Prescription drug abuse is one of the most widespread and rapidly growing drug problems in the United States. According to a 2010 survey, 2.4 million Americans misused prescriptions medications for the first time that year. Half of these individuals were teenagers.
Young adults aged 18-25 years are the population most likely to abuse prescription drugs, according to the National Institute on Drug Abuse (NIDA). These drugs are some of the most common substances abused by individuals in high school, along with marijuana, alcohol, and tobacco, possibly due to ease of access. Most young people first misuse drugs after being given the substance by a friend or relative. It can be especially dangerous for young people to misuse these substances, because multiple studies have shown a correlation between prescription drug abuse and later abuse of street drugs and alcohol.
While any prescription medication can be abused, the types of drugs that most commonly pose a problem are opioids, central nervous system depressants (CNS depressants), and stimulants. These medications can be habit-forming, and misuse can quickly lead to physical dependence and addiction.
Opioids are strong painkillers that are either derived from the poppy plant or similar compounds created synthetically. These drugs work by blocking pain signals from reaching the brain. Common opioids include:
While opioids are typically prescribed to treat moderate to severe pain, some can also be used to relieve cough and severe diarrhea. Hydrocodone is typically used to relieve chronic severe pain, like in the case of injury, while morphine is more commonly used before and after surgical procedures. Codeine can be used both to relieve mild pain and to treat coughs.
In addition to their intended uses, opioids can cause a “high,” or a rush of euphoria. These drugs affect the pleasure center of the brain, releasing large doses of a chemical called dopamine, which is responsible for positive feelings. Because of this, opioids can be addictive.
CNS depressants are commonly referred to as sedatives or tranquilizers. These drugs slow brain activity, which can be useful in relieving anxiety or encouraging sleep. Types of CNS depressants include benzodiazepines, non-benzodiazepine sleep medications, and barbiturates. Benzodiazepines are among the most commonly abused CNS depressants.
Common benzodiazepines include:
- Diazepam (Valium)
- Alprazolam (Xanax)
- Triazolam (Halcion)
- Estazolam (ProSom)
Benzodiazepines are most commonly prescribed to treat anxiety or panic attacks, as well as insomnia. These drugs are typically only recommended for short-term use, since physical dependence to these substances can form very quickly, and addiction can result.
Common non-benzodiazepine sleep medications include:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
This type of medication promotes sleep in different ways than benzodiazepines; they contain different chemical structures, but affect some of the same receptors within the brain. These drugs may carry less abuse potential than benzodiazepines, as well as fewer side effects.
Common barbiturates include:
- Mephobarbital (Mebaral)
- Phenobarbital (Luminal Sodium)
- Pentobarbital (Nembutal)
Barbiturates are not prescribed as frequently as other CNS depressants. These drugs are most commonly used during surgery or to treat seizure disorders. Barbiturates carry a higher risk of overdose than benzodiazepines, so they are rarely used to treat anxiety or sleep disorders.
Many people use these medications for legitimate purposes and do not abuse these drugs. However, this type of medication can be habit-forming, and they can lead to physical dependence. Dependence and addiction are
more likely if the drugs are misused; however, dependence can form even
with legitimate use.
Physical dependence on CNS depressants can be especially dangerous, because withdrawal can include serious, life-threatening medical complications. According to NIDA, use of these drugs must always be tapered gradually rather than stopped suddenly, even when used only as prescribed.
Stimulants are drugs that increase brain activity, resulting in elevated mental alertness and energy as well as increased heartrate, blood pressure, and respiration. These medications can be very addictive, so they are only used to treat a handful of conditions, including ADHD, narcolepsy, and severe depression that is resistant to other treatment.
Common prescription stimulants include:
- Methylphenidate (Ritalin, Metadate, Concerta)
- Dexmethylphenidate (Focalin)
- Dextroamphetamine (Dexedrine, Zenzedi)
- Dextromethamphetamine (Desoxyn)
- Lisdexamfetamine (Vyvanse)
These drugs affect the brain by mimicking naturally occurring neurotransmitters, including norepinephrine and dopamine. Stimulants increase levels of these chemicals within the brain, which can not only increase brain activity, but also cause feelings of euphoria if the drug is used incorrectly or taken when it is not needed. Abuse of stimulants is increasingly popular among high school and college students, as some young people attempt to use these drugs to boost academic or athletic performance.
Prescription Drug Addiction
Many people who develop an addiction to prescription medications were originally prescribed the medication for legitimate medical purposes but became physically dependent on the substances over time. Dependence occurs when the body acclimates to the presence of the drug and then requires it in order to function normally. Dependence does not always lead to addiction, which is a pattern of behavior in which an individual repeatedly seeks out and uses a substance despite negative consequences.
Not everyone is introduced to addictive prescription medications through legitimate means. Young people especially are more likely to get, buy, or steal these drugs from a friend or relative.
Abusing prescription medications can be dangerous in and of itself, and it can also lead to the eventual use of street drugs.
Individuals addicted to prescription opioids commonly go on to use heroin, an illicit drug with similar properties. CNS depressant addiction often goes hand in hand with alcoholism.
Some people try to intensify the effects of prescription medications by using these drugs other than how they are prescribed, such as crushing pills and then either snorting the powder or dissolving it in liquid and injecting it. Opioids are often dispensed in the form of a time-release tablet, and people can chew these tablets to release the whole dose simultaneously. Misusing these drugs in this way can significantly increase the risk of medical complications, as well as overdose.
Some warning signs of addiction can be observed by friends and loved ones. Mayo Clinic lists the following warning signs to watch out for:
- Stealing or forging prescriptions, or selling prescriptions to others
- Using higher doses of a drug than prescribed
- Unusual changes in mood
- Changes in sleep patterns
- Poor decision-making
- Appearing much more or less energetic than normal
- Frequently claiming to have lost prescriptions in order to get a new prescription
- Visiting more than one doctor to have multiple prescriptions written
Treating Prescription Drug Abuse
An addiction to prescription medications is typically treated with a combination of behavioral therapy and medications, depending on the substance of abuse. Detoxification, often called detox, is the first step in any treatment plan and involves processing all addictive substances from the body. This process typically involves withdrawal when physical dependence is present. Medications may be used during detox to minimize symptoms of withdrawal.
Behavioral therapy, also called talk therapy, is one of the most effective methods of treating a substance use disorder. The purpose of counseling is to help the individual change patterns of thought and behavior that contribute to substance use, learn life skills and coping mechanisms, and recognize triggers that lead to relapse.
Different behavioral therapies have been shown to be effective for different addictions. According to NIDA, stimulant addiction can be treated with Contingency Management, the Matrix Model, and 12-Step facilitation. An addiction to opioids may also be treated by Contingency Management and 12-Step facilitation, as well as the community reinforcement approach. Several different approaches may be used
in the case of CNS depressant addiction, including Cognitive Behavioral Therapy, Contingency Management,
community reinforcement, Motivational Enhancement Therapy, and 12-Step facilitation.
For some substances of abuse, pharmacological interventions are very effective. There are no FDA-approved medications for addiction to CNS depressants or stimulants, but several medications can be used to treat opioid addiction. The most common medication used for this purpose are naltrexone, methadone, and buprenorphine.
Methadone and buprenorphine are most frequently used during detox and as maintenance medications throughout the treatment process. These drugs work in similar ways; both mimic the effects of other opioids in order to relieve withdrawal symptoms and cravings. Using this type of medication can significantly improve an individual’s chances of avoiding relapse.
Naltrexone is used less commonly to treat addiction, but it can be effective at reversing an overdose. This medication blocks the effects of opioids, which can help to discourage relapse.
Co-occurring Disorders and Long-term Care
Drug addiction is often just one piece in a much larger puzzle; many people suffering from a substance use disorder also have co-occurring mental health disorders, such as anxiety, depression, or a personality disorder. Effective treatment of a substance use disorder must also address any other problems the individual experiences.
According to the 2014 National Survey on Drug Use and Health, 7.9 million people had co-occurring disorders in that year. Mental health disorders increase the chances of an individual experiencing addiction. Inadequate treatment for co-occurring disorders can lead to homelessness, medical complications, incarceration, and suicide. Treatment that addresses both the addiction and any other disorders is imperative for full recovery to be achieved.
Addiction recovery is often a lengthy process, and many people must undergo more than one treatment program before lasting sobriety is achieved. Aftercare is an integral part of the recovery process.
Long-term follow-up care after completing a rehabilitation program helps to ensure that relapse does not occur, and it is vital to lasting recovery.