Is it possible that you or someone you love is addicted to prescription drugs? Most of us take prescription drugs only for the reason the doctor intended. Nevertheless, an estimated 48 million people (aged 12 and older), according to the National Institute on Drug Abuse, have used prescription drugs for nonmedical reasons in their lifetime. That figure represents approximately 20% of the U.S. population.
In recent years, there has been a dramatic increase in prescription drug misuse or abuse. This increase has led to a corresponding increase in ER visits because of accidental overdoses as well as admissions to drug treatment programs for drug addictions.
What Is a Drug Addiction?
Addiction is a chronic, often relapsing brain disease. It causes compulsive drug seeking and use despite harmful consequences to the addicted person as well as the people around that person. The abuse of drugs -- even prescription drugs -- leads to changes in the structure and function of the brain.
For most people, the initial decision to take prescription drugs is voluntary. Over a period of time, however, changes in the brain caused by repeated drug abuse affect a person's self control and ability to make sound decisions. While this is going on, the person continues to experience intense impulses to take more drugs.
Which Prescription Drugs Are Commonly Abused?
According to the National Institute on Drug Abuse, the three classes of prescription drugs that are often abused include:
- Opioids used to treat pain
- Central nervous system (CNS) depressants, such as benzodiazepines (Xanax, Valium, Ativan, Klonopin), used to treat anxiety and sleep disorders
- Stimulants, such as amphetamine and dextroamphetamine (Adderall) or methylphenidate (Concerta, Daytrana, Methylin, Ritalin) used to treat attention deficit disorder and narcolepsy (a sleep disorder).
How Do Opioids Work on the Brain and Body?
Since the early 1990s, doctors' prescriptions for opioid medications -- such as codeine and morphine (Astramorph, Avinza, Kadian, MS-Contin, Ora-Morph SR) -- have greatly increased. That increase can be attributed to an aging population and a greater prevalence of chronic pain. Other drugs in this class include:
- Fentanyl (Actiq, Duragesic, Fentora)
- Hydrocodone with acetaminophen (Lorcet, Lortab, Norco, Vicodin)
- Hydrocodone (Zohydro ER, Hysingla ER)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine (Demerol)
- Methadone (Dolophine, Methadose)
- Oxycodone (OxyContin, OxyFast, Roxicodone)
- Oxycodone with acetaminophen (Roxicet, Endocet,Percocet)
- Oxycodone and naloxone (Targiniq ER)
When they're taken as prescribed, opioids and other painkillers manage pain quite effectively. They can improve quality of life for people with chronic pain. In fact, using opioids for the short-term or under a doctor's cautious supervision rarely leads to addiction or dependence. However, when used long-term, opioids may lead to drug abuse with physical dependence and/or addiction. Opioids can also be life threatening in an overdose. When they are taken with substances that depress the central nervous system -- including alcohol, barbiturates, or benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), or diazepam (Valium) -- there is a greatly increased risk of respiratory depression, even death.
Opioids can induce a euphoric feeling that's usually mild. However, opioids such as OxyContin are sometimes inappropriately snorted or injected to increase the euphoric effects.
How Do CNS Depressants Work on the Brain and Body?
Benzodiazepines depress the central nervous system (CNS). They are used by millions in the U.S. to treat anxiety and sleep disorders, including insomnia. These CNS depressants affect the brain neurotransmitter GABA (gamma-aminobutyric acid). GABA works by decreasing brain activity, which results in a drowsy or calming effect.
Barbiturates, including amobarbital (Amytal), pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal), are also CNS depressants. They are commonly used for anesthesia and are prescribed to treat seizures. At one time, they were also commonly used to treat insomnia or anxiety on a short-term basis, but because of their dangers in overdosing, they have largely been replaced for those purposes by benzodiazepines.
Taking CNS depressants for a few days to a few weeks may help you feel calm and sleepy. After a while, however, you may need larger doses to get the same calm and sleepy feeling. In addition, using CNS depressants with alcohol can slow down your heart and breathing and lead to death.
After taking CNS depressants for a long period of time, stopping suddenly can have life-threatening consequences such as withdrawal seizures.
How Do Stimulants Work on the Brain and Body?
Stimulants give your body a fast jumpstart, causing a great increase in alertness, energy, and attention. Stimulants increase heart rate, blood sugar, and blood pressure, constrict blood vessels, and open the pathways of the respiratory system.
Initially, stimulants were used to treat asthma and obesity. Today, stimulants are prescribed to treat problems such as ADHD, ADD, depression, narcolepsy, and other problems. Examples of stimulants include methylphenidate (Concerta, Daytrana, Methylin, Ritalin), dextroamphetamine (Dexedrine, Dextrostat, ProCentra), lisdexamfetamine (Vyvanse), and the combination of amphetamine and dextroamphetamine (Adderall).
Taken appropriately and under a doctor's supervision, these drugs and other stimulants are safe. When they are abused -- for instance, by taking the drugs in higher doses or crushing the pills to get a high -- they have the potential for addiction and ongoing abuse. Using stimulants with decongestants may cause irregular heart rhythms and high doses of stimulants can cause high body temperatures.
Why Is Prescription Drug Abuse on the Rise?
Most experts are unsure why prescription drug abuse is on the rise. It's thought, though, that because there are more drugs available to more people, the opportunity for abuse is greatly increased. Doctors report writing more prescriptions for patients than ever before. That includes prescriptions for commonly abused drugs such as opioids, CNS depressants, and stimulants. In addition, you only have to go on the Internet to find vast numbers of online pharmacies selling these highly addictive drugs. Online pharmacies make it easy to get these drugs -- even for children or teens.
It's not uncommon for teens to talk about stealing medication from their parents' medicine cabinets. Instead of taking illegal substances commonly sold in back alleys, some teens today tell of having prescription parties where they gather at someone's home, mix their parents' prescription pills in a bowl, and then help themselves to whichever pill looks most appealing. The problem is most teens have no idea what medications they are taking and which medications may cause serious problems, even death, if taken with other drugs or alcohol.
Why Do Some People Become Addicted and Others Don't?
Risk for addiction appears to be influenced by a person's biology, social environment, and age or stage of development. The more risk factors you have, the greater the chance that taking drugs can lead to addiction. As an example, sometimes addictions run in families with a strong genetic link. In addition, social environment including friends or colleagues may also influence addiction. Equally important is the person's developmental stage in life. Studies show the earlier someone begins to abuse drugs, the greater the chances are that the addiction may progress into more serious problems.
How Do I Know if I'm Abusing Prescription Drugs?
If you are abusing prescription drugs, you may be taking larger doses than your doctor prescribed, or using them for reasons other than prescribed. For instance, if your doctor prescribed a pain medication to be taken three times daily and you find yourself taking the same medication more frequently or taking twice as much, you are abusing prescription drugs. If you take the same pain medication for reasons other than prescribed -- such as, because you feel out of sorts or bored -- this is also an abuse of the prescription medication.
Your doctor may notice that you're calling more frequently for refills for the medication or that you're asking for increasing amounts of medications. This may also be a sign of abusing prescription drugs. In addition, your pharmacist may notice prescription drug abuse by spotting false or altered prescription forms or multiple prescriptions for controlled substances from different doctors.
Are There Some Guidelines for Using Prescription Drugs Safely?
According to the FDA, guidelines for using prescription medications safely include:
- Always follow the prescription medication directions carefully.
- Don't increase or decrease medication doses without talking with your doctor first.
- Never stop taking medication on your own.
- Don't crush or break pills (especially important if the pills are time-released).
- Be clear about the drug's effects on driving and other daily tasks.
- Learn about possible interactions of the prescription medicine with alcohol and other prescription and over-the-counter (OTC) drugs.
- Talk honestly with your doctor about any history of substance abuse.
- Never allow other people to use your prescription medications and don't take theirs.
Is There Treatment for Prescription Drug Addiction?
There are treatments, including nonaddictive medications that can help people counteract the symptoms of prescription drug addiction and regain control.
Buprenorphine is a drug used to treat opiate withdrawal, and is often combined with the drug naloxone (a combination called Suboxone) in order to prevent relapse.
A form of buprenorphine has become available that can be implanted under the skin (called Probuphine) and is used for maintenance treatment of opiate dependence in people who have been taking a stable dose of oral buprenorphine and are no longer in the midst of detoxification. It provides a constant dose of buprenorphine for six months.
Other drug treatments for opiate withdrawal include methadone and the blood pressure medicine clonidine. The drug naltrexone blocks the effects of opiates and is another treatment option for preventing opiate relapse. It can be administered orally (Revia) or as a monthly injection (Vivitrol).
Experts believe that combining addiction treatment medications with cognitive behavioral therapy is the best way to ensure success for most patients.
Are There any Warnings for Using Opioids, CNS Depressants, and Stimulants?
According to the National Institute on Drug Abuse, opioids should never be used with substances that cause CNS depression, including:
- General anesthetics
CNS depressors should never be used with other substances that depress the CNS, such as:
- Prescription opioid pain medicines
- Some OTC cold and allergy medications
Stimulants should be used with caution if combined with other substances that stimulate the nervous system, including:
- Antidepressants, as supervised by a doctor
- OTC decongestant medications
- Some asthma medications
How Can I Help a Loved One Who Is Addicted to Prescription Drugs?
If you believe that a family member or close friend is abusing prescription drugs, talk with your health care professional. Doctors can give you referrals to drug treatment programs for the family member or friend. Many of these programs use outpatient treatment with medications and behavioral therapy.
Most importantly, talk to the person about your concerns so he or she knows that you are aware of the problem. Be prepared for a considerable amount of resistance and denial. Many people with addiction must experience serious consequences before they acknowledge their illness. Then, stand beside the person as he or she works to move beyond the addiction.