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. But the National Institute on Drug Abuse says about 48 million people (ages 12 and older) 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 rise in prescription drug misuse or abuse. This increase has led to more ER visits because of accidental overdoses and more admissions to treatment programs for drug addictions.
What Is a Drug Addiction?
Addiction is a chronic brain disease that often happens again. It causes compulsive drug seeking and use despite harmful effects on the addicted person and the people around that person. The abuse of drugs -- even prescription drugs -- leads to changes in how the brain looks and works.
For most people, the first decision to take prescription drugs is voluntary. But over time, 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 have intense impulses to take more drugs.
Which Prescription Drugs Are Commonly Abused?
The National Institute on Drug Abuse says the three classes of prescription drugs that are often abused are:
- Opioids used to treat pain
- Central nervous system (CNS) depressants, such as benzodiazepines (Xanax, Valium, Ativan, ), used to treat anxiety and sleep disorders
- Stimulants, such as amphetamine and (Adderall) or (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, Oramorph SR) -- have greatly risen. That increase can be attributed to an aging population and more widespread chronic pain. Other drugs in this class include:
- Fentanyl (Actiq, Duragesic, Fentora)
- Hydrocodone (Zohydro ER, Hysingla ER)
- Hydrocodone with acetaminophen (Lorcet, Lortab, Norco, Vicodin)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine ()
- 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 well. 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. But when they're used long-term, opioids may lead to drug abuse with physical dependence and 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), (Klonopin), or diazepam (Valium) -- there is a much higher chance of respiratory depression, or even death.
Opioids can cause a mild joyful feeling. But opioids such as OxyContin are sometimes wrongly snorted or injected to boost that feeling.
How Do CNS Depressants Work on the Brain and Body?
Benzodiazepines depress the central nervous system (CNS). Millions of people in the U.S. use them to treat anxiety and sleep disorders, including insomnia. These CNS depressants affect the brain neurotransmitter GABA (gamma-aminobutyric acid). GABA lowers brain activity, which makes you drowsy or calm.
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 also commonly treated insomnia or anxiety on a short-term basis. But because of overdose dangers, benzodiazepines have largely replaced barbiturates for those purposes.
Taking CNS depressants for a few days to a few weeks may help you feel calm and sleepy. But after a while, you may need larger doses to get the same calm and sleepy feeling. Also, using CNS depressants with alcohol can slow down your heart and breathing and lead to death.
After taking CNS depressants for a long time, stopping suddenly can have life-threatening effects such as withdrawal seizures.
How Do Stimulants Work on the Brain and Body?
Stimulants give your body a fast jump-start, causing a great boost in alertness, energy, and attention. Stimulants raise heart rate, blood sugar, and blood pressure, constrict blood vessels, and open the pathways of the respiratory system.
Stimulants were first used to treat asthma and obesity. Today, they're also prescribed to treat problems such as ADHD, ADD, depression, narcolepsy, and other problems. Examples of stimulants are dextroamphetamine (Dexedrine, Dextrostat, ProCentra), lisdexamfetamine (Vyvanse), methylphenidate (Concerta, Daytrana, Methylin, Ritalin), and the combination of amphetamine and dextroamphetamine (Adderall).
Taken the right way 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 can cause addiction and 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 there's more prescription drug abuse. It's thought, though, that because there are more drugs available to more people, drug abuse is easier. Doctors report writing more prescriptions for patients than ever before. That includes prescriptions for commonly abused drugs such as opioids, CNS depressants, and stimulants. Also, you only have to go to the Internet to find many 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 ones may cause serious problems -- even death -- if taken with other drugs or alcohol.
Why Do Some People Become Addicted and Others Don't?
Your biology, social environment, and age or stage of growth seem to affect how likely you are to get addicted. The more risks 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. Your social environment, including friends or colleagues, may also influence addiction. Equally important is your stage of growth. Studies show the earlier someone begins to abuse drugs, the greater the chances are that the addiction may become more serious problems.
How Do I Know if I'm Abusing Prescription Drugs?
If you are abusing them, 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 are taking it more often 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 prescription drug abuse.
Your doctor may notice that you're calling more frequently for refills for the medication or that you're asking for larger amounts of it. This may also be a sign of abusing prescription drugs. Also, 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?
The FDA says guidelines for safe prescription medication use include:
- Always follow the prescription medication directions carefully.
- Don't raise or lower medication doses without talking with your doctor first.
- Never stop taking medication on your own.
- Don't crush or break pills, especially if the pills are time-released.
- Be clear about the drug's effects on driving and other daily tasks.
- Learn about the effects the prescription medicine can have when it's taken 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 stop the symptoms of prescription drug addiction and regain control.
Buprenorphine is a drug used to treat opiate withdrawal, and it is often combined with the drug naloxone (a combination that can be called Suboxone, Bunavail, or Zubsolv) to prevent relapse.
A form of buprenorphine (called Probuphine) can be implanted under the skin. It treats opiate dependence in people who have been taking a stable dose of oral buprenorphine and are no longer ridding their bodies of the drug they're being treated for. It provides a constant dose of buprenorphine for 6 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 taken 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 central nervous system, 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 refer you 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 knows that you are aware of the problem. Be prepared for a lot of resistance and denial. Many people with addiction must go through serious consequences before they accept their illness. Then, stand beside the person as he works to move beyond the addiction.