Prescription drug addiction begins when a person takes medication in ways that have not been prescribed by a doctor. Perhaps they feel like they need to take more to get the original effect because their body is building up a tolerance; maybe they struggle with compulsively taking the drug or obsessing over when the next dose will occur; or perhaps they steal prescription medications from others and abuse the substances for completely nonmedical reasons. Any of these problems can indicate addiction to the prescription medication.
The Epidemic of Prescription Drug Abuse
The Centers for Disease Control and Prevention (CDC) has labeled the widespread misuse of prescription drugs in the United States an epidemic. Since 1999, abuse of prescription medications, especially painkillers, has risen dramatically; between 2000 and 2015, a half-million people died from a drug overdose, and many of these overdoses involved drugs prescribed to help these individuals. The National Survey on Drug Use and Health (NSDUH) from 2014 found that 15 million people, ages 12 and older, abused prescriptions for nonmedical reasons in the year prior to the study while 6.5 million abused prescription drugs in the previous month.
The Monitoring the Future (MTF) Survey, which gathers data about substance abuse among middle and high school students, found that 10 percent of 12th graders abused narcotics besides heroin at least once in their lifetime; 17 percent abused amphetamines like Ritalin; 10 percent abused barbiturates; and 11 percent abused other tranquilizers.
Prescription drug abuse primarily affects young adults, according to the National Institute on Drug Abuse (NIDA). People between the ages of 18 and 25 are the leading abusers of prescription drugs, although opioid abuse occurs across middle and older adults, too. In 2014, about 12 percent of those 18-25 years old abused prescription drugs. That year, 119 young adults were sent to the emergency room due to overdose or harmful side effects from prescription drug abuse; 22 were hospitalized for longer-term treatment due to serious outcomes; and five young adults died every day. There were 1,700 people in that age range who died in 2014 from abusing prescription drugs for nonmedical reasons.
The reasons that so many people have become addicted to prescription drugs is complex. Factors like genetics, environment, and family history intersect in ways that may increase an individual’s risk for developing substance abuse or addiction problems. Many potent drugs, including those prescribed to treat specific conditions, can trigger the release of neurotransmitters like dopamine and serotonin. This is a benefit in some ways because the person will feel better while they take their medication; however, if a drug quickly changes how these neurotransmitters are released and absorbed, then the brain’s reward system can be stimulated very quickly, creating a sense of euphoria, or a high.
With prescription drugs, the individual will begin by following their doctor’s instructions; however, for too many people, these drugs lead to abuse because the person compulsively seeks stimulation to the reward center. General reasons people begin abusing, or continue to abuse, prescription drugs include:
- To get high
- To relieve stress or tension
- To reduce appetite and lose weight
- Peer pressure
- Because of physical dependence
Some people assume that prescription drugs are safer than illicit drugs, but they can be just as addictive. Opioids, central nervous system depressants, stimulants, and steroids all affect the brain and body in different ways and can lead to substance abuse.
The Most Abused Prescription Drugs
Prescription painkillers are the most abused class of prescription drugs. With efforts to control the over-prescribing and abuse of narcotic painkillers, there are now tighter regulations and greater monitoring of prescriptions for opioids, which have caused many people struggling with prescription narcotic addiction to turn to heroin, which is less expensive and often easier to acquire in the US. Drugs in the category of opioid analgesics include:
- Hydrocodone drugs like Vicodin and Lortab
- Oxycodone drugs like Percocet, Percodan, and OxyContin
- Fentanyl and Dilaudid
Side effects from opioid abuse include sleepiness, constipation, slowed breathing, low heartbeat and blood pressure, and harm to organ systems from oxygen deprivation. It is very possible to take too much of an opioid medication and overdose. The main symptom of opioid overdose is irregular, shallow, or depressed breathing. The person could fall into a coma and die from oxygen deprivation without emergency medical assistance. The CDC reported that, since 2015, there are 91 people in the US who die every day from opioid overdoses.
Withdrawal from opioids is not life-threatening, but it can be uncomfortable, so it is important to get medical supervision. Symptoms most often feel like the flu and include cold sweats, fever, muscle aches and joint pain, runny nose, watery eyes, diarrhea, and excessive yawning. However, the psychological symptoms, including cravings, depression, anxiety, and insomnia, are more likely to lead a person to relapse if they are not working with a doctor to safely detox.
This class of medications, which became popular in the 1960s with Valium, is prescribed for short-term treatment of anxiety and panic disorders. Benzodiazepines are sometimes prescribed to treat epilepsy or other seizure disorders, and they can be prescribed off label to treat alcohol withdrawal. The body quickly develops a tolerance to these medications, which act on the GABA receptors, much like alcohol. Withdrawal symptoms from benzodiazepines feel a lot like the psychiatric symptoms they were prescribed to treat, including anxiety, panic attacks, and seizures, so ending abuse of these medications is tough without medical supervision.
The most popular forms of benzodiazepines currently are Xanax, Klonopin, and Valium. They are the most widely prescribed forms and end up diverted for illicit sale most often. Although benzodiazepines can, by themselves, be abused, they are more often mixed with other CNS depressants, especially alcohol or opioids. Benzodiazepines mix with these substances and increase their potency.
The Drug Abuse Warning Network (DAWN) Report from 2014 found that, between 2005 and 2011, close to 1 million people were hospitalized for overdoses involving benzodiazepines: 20 percent (89,310 admissions) of those were for benzodiazepine misuse alone; 50,561 admissions were for benzodiazepines combined with opioids; 27,452 involved benzodiazepines and alcohol; and 8,229 involved all three drugs.
Since benzodiazepines can become addictive, and are too often mixed with other substances as a form of drug abuse, sedative-hypnotics like Ambien, Lunesta, and Halcion were developed as nonbenzodiazepine medications to treat insomnia. They are intended for short-term use, but unfortunately, like benzodiazepines, they often become part of a pattern of polydrug abuse. These drugs are most likely mixed with alcohol, either by accident or to get high; this can result in overdose, but it also likely results in dangerous parasomnias, like walking, eating, having sex, and driving while asleep.
A doctor should oversee withdrawal from these drugs, as symptoms can be similar to those associated with withdrawal from benzodiazepines and opioids. Cravings are the most common side effect, but rebound insomnia, anxiety, or fatigue are common, too.
Drugs in this category are typically amphetamines, a potent stimulant drug that helps people who need it stay awake, concentrate on tasks, and regulate their neurotransmitters so they feel better. Attention deficit hyperactive disorder (ADHD), narcolepsy, and rare forms of depression are all conditions that benefit from closely monitored prescriptions of stimulant drugs, like Adderall and Ritalin.
People who do not need prescription stimulants may abuse these drugs for a variety of reasons. Amphetamines force the brain to flood with dopamine, which can make the person feel exhilarated, energetic, and happy. However, too much dopamine can also make the person hallucinate, feel paranoid, become delusional, or suffer physical harm from high heart rate and blood pressure. Adolescents and young adults are most at risk for abusing prescription stimulants because they are mistakenly believed to enhance scholastic performance. Some young adults also take prescription stimulants as a form of diet pill because they suppress appetite and increase energy.
- Irregular heartbeat
- Risk of heart attack and stroke
- High blood pressure, damaging the kidneys
- Aggression and violence toward oneself and others
Ending an addiction to these drugs is tough without help. Withdrawing from stimulants leads to intense cravings for the drugs, chronic depression, insomnia and anxiety; however, it is important to end stimulant addiction because physical damage to the heart, liver, kidneys, and lungs can occur, which may require years of medical treatment.
These drugs are not abused for the same reasons as other prescription medications, but they can still become a target. People who abuse steroids typically have a psychiatric condition like an eating disorder or body dysmorphic disorder, and abuse the drugs to reshape their physique. NIDA reports that people abuse anabolic steroids in three ways:
- Cycling: taking doses over a certain period of time, stopping for a recovery period, then starting again
- Stacking: combining two or more kinds of steroids
- Pyramiding: increasing the dose gradually, peaking, then decreasing the dose
Steroid abuse does not release dopamine through the same control over neurotransmitters as other prescription drugs; however, it can change brain chemistry and structure over time. People who abuse steroids may develop mental and emotional changes, including paranoia, delusions, aggression and irritability, and impaired judgment. Physical side effects from long-term abuse include kidney failure, liver damage, chronic high blood pressure, cholesterol changes, and an enlarged heart.
Prevention and Treatment to Stop the Epidemic
Prescription drug abuse is a serious epidemic, harming the lives of millions of people across the United States. Lawmakers and medical professionals are working hard to change approaches to prescribing practices, increase access to care, and understand the underlying causes.
There are two basic steps in drug addiction treatment that are proven to work for the most people: safe, medically supervised detox followed by participation in a rehabilitation program for at least 90 days. Some kinds of withdrawal, such as opioid detox, can be managed using medication-assisted therapy; this usually involves buprenorphine but may sometimes involve methadone. The new prescription replaces opioid abuse, and the doctor can slowly help their patient taper buprenorphine use over time until their body is no longer dependent on opioids. Other drugs, like stimulants, do not have a similar kind of replacement therapy; however, working with a medical professional means access to other drugs, like anti-nausea medicines or anti-seizure drugs, which can reduce risks associated with withdrawal. Those who are dependent on benzodiazepines may be put on a tapering schedule where the dose of a long-acting benzo is slowly lowered over time as the person is weaned off the drug.
The most effective treatment for substance abuse and addiction is counseling. Cognitive Behavioral Therapy, used both during individual and group sessions, helps the person understand their emotional responses to stress, triggers, or pain that drive their behavior toward seeking drugs. With a better understanding of themselves, people can change their behaviors to bring about more positive outcomes. Therapy can also help to diagnose and treat underlying mental health conditions, like depression, anxiety, bipolar disorder, and schizophrenia.
Better access to evidence-based care, and incorporating substance abuse and mental health treatment into general healthcare screenings and routine physician visits, is a goal for many states, insurance companies, and healthcare providers. Prescription tracking databases may help to prevent prescription drug abuse, and getting care for conditions that contribute to substance abuse is incredibly important.