescription drugs than respondents who abstained from alcohol over the last 12 months. It is important to note that the DSM-IV diagnoses are widely used by doctors and clinicians alike to diagnose a range of conditions including alcohol related disorders.

Alcohol Interactive Medications

Many prescription medications are referred to as “alcohol interactive”. This means that the prescription drug and the alcohol interact with each other to intensify the effects of both. The side effects of combining medications classified as alcohol interactive with alcohol are varied by can include dizziness, nausea, drowsiness, increased sedation, increased risk of illness and injury and even death. In fact, it is suspected that many hospital emergency room visits can be attributed to the consequences of alcohol and drug interactions⁶. Doctors and pharmacists need to do more to ensure that patients are aware of receiving any alcohol interactive medications and what exactly the risks are.

Prevalence of Alcohol and Drug Interactions

One study conducted research on over 8,000 different participants to learn about the prevalence of patients combining alcohol with alcohol interactive medications⁷. Their study showed that 13.5% of the respondents were taking a medication defined as alcohol interactive. 5.6% of this group admitted to drinking three or more drinks on occasion while using the medication. Even if the prescription was being used according to the doctor’s orders in every other way, the use of these prescriptions combined with the use of alcohol is ill advised. Combining alcohol and prescription medications is unwise and can potentially be fatal.

The use of alcohol in conjunction with alcohol interactive medications is thought to be extremely common in the general population. Some of these drugs can have adverse effects after the patient consumes just one glass of alcohol. This problem may grow larger in scope as the population continues to age and consume more prescription medications. The baby boomer generation is thought to be much more likely to indulge in heavy drinking than the generations before it making this problem even more troublesome.

Examples of Alcohol Interactive Medications

Here are some examples of medications which may interact with Alcohol.

• Statins
  Examples:  Crestor, Lipitor, Livalo, Lovastatin, Pravastatin, Simvastatin.
  Excessive Alcohol use while on cholesterol lowering medications, called statins, is not safe and is not recommended. Moderate consumption may not be harmful and in fact, a study shows that moderate intake may positively impact the cholesterol profile of the patient.⁸
  
• Antibiotics
  Examples: Amoxicillin, Flagyl, Ciprofloxacin, Doxycycline, Bactrim
  Although Alcohol may not reduce the effectiveness of most antibiotics, the combination can cause additional or more severe cases of headaches, increased heart rates and gastrointentinal issues such as nausea and vomiting.
• Antidepressants
  Examples:  Amitriptyline, Zoloft, Lexapro, Effexor, Citalopram, Paxil, Trazodone, Prozac.
  Alcoholism and Depression often accompany each other.  The combination should be avoided as the result could worsen symptoms of depression as well as cause other more dangerous side effects.
• Sedatives & Sleepaids
  Examples:  Valium, Ativan, Ambien.
  Excessive Alcohol consumption may prolong the sedative effects of these kinds of medications.  There have been cases of this combination leading to death and as a result should be avoided at all times.
• Antidiabetic Medications
  Examples: Metformin, Actos, Victoza
  For most diabetes medications, consuming a small amount of Alcohol should not be problem.  However, excessive Alcohol consumption in people with diabetes can result in increases in their blood sugar level.  Occasional drinks should only be consumed when their sugar levels are well-controlled.
• Antacids & Antiulcer Medications
  Examples:  Omeprazole, Reglan, Pepcid, Maalox, Nexium, Pepto-Bismol, Zantac
  Combining alchohol with these types of medicatons can allow for a higher blood-alcohol level, magnifying the effects of alcohol on the body.
• Antihistamines / Allergy Medications
  Examples:  Benadryl, Claritin, Zyrtec, Singulair, NyQuil
  The effectiveness of Allergy Medications and antihistamines may be severely diminished if consumed with large amounts of Alcohol.   Many antihistamines may also cause drowsiness, and so when combined with alcohol, those sedating side effects are are magnified.
• Pain Relievers
  Examples: Codeine, Morphine, Oxycodone, Percocet, Vicodin
  The sedative effects of Alcohol and prescription narcotic pain relievers are increased when they are combined.  With excessive use, the combination could also lead to respiratory issues and liver damage.

What Should Be Done?

Doctors need to be aware of the link between alcohol abuse and nonmedical prescription drug use. Researchers encourage clinicians to conduct extensive drug use histories with patients suffering for alcohol use disorders. These patients must be educated about the serious consequences that can occur when these prescription drugs and alcohol are used together. Patients receiving prescriptions, especially for opioids, stimulants, sedatives and tranquilizers, must be informed of the dangerous interactions that can occur between their prescribed medication and any alcohol that the person may consume. College campuses need to pay particular attention to the relationship between alcohol and prescription drug abuses.

While prescription drugs are safe when used as prescribed, the consequences of misusing these medications are too severe to simply ignore. More research must be done to examine many facets of the relationship between alcohol and prescription drug use. This research should focus on the age respondents begin using alcohol and prescriptions together, the transition between adolescence and adulthood in relation to drug and alcohol use, the possible effects of using these substances together and what effect education has on the relationship between drugs and alcohol use.

Further work must be done to examine the relationship between alcohol and prescription drug use. Patients, especially those in the most effected age group of 18-24, must be educated about the risks involved with combining alcohol and the nonmedical use of prescription drugs. Adults involved with young adults including parents, teachers and clinicians also need to be aware of the link and associated risks. Education can help to prevent a problem before it even begins.

Citations

1. McCabe, S.E., et al. The relationship between past year drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample. Drug and Alcohol Dependence 2006, 84(3):281-288.
2. National Institute of Drug Abuse. Topics in Brief: Prescription Drug Abuse. http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse. December 2011.
3. Grant, et al. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol Dependence June, 2004, 74(3):223-34.
4. The Henry J. Kaiser Family Foundation. United States: Prescription Drugs. http://www.statehealthfacts.org/profileind.jsp?sub=66&rgn=1&cat=5.
5. McCabe, S.E. et al. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol 2006, 67(4):529-537.
6. Holder HD. Effects of alcohol, alone and in combination with medications. Prevention Research Center. Walnut Creek, CA: Prevention Research Center; 1992.
7. Jalbert, Jessica J., et al. A profile of concurrent alcohol and alcohol-interactive prescription drug use in the US population. Journal of General Internal Medicine September 2008, 23(9): 1318-1323.
8. The effect of simvastatin associated with ranitidine and alcohol upon serum lipids http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15529604