In the report on the consumption of medicines in Italy there are some aspects to note.
There is a slight reduction in the prescription of benzodiazepines and similar sedatives (-12%), even if essentially they are widely consumed drugs, inexpensive and mostly borne by the citizen: they occupy the first place as in previous years, followed as in the past by pro-erectile drugs and estroprogestinic female sex hormones. Among the top twenty non-loanable drugs, tranquilizers-sedatives are represented in 3rd place (lorazepam), 4th (alprazolam), 7th (bromazepam), 9th ( lormetazepam), 13 ° (zolpidem), 17 ° (triazolam).
The various molecules maintain similar positions, with slight increases in consumption for zolpidem and slight decreases for lorazepam and bromazepam. The anomaly therefore persists with respect to the prescriptive indications: these are inexpensive products, which in order to occupy some of the first positions in terms of consumption are evidently consumed continuously, at least by a considerable part of the holders of a prescription.
It is therefore a habitual consumption, except for non-therapeutic exceptions (these are not antiepileptic sedatives), mediators of dependence on tranquilizers, minor (symptomatic of non-stabilized anxiety or mood disorders) or primary (drug addiction to tranquilizers ). The underground market for the use of benzodiazepines among drug addicts is probably not represented, given that it draws on a black market or in any case without correspondence in prescriptions.
Parallel to this, there is a 20% increase in opioid prescribing. The increase concerns in particular the so-called “minor opioids” in combination, in particular oxycodone in combination products (+ 65%; oxycodone alone and specularly in reduction, but only by 16%, codeine in combination up by 12 %). These are products used mainly for pain relief indications. However, it is interesting that 233 reports have been registered for paracetamol-codeine, of which 33% serious.
These data may indicate some tendency towards abuse, not absurd if we consider that in countries where the use of minor opioids is less subject to control (USA), the so-called minor opioids are the first voice of opiate addiction, coming to supplant the classic illegal opiates (heroin).
It should be remembered that it is not the “potency” in pharmacological terms that makes a substance at risk of inducing addiction, but the availability of rapid release formulations of even “weak” products, or the possibility of administering them directly (intransal, inhaled, intravenous) although originally prepared for oral administration (buprenorphine).
The heroin itself, moreover, is not so much characterized by power as by rapidity of concentration in the central nervous system. Furthermore, the case of the “ultra-toxic” abuse of krokodil, the “new drug” that produces destruction of skin and soft tissues as a side effect, used by Russian drug addicts because it is legal (pharmaceutical desomorphine) and inexpensive compared to illegal heroin.
Against any theory of the prohibitionist conspiracy, there is therefore a reflux of the addiction from the illegal to the legal, without this involving the observation of harmless and accepted “habits” to the consumption of opiates, but with pictures that instead correspond to real drug addiction, outside from any confusion with the concepts of vice and marginal lifestyle. The availability of products of this type and therefore a modality of “hidden” relapse of heroin addictions, which recur as addictions to non-therapeutic “drugs”.
Furthermore, it is more than possible that in the future the market will begin to draw on pharmaceutical sources to support low-cost but more widespread addictions, for example in young populations. The circulation of medicines via the internet anonymously or in any case difficult to control is also a way to override the prescriptive limits of one’s state. Opioid dependence remains unchanged, and therefore treatable with therapeutic opiate-based therapies used to restore control over the “appetite” behavior of toxic products.
A solution has also recently been developed for the therapy of true dependence on tranquilizers (minias / lormetazepam, lexotan / bromazepam, control / tavor-lorazepam prevail) based on the controlled use of an “agonist” drug with a duration of long-acting and slow-acting, clonazepam.
