Which prescription drugs are abused?
Prescription drug abuse is the fastest growing drug problem in the United States and has been classified as an epidemic by the Centers for Disease Control and Prevention (CDC). The most commonly abused prescription drugs fall into three classes:
- opioids or analgesics for treating pain (painkillers), such as methadone, oxycodone (OxyContin), fentanyl base, morphine, hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), and codeine
- depressants for treating anxiety and sleep disorders (tranquilizers and sedatives), such as diazepam (Valium), alprazolam (Xanax), and other benzodiazepines
- stimulants for treating ADHD and narcolepsy, such as dextroamphetamine (Adderal, Dexedrine) and methylphenidate (Ritalin)
Sources of prescription drugs used for illicit purposes include “pill mills” or illegal pain clinics, prescription fraud, theft, illegal online pharmacies, and “doctor shopping” (the practice of visiting several doctors to obtain multiple prescriptions). The biggest source of prescription drugs, however, is friends and family. Adolescents may even throw “pharmaceutical parties” where they bring pills from home and deposit them in a jar or bag mixed with a variety of pills from other people. New federal guidelines are currently in place to curb abuse and access to prescription drugs, especially painkillers.
People mistakenly think that drugs prescribed by doctors are safer than illegal drugs. But prescribed medications are only safe when taken exactly as prescribed. When abused, prescription drugs can cause addiction and put abusers at risk for other adverse health effects, including overdose, especially when taken along with other drugs or alcohol.
It is also important to note that over-the-counter (OTC) drugs can also be abused. The most commonly abused OTC drugs are cough and cold remedies containing dextromethorphan.
What is prescription drug abuse?
Prescription drug abuse occurs when a person takes a medication that has been prescribed for someone else, takes a drug in a larger quantity or in another manner than prescribed, or takes a drug for another purpose than prescribed. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines non-medical use as a person taking a prescription drug, even once, when it was not prescribed for that person, or for the experience or feeling that it produces.
If a person continues to take prescription medication long after it is needed, he or she may already have a problem or could be in danger of developing a dependency. Repeatedly trying to re-experience that feeling of a prescription medication can lead to addiction, physical dependence, and withdrawal symptoms just as with any other illicit drug bought on the street.
The American Psychiatric Association (APA) uses the term “substance use disorder” to define a pattern of substance use that leads to significant physical, interpersonal, medical, or work problems. Substance use disorder is further broken down into categories based on the substance and its effects (such as stimulant use disorder, opioid use disorder, etc.). Substance use disorders are rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with a substance use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with substance use disorder should receive treatment, and those who identify themselves as addicts often find the skills and support to stay sober through peer support groups like Narcotics Anonymous.
Addiction is considered a brain-based disease characterized by abnormal drug-seeking behavior that leads to impaired control over one’s drug use. Addiction means a person will continue using alcohol or other drugs despite the harm it does to their health, family, work or school, and relationships. An addict may experience withdrawal symptoms (physical pain, fatigue, depression, trouble sleeping, irritability) if he or she stops using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.
Are prescription drugs dangerous?
Prescription drugs can be very dangerous if not taken properly. In the last decade, opioid pain relievers have contributed to a dramatic increase in the number of drug-related deaths.
Long-term use of opioids (painkillers) can lead to physical dependence and addiction. They can produce drowsiness and constipation, and depending on the amount taken, they can slow the heart rate or stop breathing. Depressants, such as benzodiazipines, slow down brain function. When combined with alcohol or other medications that cause drowsiness, a person’s heart rate and respiration can slow down to a dangerous degree. Taken repeatedly or in high doses, stimulants can cause anxiety, paranoia, dangerously high body temperatures, irregular heartbeat, or seizures.
How does prescription drug abuse affect the brain?
When prescription drugs are taken in unadvised quantities or when symptoms of illness aren’t present, they may affect the brain in ways very similar to illicit drugs. When abused, all of these classes of prescription drugs—painkillers, tranquilizers or sedatives, and stimulants—directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain’s reward pathway.
Opioids or pain relievers like OxyContin attach to the same cell receptors targeted by illegal opioids like heroin. Prescription depressants produce sedating or calming effects in the same manner as the club drugs GHB and Rohypnol, by enhancing the actions of the neurotransmitter GABA (gamma-aminobutyric acid). Depressants like benzodiazepines slow down brain activity and can cause sleepiness and loss of coordination. Finally, stimulants such as Ritalin increase alertness, attention, and energy the same way cocaine does—by boosting the amount of the neurotransmitter dopamine. Taking some stimulants in high doses or repeatedly can lead to hostility or feelings of paranoia.
How does prescription drug abuse affect a co-occurring mental health disorder?
Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.
The effects of prescription drugs may mask an underlying untreated mental illness, or mimic the symptoms of mental illness, leading to misdiagnosis. Because many prescription drugs are used to treat mental health disorders (like anxiety, ADHD, or depression) some may assume that the pleasure they get from taking the drug means they also have the mental illness. But these mental illnesses need to be diagnosed by a professional.
Is addiction to prescription drugs treatable?
Yes. It is important to remember that detoxification is the beginning of treatment, not the entire process. Withdrawing from certain drug types, such as long-term use of benzodiazepines, can be dangerous, and should be conducted under medical supervision. Very often a person abusing prescription drugs may also be abusing other drugs as well. It is important that medical personnel find out the exact history of a person’s drug use, as this knowledge could save his or her life.
Addiction won’t go away, like a cold or the flu. It is a chronic disease, meaning you have it all your life. However, by staying sober and getting ongoing support, recovering people live normal, healthy, productive lives.
There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.
National Institute on Drug Abuse (NIDA):This government organization is dedicated to addiction research and education. Through its website you can access up-to-date publications about many different drugs of abuse as well as emerging trends.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA is part of the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.