Identifying and Evaluating Control Mechanisms for Illicit Prescription Drugs Markets by Focusing on Consumption of Main Abuse Potential Prescription Drugs

Abstract

Following the global expansion of drug markets and introduction of licit pharmaceutical drugs use with illicit drugs, this research project designed to identify and evaluate control mechanisms for illicit prescription drugs markets of Pakistan by collecting a wealth of information about prescription drugs dependence among addiction treatment seeking individuals with or without concurrent illicit drugs use. In order to explore the magnitude of the prescription drugs problem the Study 1 investigated the extent of prescription drugs consumption and associated factors of prescription drug dependence (PDD), as opposed to concomitant prescription drug dependence and illicit drug use (PIDU), within a sample of individuals seeking addiction treatment. The cross sectional study was conducted on the sample recruited from drug treatment centers in Pakistan. Face-to-face interviews were conducted with participants who met ICD-10 criteria for prescription drug dependence. Binomial logistic regression models examined the factors associated with PDD and PIDU. Of the 537 treatment seeking individuals interviewed at baseline, close to one third (178, 33.3%) met criteria for dependence on prescription drugs. Among participants who met criteria for dependence on prescription drugs, (71.9%) reported benzodiazepines as the most frequently used drug, followed by narcotic analgesics (56.8%), cannabis/marijuana (45.5%), and heroin (41.5%). The patients reported alprazolam, buprenorphine, nalbuphine, and pentazocin use as alternatives to illicit drugs. PDD was significantly negatively associated with injectable route (OR=.281, 95% CI, .079- .993) and psychotic symptoms (OR=.315, 95% CI, .100, .986). PDD was associated with the attitude that prescription drugs are safer than illicit drugs (OR=4.057, 95%CI, 1.254-13.122). Study 2 investigated the severity of dependence on prescription drugs and illicit drugs and their related health consequences in addictive patients. Using multicenter cross-sectional study design, participants having prescription drugs dependence (PDD) and drugs use disorders (DUDs) recruited from addiction treatment centers in Pakistan. Probability of drug-related diagnosis determined using DUDIT and DSM-5. We constructed two statistical models: simple linear regression model analyzing the impact of frequency/dose and duration of drugs on Severity of Dependence Scale (SDS) score and logistic regression model analyzing correlates of health consequences with mutually exclusive groups of prescription drugs dependents with alcohol, heroin, cannabis/marijuana and opium. Mean value of vii SDS score of nalbuphine, opium, narcotics analgesics, pentazocin, and buprenorphine is 9, therefore these drugs are concluded as harmful addictive substances. In binary logistic model, reporting couse of alcohol with pharmaceutical drugs was positively associated with involvement in criminal justice (Odds ratio=2.826, CI=1.132- 7.05).While participants reporting heroin use with PDD were more likely to report cardiovascular disorders (Odds ratio=5.595 CI=2.389-13.106, P < 0.05), respiratory disorders (Odds ratio=4.848, CI=2.429 -9.679), and reproductive system disorders (Odds ratio=4.289, CI=2.270-8.104). While cannabis/marijuana with presription drugs are more likely to suffer psychotic disorders (OR=3.444, CI=1.785-6.646), worst relationships with family and peers (OR=19, CI=2.483-145.381) and odds of cardiovascular disorders of patients using opium with prescription drugs is 2.861 times higher with CI=1.198-6.833. K-means cluster analysis explored that each cluster of drugs had physical, psychiatric and social vulnerabilities. Study 3 focused on reasons of PDD with evaluation of pharmacy and physician practices in dispensing and prescribing abuse potential prescription drugs (APPD) to the addictive patients. The lack of professional and qualified pharmacists at community pharmacies, lack of implementation of drugs sales laws, sale of APPD without verification of prescription and negligible provision of information about abuse potential of prescription drugs by prescribing physicians and retailers on drugs stores leads to the dependence on prescription drugs in Pakistan. Finally, Study 4 provides latest estimates and trends of the market share of synthetic drugs (amphetamines, benzodiazepines, ketamine) against the market share of semi synthetic drugs (heroin, cocaine) and the natural drugs like Cannabis/Marijuana/Hashish. Data on drugs control mechanisms with legal framework of agencies to curb the illicit drugs use along with pharmaceutical drugs gathered by getting access to (MNC) ministry of narcotics control and (DDR) Drug Demand Reduction department of Anti-narcotics force (ANF). Officials of (MNC) ministry of narcotics control of Pakistan and anti-narcotics force approached to assess data on all commercial level seizures in Pakistan from 2018 to 2023. Aggregate seizure of cannabis products including marijuana and hashish is the most trafficked illicit drug in the Pakistan weighing 325153 kg in total followed by opium (97827.599kg), heroin (39322.95kg) and morphine (35053.97kg) from 2018 to 2023.