Studies have also shown that a drug's effects are influenced by the context in which it was given, for example, school versus party environment. Volkow cited a study where methylphenidate was administered while individuals were in a boring context as compared to when they were in an exciting context (Volkow et al., 2004c). Dopamine increases were larger when methylphenidate was given with a task that required cognitive performance that was remunerated than when it was given with a task that did not require performance and was not remunerated.
In looking at other factors influencing the abuse of prescription medications, Volkow pointed to the tremendous increase in availability, media coverage and the World Wide Web. "Prescriptions for stimulant medications, for example, have doubled every five years over the past 15 years," she said. "Last year, one of the most frequently prescribed drugs in this country was Vicodin. So the increase in prescribing has contributed to the increased availability of these drugs."
Awareness of the drugs has increased through television advertisements and such magazine stories as Newsweek's "Ritalin: Are We Overmedicating Our Kids?" and the New York Times' "The OxyContin Underground: How a Prescription Painkiller is Turning Into a Pernicious Street Drug," she added.
"The Web, of course, is a very valuable tool in terms of disseminating information," Volkow said. "Unfortunately, it [also] is a valuable tool for the diversion of drugs. If you go to Google tonight and enter 'prescription drugs' and then enter 'prescription drugs, no prescription required,' you will get thousands of sites where you can actually get prescription medications without the need for a prescription … The only thing you need is a credit card number. You could be 10 or 12 years of age, nobody will check that … Now we have access to these pharmacies, many of them illegal and many of them in other countries where the quality control of the medications cannot be assured, increasing the likelihood of toxicity."
NIDA's Role
What is the role of NIDA in fighting prescription drug abuse? Volkow said, "We have a multi-target approach that involves multiple projects."
These projects include developing medications to treat the problem of addiction to opioid analgesics; developing medications that can treat pain but do not have the abuse potential; and educating the public and health care professionals about prescription drug abuse.
Volkow noted that NIDA has launched a very large educational campaign to alert the public and health care professionals on the most frequently prescribed drugs that have the potential for abuse and to provide them resources for more information such as NIDA's Web site .
