Misuse of psychoactive medicines and its consequences in the European Union – a scoping review

ABSTRACT

Background

Medicines acting on the central nervous system can be inappropriately used. The aim of this study was to clarify the key concepts on misuse of prescription medicines, mapping the existing body of evidence on this topic in the European Union and identifying the main medicines misused, risk factors, and morbidity/mortality consequences of this behavior.

Methods

Three databases – PubMed, Scopus, and Web of Science – were searched. Retrieved articles were added to other studies previously identified from additional sources (e.g., PubMed alerts). Following the PRISMA-ScR flow diagram, the final list was screened for article selection.

Results

A total of 1,637 abstracts were reviewed, resulting in the inclusion of 136 articles. Most studies reported misuse of prescription opioids (66%), benzodiazepines/z-drugs, gabapentinoids, and antidepressants. Risk factors included history of substance use/addiction, mental health or alcohol disorders, female sex, older age, low income/deprivation, and psychoactive substance concomitant use. The main consequences addressed were adverse drug reactions, poisonings, emergency visits, and deaths.

Conclusions

The medicines with highest potential misuse were opioids, benzodiazepines/z-drugs, and gabapentinoids. The considerable variety of data among EU countries suggests the need to invest in systematic centralized research to identify and understand prescription drug misuse at country-level across the EU.

KEYWORDS:

• Psychoactive medicines
• prescription drug misuse
• abuse
• non-medical use
• consequences of medicines misuse

Acknowledgments

The authors would like to gratefully acknowledge:

Susana Oliveira Henriques, Health Information Specialist from the University of Lisbon School of Medicine, for her relevant contribution to the searches performed in the selected databases.

Paulo Duarte and Nuno Raposo, from the Scientific and Technical Documentation Centre of INFARMED, I.P., for their strong commitment in providing expedited bibliographic support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The detailed data of the final selected articles that support the findings of this study are available from the corresponding author, ACA, upon reasonable request.

Notes

1. DDD – Defined Daily Dose: assumed average maintenance dose per day for a drug used for its main indication in adults (WHO).

2. EudraVigilance – the pharmacovigilance database of suspected adverse drug reactions to medicines authorized in the European Economic Area (EEA), managed by the European Medicines Agency.

3. GTNet program – The Global Toxicosurveillance Network (GTNet) program was established in 2011 by the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) system to collect poisoning data in the USA, Europe, and Australia on intentional and unintentional exposures reported to prescription medicines.

4. The European Drug Emergencies Network (Euro-DEN) was established in 2013 connecting EU sentinel centers and emergency departments to collect data on acute toxicity presentations related to the use of recreational drugs, prescription medicines, and new psychoactive substances (NPS).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.