Search Results for: Soma

How to Help a Soma Addict

Help for Soma Addicts question 1

Help for Soma Addicts

Soma (generic name: carisoprodol) is a prescription muscle relaxer that can be addictive if used beyond the recommended dosage or duration. Taking Soma can also be problematic if abused in combination with other substances such as alcohol, opiates and other prescription sedatives.

Hear from others who have loved ones struggling with substance abuse.

Abuse of the drug is increasingly prevalent and it is found to be more addictive than originally believed. Treatment approaches frequently include one or more of the following:

  • Medical detoxification.
  • Inpatient or residential rehabilitation.
  • Outpatient treatment.
  • Aftercare and relapse prevention.
Help for Soma Addicts question 2

Is It Addictive?

Soma effectively blocks the pain pathway between nerves and the brain. It acts on the central nervous system (CNS) and produces:

Soma may even be addictive to those taking it as directed, especially if the user has a history of substance abuse.

  • Feelings of sedation.
  • Decreased feelings of pain.
  • Reduced anxiety.
  • Drowsiness.

Soma is a Schedule IV controlled substance, meaning it has the potential for abuse and addiction; it may even be addictive to those taking it as directed, especially if the user has a history of substance abuse. Soma’s potential for abuse and addiction is especially high when it is taken:

  • Above the recommended dosage.
  • For prolonged periods of time.
  • In combination with other prescription and illegal drugs, or when combined with alcohol.

Abuse and dependence potential are thought to be due to Soma’s metabolite meprobamate, a compound that impacts receptors in the brain to slow brain and nervous system activity. Meprobamate itself was once a widely prescribed sedative drug (marketed under the name Miltown), with known addictive potential.

High or prolonged levels of meprobamate in your blood can lead to dependency. In fact, long-term use of the drug is associated with abuse and dependency. One can develop tolerance for the drug quickly, requiring higher and higher doses to achieve the same effect.  Soma is normally prescribed for no more than 2-3 weeks to lessen the risk of tolerance and dependency.

Did You Know?

  • Those using Soma to get high often combine it with other drugs and alcohol to enhance its effects. It is often mixed with:
    • Alcohol.
    • Codeine (Soma Coma).
    • Vicodin (Las Vegas Cocktail).
  • Many also use Soma to cope with withdrawal from various narcotics.
  • Use and abuse of the drug has increased over the last 10-15 years. In 2000, it was the second most frequently prescribed muscle relaxant. That same year, it was ranked the 20th most abused drug by the Drug Abuse Warning Network.
  • It’s nonmedical use doubled between 2004 and 2008.
  • In 2012, Soma was classified as a Schedule IV controlled substance, requiring it to be federally controlled due to its potential for abuse.
Help for Soma Addicts question 3

What are the Signs of Addiction?

It may be difficult to identify specific signs and symptoms for addiction to Soma, as it is often  abused with other drugs. Signs can vary and are dependent on frequency of use, combination use with other drugs and past user drug history. Common signs and symptoms that may indicate Soma abuse include:

  • Hypnotic, lethargic feeling/state.
  • Drowsiness.
  • Loss of coordination.
  • Slurred speech.
  • Euphoria.
  • Decreased anxiety.
  • Blurred vision.
  • Dizziness.

  • Chest tightness.
  • Speeding heart rate.
  • Tremors.
  • Depression.
  • Insomnia.
  • Stomach problems.
  • Nausea and vomiting.
  • Inability to think clearly.

Help for Soma Addicts question 4
Am I Addicted to Soma?

You may be addicted to Soma if:

Fusce vitae
  • You are taking it beyond its recommended prescription dosage or duration to achieve a specific physical or emotional feeling.
  • You are consistently mixing Soma with other drugs to heighten their effects.
  • You have begun relying on the drug to deal with withdrawal from another drug.
  • Over time, you need a higher dose to achieve the same feeling.
  • You crave using Soma alone or in combination with other drugs.
  • You prioritize the drug use over other responsibilities or activities.
  • Your use is causing personal issues, such as relationship or financial problems.

If you think you might have a problem, don’t wait to get help. It’s never too late to find recovery from addiction. Call 1-888-744-0069Who Answers? to learn more about treatment for prescription drug abuse.

Help for Soma Addicts question 5

Addiction Treatment

Due to the severity of withdrawal symptoms (abdominal pain, depression, heachache, insomnia, nausea, etc.), many people choose to get off Soma through medically supervised detox and treatment.

Treatment can be complex, especially when Soma is combined with other drugs. In these cases. Rehabilitation programs that include therapy and detoxification steps are often required for successful recovery from prescription drug addiction.

Help for Soma Addicts question 6

Call Our Hotline Today

If you or someone you know might be addicted to Soma, it is extremely important to get treatment as soon as possible. Long-term abuse or overdose of this drug can lead to seizures, damaged organs, and hospitalization.

Don’t let Soma addiction steal one more day. Call 1-888-708-0796 to help yourself or a loved one today.


  • Soma (Carisoprodol). New York State Office of Alcoholism and Substance Abuse Services Website. Accessed July 15, 2015.
  • Zacny JP, Paice JA, Coalson DW. Characterizing the subjective and psychomotor effects of carisoprodol in healthy volunteers. Pharmacol Biochem Behav. 2011;100(1):138-43.
  • Reeves RR, Bruke RS, Pinkofsky H. Carisoprodol: abuse potential and withdrawal syndrome. Curr Drug Abuse Rev. 2010;3(1):33-8.
  • Gonzalez LA, Gatch MB, Forster MJ, Dillon GH. Abuse Potential of Soma®: the GABAA Receptor as a Target. Mol Cell Pharmacol. 2009;1(4):180-186.
  • Littrell RA, Sage T, Miller W. Meprobamate dependence secondary to carisoprodol use. Am J Drug Alcohol Abuse. 1993;19(1):133-134.
  • Bailey DN, Briggs JR. Carisoprodol: an unrecognized drug of abuse. Am J Clin Pathol. 2002;117(3):396-400.
  • Rho JM, Donevan SD, Rogawski MA. Barbiturate-like actions of the propanediol dicarbamates felbamate and meprobamate. J Pharmacol Exp Ther. 1997;280(3):1383-91.
  • Luo X, Pietrobon R, Curtis LH, Hey LA. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States. Spine (Phila Pa 1976). 2004;29(23):E531-7.
  • Gatch MB, Nguyen JD, Carbonaro T, Forster MJ. Carisoprodol Tolerance and Precipitated Withdrawel. Drug Alcohol Depend. 2012;123(1-3):29-34.
  • Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
  • Reeves RR, Burke RS, Kose S. Carisoprodol: update on abuse potential and legal status. South Med J. 2012;105(11):619-23.

Concurrent Alcohol and Soma Abuse

Mixing alcohol with pills

The Problem of Alcohol and Soma Abuse

When used with alcohol, Soma’s effects are enhanced, making this combination a particularly risky one.

Abusing Soma (a muscle relaxant) and alcohol (a depressant) together can compound the negative health effects of both. Treatment is vital for someone abusing these drugs.

Soma (generic name: carisoprodol) is a centrally-acting prescription muscle relaxant used to relieve skeletal muscle spasms (especially in the lower back) and associated pain in acute musculoskeletal conditions. Its therapeutic effects can last from 4 to 6 hours.

Carisoprodol is metabolized in the body into a second compound known as meprobamate. Meprobamate itself is an addictive anti-anxiety medication that enhances activity at a particular type of communication receptor in the brain (the GABA receptor) related to reducing brain activity. Essentially, Soma dampens pain signals between the nerves and the brain, which can have the therapeutic effect of reducing skeletal muscle pain.

Alcohol affects a similar subset of receptors types, but in different areas of the brain. When used at the same time, Soma and Alcohol work together to:

  • Reduce brain activity.
  • Reduce vital bodily functions, such as breathing and blood pumping.

When used as prescribed, Soma can lead to pain relief, muscle relaxation, and decreased anxiety; however, due to its powerful effects, Soma has been increasingly used as a recreational drug. As with all muscle relaxants, Soma has a very high potential for abuse, leading to a ban on the drug in Norway, Sweden, and Indonesia.

When used with alcohol, a dangerous synergy can result – Soma’s effects are enhanced, making this combination a particularly risky one.

If you’re trapped in the cycle of addiction, don’t want to find relief.
Call 1-888-744-0069Who Answers? for help finding the right treatment program for you.
Alcohol and Soma Abuse question 1 Alcohol and Soma Abuse question 2

Effects of Concurrent Alcohol and Soma Abuse

While each drug used alone has its own set of effects, use together can lead to greatly increased risk.

When taken concurrently, users report:

  • Greatly increased drowsiness.
  • A sense of euphoria, though this tends to be short lived.
  • Intense muscle relaxation, leading to a loss of muscle control.

One of the biggest risks associated with concurrent use is the operation of vehicles or machinery. Soma use alone, even within the prescribed dosage, has been shown to negatively affect psychomotor performance, despite no subjective feelings of the effects (Zacny, Paice, & Coalson, 2011).

Because alcohol enhances these psychomotor effects, you may use these drugs together and endanger yourself, believing you feel little to no effects and attempting to drive or perform other tasks.

Alcohol and Soma Abuse question 3

Signs and Symptoms

The combination of the effects of Soma and the effects of alcohol on the GABA receptors reduces overall communication in the brain, leading to similar compounding effects. The symptoms of abuse for each of these drugs are exaggerated by concurrent use, leading to more severe potential consequences.

Signs and Symptoms of Soma Abuse

  • Blurred vision.
  • Dizziness and loss of coordination.
  • Drowsiness.
  • Loss of coordination
  • Increased heart rate.
  • Chills.
  • Excessive sedation.
  • Tightness in chest.
  • Amnesia and confusion.
  • Vomiting.
  • Inappropriate (sometimes violent) behavior.
  • Unusual weakness and loss of muscle control.
  • Weak breathing.
  • Coma.
  • Death.

Signs and Symptoms of Alcohol Abuse

  • Drowsiness.
  • Nausea and vomiting.
  • Disrupted sleep patterns.
  • Temporary loss of consciousness.
  • Cardiac rate/rhythm disturbances.
  • Liver disease.
  • Coma.
  • Death.

Symptoms of Simultaneous Soma and Ritalin Abuse

  • Increase in Soma’s nervous system side effects:
    • Dizziness.
    • Drowsiness.
    • Difficulty concentrating.
    • Loss of movement control.
  • Impairment in thinking and judgment.
  • Problems with memory.
  • Increased risk of seizures.
  • Coma
  • Death
Alcohol and Soma Abuse question 4

Concurrent Alcohol and Soma Abuse Treatment

Treatment for co-abuse of Soma and alcohol will vary based on the type of addiction the individual is experiencing.

Soma users may experience both a physical dependence on the drug as well as a psychological dependence. In either case, the patient will typically have at least:

  • An initial assessment by an addiction treatment professional.
  • A period of supervised detoxification.


Supervised Detox

Withdrawal can be scary for many struggling with substance abuse. Monitored detox increases your comfort and ensures your safety through the process.

It is vital that an individual seeking help with concurrent Soma and alcohol abuse receive professional assistance and supervision, as detox from alcohol and Soma can induce symptoms ranging from uncomfortable to life-threatening.

Many inpatient treatment centers offer monitored detox as part of treatment. During supervised detox, you can get the drugs out of your body while having your symptoms managed to facilitate maximum comfort during the process.

Alcohol and Soma Abuse question 5


Multiple treatment options are available to address the root of the addiction and find effective ways to cope with the stress of recovery.

Residential treatment offers immersive treatment in which you live in the recovery facility so that you can focus 100% of your sobriety.

Outpatient treatment will provide multi-faceted care, such as therapy and 12-step programs, but still allow you to continue living at home as you recover.

Medication assistance may be used in the treatment process. To address a physical dependence on Soma, the patient may be asked to switch over to a long-acting benzodiazepine (like diazepam or clonazepam), then be slowly weaned off of the replacement drug at a rate that is clinically determined to be the most safe and effective for the individual.

Therapy, particularly cognitive-behavioral therapy, will address rebound anxiety, relapse prevention skills, and aftercare planning.

If you are not sure what kind of treatment might be right for you, call us at 1-888-747-7155 to speak with someone to determine the right type of care to get you back on your feet.

Alcohol and Soma Abuse question 6

Key Statistics

  • In 2000, Carisoprodol (Soma) accounted for 21% of all skeletal muscle relaxant prescriptions in the United States (Luo et al. 2004).
  • “According to IMS Health(TM), there were approximately 8.5 million carisoprodol products dispensed in the U.S in 2013.” – Drug Enforcement Administration
  • According to the 2012 National Survey on Drug Use and Health (NSDUH), the number of people using Soma in their lifetime for non-medical reasons rose from 3.06 million people in 2011 to 3.69 million people in 2012.

Resources, Articles and More Information

To learn more, check out the following articles:

Also, share your thoughts and questions with others by visiting our Forum today.


  1. Luo X, Pietrobon R, Curtis LH, et al. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States. Spine. 2004; 29:E531-E537.
  2. Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: United States, 2014. HHS Publication No. SMA-15-4895. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
  3. Zacny, J. P., Paice, J. A., & Coalson, D. W. (2011). Characterizing the subjective and psychomotor effects of carisoprodol in healthy volunteers. Pharmacology, Biochemistry and Behavior, 100. 138-143.

The Effects of Soma Use

Snorting with bill

Soma (generic name: carisoprodol) is prescribed for short-term relief of acute musculoskeletal pain. It is intended only to be used for short time periods (generally up to 3 weeks).

Soma Effects question 1

Is Soma Dangerous?

The therapeutic effect of Soma is effectively to interfere with pain sensation signaling that occur between peripheral pain receptors (nerves) and certain areas of the central nervous system (the brain). In addition to the modification of pain signaling, Soma and its main metabolite (meprobamate) exert mild sedative effects.

Many Soma users find the sedative effect of carisoprodol to be pleasant which, in turn, can drive a compulsion for continued use.

When taken as prescribed, it is generally viewed as safe. For that reason, it has not yet made it onto the DEA’s controlled substances list. However, it can be addictive. In fact, some states have listed Soma as a scheduled substance.

Soma is metabolized in the body to a second compound called meprobamate, which is a Schedule IV substance. Meprobamate was marketed as a prescription sedative (trade name: Miltown) beginning in the mid-20th century. It has a demonstrated potential for abuse, but as a standalone sedating agent, has been largely replaced these days by benzodiazepines and other types of more effective anti-anxiety medications.

Soma Abuse and Addiction

Soma abuse and addiction occur when:

  • Soma is taken without regard to intended usage, e.g., inappropriate doses or via alternate methods, such as intravenous administration.
  • Soma is taken for longer periods than intended.
  • Soma is mixed with other drugs, such as: Vicodin (“Las Vegas Cocktail”), codeine (“Soma Coma”), and Alcohol.

Soma can heighten the dangerous effects of all of these substances, making the risks of concurrent use all the more serious. Unfortunately, this has become a common trend, as Soma is a relatively easy to obtain and a popular prescription drug of abuse.

Short-term Effects of Soma

Soma produces the following short-terms effects that many users find favorable:

  • Sedation.
  • Pain relief.
  • Sleepiness.
  • Euphoria.
  • Relaxation.

However, it is not without negative side effects, and Soma abuse, in particular, can result in a number of dangerous reactions, especially when drug combinations are involved.

Soma Effects question 2

Side Effects

Because Soma has some sedative properties, its side effects mirror those of other sedatives, especially when taken in excess. These include:

  • Drowsiness.
  • Dizziness.
  • Blurry vision.
  • Altered heart rate.
  • Headache.
  • Loss of coordination.

  • Depression.
  • Weakness.
  • Chills.
  • Tremors.
  • Vomiting.
  • Seizures.

Soma Overdose Symptoms


Signs and symptoms of a Soma overdose may include:

  • Jerky, uncontrolled eye movements.
  • Respiratory difficulty.
  • Precipitous or dangerous drop in blood pressure.
  • Double vision (diplopia) or otherwise impaired vision.
  • Seizures.
  • Coma.
  • Death.

If you notice any of these symptoms, get help immediately. Learn more at our blog, Taking Action: How to Intervene During an Overdose.

Soma Effects question 3

Long-term Effects

The long-term effects of Soma are typically reserved for those exhibiting prolonged abuse of and/or dependency to the drug. An addict of Soma, like any other drug, will begin to manifest certain behavioral changes, such as:

  • Mood changes.
  • Thoughts of suicide.
  • Consistent attempts to procure prescriptions.
  • Declining work or school performance.
  • Withdrawal from previously enjoyed activities.
  • Strained relationships.
  • Crime.

The body is also susceptible to damage from long-term use of Soma (and other drugs, if combined). Sustained use may cause organ damage, respiratory troubles, and seizures, among other effects.

Soma Effects question 4

Soma Dependency

While there is the potential for those who take it to develop tolerance and dependency on the drug from taking excess doses, Soma addiction is frequently seen in a setting where users combine it with other drugs and/or alcohol.

Effects of certain mixtures, such as Soma and Vicodin, can mimic the feelings associated with heroin use.

Misuse of Soma can quickly lead to abuse and dependency, as well as all of the negative physical and social aspects of addiction.

Soma Effects question 5

Withdrawal Treatment

One indication that Soma is actually more addictive than may be thought by some is that it produces a number of withdrawal symptoms upon abrupt cessation of use.

Fortunately for those seeking to get off of it, withdrawal from Soma is not as severe as withdrawal from narcotics or alcohol, which can be highly addictive and produce dangerous and life-threatening withdrawal symptoms.


Someone who has been abusing Soma may experience the following symptoms of withdrawal:

  • Abdominal cramping.
  • Nausea and vomiting.
  • Anxiety.
  • Diarrhea.
  • Headaches.
  • Insomnia.

Treatment for Soma abuse can get a little tricky when concurrent abuse of other substances comes into play. In these instances, the multi-substance abuser will likely need to withdrawal gradually from use of any Vicodin, codeine, alcohol or any other substance as well.

In the case of alcohol and certain other sedatives, the period of detox and withdrawal should be completed under the watchful supervision of a medical professional, as certain symptoms may arise that could be quite severe and/or life-threatening. Inpatient rehab centers often include medically supervised detox to ensure safety and maximum comfort during the process.

To enlist the help you need to overcome your Soma habit, and to determine whether a structured period of detox and withdrawal is necessary, please call 1-888-744-0069Who Answers? to talk about your treatment options with an advisor from our treatment support team.
Soma Effects question 6

Soma Abuse


What Is Soma?

Soma is the trade name for carisoprodol, a muscle relaxant that is prescribed for the treatment of muscle pain and spasms. Soma is often abused for its sedating effects on the user, and the addictive properties of this drug have recently been recognized by many in the medical profession as more significant than was originally believed.

The main metabolite in Soma is meprobamate, which is proven to have habit-forming effects similar to benzodiazepines.

Soma Abuse question 1

Soma Abuse

Prescription medication creates a false illusion of safety for many.

Many users of prescription drugs believe that drugs that are legitimately prescribed will not have effects as dangerous as those of street drugs and will, in turn, take excess amounts without the same fear.

Alcohol medication combination

Severe addiction often begins with a legitimate medical issue that turns into dependency as the body develops a tolerance to the drug and requires larger doses to feel the same effects. Soma is no exception.

Whereas Soma was originally thought to have low potential for abuse and addiction, recent evidence shows that it is habit-forming, especially when taken in combination with other drugs. Note that:

  • Soma produces sedative, euphoric effects that are often sought after by addicts.
  • Soma intensifies the effects of other drugs like Xanax and the combination is severely addictive and potentially dangerous.

The Problem with “Pill Mills”

The relative ease of finding prescriptions for recreational use only adds to the problem. “Pill mills” that dole out medications to those shopping for prescriptions are popping up on a consistent basis throughout many states and making drugs available to those who need them the least.

The availability of prescriptions, however, is matched by the availability of treatment. To find out how to break away from addiction with the help of a recovery program, call 1-888-744-0069Who Answers?.

Soma Abuse question 2

Signs and Symptoms

When taken in large doses, Soma use can produce a number of telling side effects. Signs and symptoms of Soma abuse include:

  • Impaired physical coordination.
  • Flushed skin.
  • Euphoria/feeling or appearance of being drunk.
  • Irritability upon withdrawal.
  • Dizziness and fainting.
  • Seizures.
  • Rapid heart rate.
  • Insomnia.
Soma Abuse question 3 Soma Abuse question 4

Effects of Soma Abuse

The physiology of Soma addiction is only half the story. The social and mental impact of abuse is typically similar to that of other dugs. Long-term abusers of Soma and/or other drugs often:

  • Continually make appointments with doctors in attempts to get pills.
  • Agitation and irritability.
  • Withdraw from friends and social activities.
  • Depression.
  • Inability to sleep.
  • Impaired concentration and ability to think clearly.
Soma Abuse question 5

Soma Abuse Treatment

If you are concerned about your use of Soma and/or other drugs, you can get help. There are a number of options for recovery that will get you back on the road to a healthy and fulfilling life. Consider one or more of the following methods of treatment:


  • Inpatient treatment. This offers an immersive and supervised recovery process.
  • Outpatient treatment. This option does not have the immersive environment but does offer the option to live at home and continue working during the process of recovery.
  • 12-step programs. These programs offer a supportive network and a clearly outlined path to sobriety.
  • SMART Recovery. This option uses a specific 4-point model for getting your life back on track and maintaining sobriety.

If you’re crumbling under the weight of addiction, you can get back up. Call 1-888-744-0069Who Answers? to speak to one of our caring treatment support representatives and discuss the best option for you.

Soma Abuse question 6

Soma: Key Statistics

  • According to the Centers for Disease Control (CDC), one out of every 20 people in the U.S. over 12 years old reported misusing prescription painkillers in the prior year.
  • The CDC also reports that in 2010 alone, enough prescriptions were doled out to provide 24/7 medication for every American adult.
  • Over 3 million people in the U.S. have reported recreational use of Soma at some point in their lives, according to the 2012 National Survey on Drug Use and Health.

Teen Soma Abuse

Prescription drug use is a concern among teens because they can be easier to access and perceived as less threatening than illicit drugs.

If you have prescriptions, always lock them away and monitor the amounts used. And remember, the best way to prevent drug use in your teen is to talk to them about the dangers of drug use (more than once).

It’s important to clearly explain that prescription drugs are not safe just because they come from a doctor, and that they are especially dangerous when not taken as prescribed, taken in combination with alcohol or other drugs, or taken via alternate methods such as injection.

Additional Resources

To get additional information on Soma abuse and addiction, read the following articles:

You can also find a network of people discussing addiction and recovery at our Forum.

Has Kombucha Gotten a Bad Rap?

Often touted as a miracle elixir, Kombucha offers a plethora of health benefits.

For those who don’t know, Kombucha is a fermented beverage made from tea, sugar, bacteria, and yeast. It’s available in most health food stores in a variety of flavored tea combinations. Of course anything that’s fermented contains trace amounts of alcohol and some in recovery consider this tea to be a threat to their sobriety.

Examining the Merits of Kombucha

Historically, Kombucha is thought to have originated in the Far East – where its first recorded use comes from China in 221 BC during the Tsin Dynasty. It was known as “The Tea of Immortality.” Initially only available in health food stores, its demand has grown so much that Kombucha can now be found at most grocery stores in the U.S.

But what is it exactly? It’s a probiotic drink that contains healthy bacteria and yeast – known as SCOBY and it claims to keep the body healthy, happy, and vibrant; with benefits including:

  • Improved digestion
  • Boosts immunity
  • Weight loss
  • Hormone regulation
  • Healthy skin
  • Improved mental health

Finding the “Hidden” Alcohol

Here’s the controversial part: Kombucha contains trace amounts of alcohol, which is defined in the U.S. as less than 0.5 percent alcohol by volume.

What some people might not realize is that many other foods, drinks, and medicines, contain trace amounts of alcohol, such as:

  • Coca Cola
  • Vanilla extract
  • Vinegar
  • Mouthwash
  • Sugarless gum
  • Protein bars
  • Vitamins
  • Ripe fruit
  • Chewing tobacco/dip (fruit flavors)
  • Nyquil

All of these substances are known to skew breathalyzer tests. So, this poses an interesting question: Should people in recovery drink it or abstain?

To Drink…or Not To Drink?

I posted this question on Facebook yesterday and received both positive and negative responses:

  • Yes absolutely; it’s a health tonic that helps relieve my IBS; since drinking it, I have stopped my acid reflux medicine; I really enjoy it as a more flavorful non-alcoholic drink.
  • No, it tastes gross.

The most surprising response was an indirect implication that one should question their understanding of Step One and reconsider their sobriety date!

My experience is that I was skeptical at first. From early sobriety, I was told alcohol was something to be feared. We called it King Alcohol, and we told ourselves that we were powerless over it. My experiences in AA instilled a high level of fear within me. I took the group’s advice to be vigilant, and I avoided any trace of it. I stopped using mouthwash; I wouldn’t eat foods cooked in alcohol; I refused to have it in my home; I wouldn’t go anywhere that served alcohol.

For me, living like that was like living in a bubble.

Breaking From the 12 Step Mold

Moving to Portland changed all my perceptions. I discovered people here are more relaxed and health conscious. Portland is a lot more supportive of people’s choices and journeys. What I mean is that my eyes were opened: I saw people in recovery using non-psychoactive marijuana for anxiety, I learned about other treatment modalities such as Refuge Recovery, and I saw a huge range of health tonics, potions, and foods all around me – including people in recovery consuming pints of Kombucha. Initially, I was shocked.

As an inquisitive person, I took this as an opportunity to investigate my feelings. I discovered these feelings stemmed from my background in 12 step groups. I saw people drinking Kombucha who didn’t relapse, and I saw different concepts of recovery – outside of AA – and they were healthy and happy. Those realizations gave me the confidence to burst my own bubble and try Kombucha.

Here’s why: I’ve suffered with acne and IBS my entire life. The stress of moving to a new city made those conditions worse. I’d done some research into gut health and discovered Kombucha has been shown to be beneficial. So I gave it a go. I was confident enough in my recovery to know that, if I was triggered in any way, I would immediately stop. But I wasn’t triggered. I really enjoyed it and, unsurprisingly, my IBS improved and my skin cleared up. I also enjoyed discovering a new and interesting drink other than water, tea, and coffee.

I spoke to an employee of SOMA – who is in recovery – about his view of this “wonder tonic.” He said he “wasn’t in any way threatened by Kombucha”. In fact, he told me he’d done enough work in his 20-plus years in recovery to know what he was initially going to the liquor store for – and he doesn’t drink Kombucha for those reasons.

I have a tendency to agree: I don’t drink Kombucha to escape difficult feelings or to check-out. I drink it because I enjoy its flavor and health benefits. If I was alcohol purest, where would I draw the line? I draw the line by not going to the liquor store.

So my answer is this: It’s entirely a personal choice, and I respect your choice. What I don’t respect is anyone’s implication that my choice gives me less of a recovery.

Have you ever tried Kombucha? Why or why not? Tell us about it in the comments section below!

Image Source: iStock

Penalties and Sentencing

Problematic substance use has the potential to negatively impact every area of your life. As dependence and addiction to alcohol or other drugs develop, these substances may begin to influence your physical and mental health, significantly affecting the way you feel and think.1 With time, your social relationships and employment status may suffer as becoming drunk or high becomes your sole focus.1 Drug abuse and addiction can even steal away your freedom.

Depending on the situation and the substances involved, possessing, selling, manufacturing, or transporting drugs (even legal ones) can lead to serious legal consequences, the effects of which may last a lifetime.2

Legal Repercussions

People caught engaging in illegal behaviors involving drugs face a variety of consequences, including:2,3

  • Time in jail or federal prison.
  • Heavy fines.
  • Community service.
  • Probation.
  • Other forms of confinement like house arrest.
  • A criminal record that affects your ability to get or maintain a job, receive approval for college loans, vote, own a gun, or join the military.

Jails and prisons are filled with people charged with crimes related to drugs. In 2012, judges sentenced nearly 95,000 people to prison for drug charges.4 As a comparison, the category with the next highest sentencing rate was weapon charges, with about 28,000 offenders.4

What are the penalties for drug abuse and possession in the United States based on?

The penalties for drug-related charges are determined by several factors: the substance, the amount of the substance in question, the activity the person was engaged in, and their prior encounters with law enforcement.5,6 Those repeatedly committing serious crimes with large amounts of dangerous drugs are more likely to receive harsher penalties.4-6

Drug Enforcement Schedules

With regard to law enforcement, not all drugs are treated equally. Both legal and illicit substances are separated into categories based on their perceived risks and medical benefits (or lack thereof). These categories developed by the Drug Enforcement Administration (DEA)—called schedules—play a significant role in dictating legal penalties on the federal level. Individual states may treat these drugs differently. See below for schedules and examples of drugs in those schedules.5-7

heroin and pills

Schedule I: Substances with a high potential for abuse and no medically recognized purpose.

  • Heroin.
  • LSD.
  • Marijuana.
  • Peyote.
  • MDMA/Ecstasy.

Schedule II: Drugs that have approved medical uses but still pose a high potential for abuse and dependence.

  • Cocaine.
  • Many opioid pain medications like Vicodin, OxyContin, and methadone.
  • Methamphetamine.
  • Prescription stimulant medications like Adderall and Ritalin.

Schedule III: Medications and substances with a lower risk of abuse and dependence than drugs in Schedule II.

  • Tylenol with codeine.
  • Ketamine.
  • Steroids.

Schedule IV: Medications with a low risk of abuse and dependence.

  • Soma.
  • Many benzodiazepines like Xanax and Ativan.
  • Tramadol.

Schedule V: Drugs with the lowest risk.

  • Lyrica.
  • Cough medications containing low codeine levels.

Drug Use and Possession

Simple possession is a crime that occurs when a person has a small amount of a substance on their person or available for their own use.3 For simple possession to apply, there must be no intent to sell or give the drug to someone else.

If an individual is caught with possession of illegal drugs or controlled substances, they can face jail time. The length of jail time differs according to the state in which the offense occurs and the previous criminal record of the individual. Under federal law, simple possession is a misdemeanor offense that can lead to a prison term of a year or less for a first offense; however, for subsequent offenses, felony charges and additional years of jail time may apply.3,8

In addition, individuals in the U.S. could face steep fines for possession of drugs. At the federal level, simple possession carries a fine of at least $1,000.3 Some judges may require that the individual commit a large number of hours to community service as well.6

Selling Drugs

drug dealing

Selling drugs carries much harsher penalties than those received for simple drug possession in the U.S. Consequences will vary by state, but, as an example, in Wisconsin, any delivery or distribution of a controlled substance is a felony with a fine of up to $100,000 and 40 years imprisonment.6 An individual who has repeatedly been caught selling drugs may face double the fines and incarceration time, depending upon the situation.6

Those who are found guilty of selling drugs to a minor face an even bleaker future, with prison terms that can increase by 5 years from standard sentences.6 A person employing someone 17 or younger to deliver drugs faces a Class F felony, and the law doesn’t allow for a defense based on not knowing the minor’s age.6

To charge someone with possession of drugs and intent to sell, law enforcement officers will look for evidence like large amounts of cash, scales, or small plastic bags that would be employed in the sale of drugs. In some instances, it doesn’t take much of a substance to spawn these charges. You can be charged with a Class F felony for intending to distribute less than 3 grams of heroin in some states.6

Smuggling Drugs into the United States

Like selling drugs, trafficking controlled substances into and across the United States is a serious offense, and it is considered a federal crime with long mandatory sentences.7 For many Schedule I and II controlled substances, the first trafficking offense is punishable by at least 5 years in prison.7 If someone was seriously injured in the process, the minimum sentence is moved to 20 years.7 Fines for a first individual trafficking offense can go up to $5 million.7 The penalties increase based on the quantity of the substance and the number of offenses. A second offense that leads to serious injury has a penalty of mandatory life imprisonment.7

The vast majority of people currently incarcerated in the American prison system for drug charges are there for trafficking charges.4 Often, individuals who are caught trafficking drugs may not be carrying enormous amounts, but rather just enough to cross the line to be charged with trafficking. In the case of LSD, 1 gram is needed to warrant trafficking charges.7

Additional Charges and Penalties

man getting pulled over for drunk driving

Along with possession and trafficking, people can receive drug-related charges for:6,8,9

  • Manufacturing – Using ingredients to produce or manipulate controlled substances can bring about penalties that equal or surpass those for drug dealing.
  • Paraphernalia – Possessing or advertising any materials primarily associated with growing, storing, packaging, or using controlled substances can lead to fines and, in some cases, jail time.
  • Driving while intoxicated – Operating a vehicle while under the influence of alcohol or controlled substances, including prescribed medications, can result in jail times, fines, and driver’s license revocation.

Drug Penalties Around the World

The penalties for drug-related crimes vary drastically from country to country:10

  • In the Czech Republic, people are freely allowed to possess small amounts of marijuana and heroin for personal use.
  • In Portugal, drug possession was decriminalized in 2001, so users do not serve jail time. Rather, they face fines and community service. This change has not led to an increase in drug use rates and has been correlated with a sharp increase in individuals seeking treatment for addiction.

Other parts of the world are crueler with their treatment of substance users:10

  • The United Arab Emirates gives jail time to those with tiny amounts of drugs in their urine or blood.
  • In Indonesia, drug trafficking is punishable by long jail sentences and sometimes the death penalty.
  • People in possession of drugs in Iran can face a public lashing for their crime. Other offenses such as trafficking can lead to the death penalty; about 70% of Iran’s executions stem from drug charges.

Get Help for Addiction

The legal ramifications for drug possession in the United States and around the world can be quite steep. If you or someone you know is regularly using drugs, finding effective treatment options can be the difference between freedom and incarceration, life and death. Don’t stand by while your future is lost to drug addiction. Contact us today and we can connect you with a high-quality treatment program.


  1. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  2. Drug Enforcement Administration. (n.d.). You are Caught with Drugs.
  3. United States Sentencing System. (2016). Weighing the Charges: Simple Possession of Drugs in the Federal Criminal Justice System.
  4. United States Department of Justice. (2015). Drug Offenders in Federal Prison: Estimates of Characteristic Based on Linked Data.
  5. Drug Enforcement Administration. (n.d.). Drug Scheduling.
  6. Wisconsin Legislative Counsel. (n.d.). Drug Laws in Wisconsin.
  7. Drug Enforcement Administration. (n.d.). Federal Trafficking Penalties.
  8. Congressional Research Service. (2015). Drug Offenses: Maximum Fines and Terms of Imprisonment for Violation of the Federal Controlled Substances Act and Related Laws.
  9. State of Michigan. (n.d.). Substance Abuse and Driving.
  10. The Guardian. (2016). From cannabis cafes to death row: drugs laws around the world.

Concurrent Alcohol and Drug Use

Mixing alcohol with prescription or illicit drugs can be harmful. For example, mixing alcohol with certain medications could lead to or worsen side effects such as nausea, drowsiness, fainting, or difficulty breathing 1.

A Dangerous Combination

Because alcohol is a depressant, it can make you sleepy or lightheaded. So when you combine alcohol with another drug—for example, a stimulant such as cocaine—your brain receives conflicting signals. The effects of each individual substance may be somewhat masked, leading to unchecked combined consumption that can quickly overwhelm the person.

If you combine alcohol with another depressant, such as heroin, the two substances work to intensify the depressant effects, putting your brain and your entire central nervous system at great risk for harmful side effects 1.

And mixing alcohol with opioids such as Vicodin, OxyContin, or Percocet can dangerously slow breathing—leading to coma or death 2.

The statistics bear out the dangers of mixing alcohol with various drugs 3,4,5:

  • In 2015, 26.9% of people ages 18 or older reported that they engaged in binge drinking in the past month.
  • In a study of undergraduate students, researchers found that the prevalence for using alcohol and prescription drugs was 12.1%.
  • One study found that 5% of current drinkers reported using drugs other than marijuana in the last 12 months. In this study, several factors were associated with concurrent alcohol and drug use, such as being younger, having less than a high school education, not having a regular partner, and heavier drinking patterns.

Concurrent Alcohol and Prescription Drug Use

Concurrent Alcohol and Illicit Drug Use

Getting Treatment for Concurrent Alcohol and Drug Use

If you are struggling with an addiction to drugs and alcohol, the best thing you can do is to seek professional treatment. Several treatment options are available, including the following:

  • Detox—Typically lasting 5-10 days, depending on your drugs of choice and length of use, detox programs are designed to safely and effectively rid your body of the drug. Detoxing in an inpatient or outpatient setting can help relieve your withdrawal symptoms and give your body time to adjust to no longer having the drug in its system. Supervision is especially important when detoxing from multiple substances at once. Depending on the drug, the facility, and your severity of addiction, the detox process may involve medication-assisted treatment. 
  • Inpatient Treatment—Inpatient treatment is more intensive than an outpatient setting because you live at the treatment center and receive constant medical and clinical supervision while you withdraw from a drug. Inpatient treatment can take place in a hospital setting, clinic, or residential treatment facility. The relatively intensive care made available in inpatient settings can be the right approach to simultaneously tackle more than one substance abuse issue at once. Because many inpatient treatment centers offer a more comprehensive and immersive treatment approach, they are often more expensive than outpatient options.
  • Outpatient Treatment—In an outpatient setting, you live at home and come into the treatment center for groups and individual therapy. There are varying levels of care available, including partial hospitalization programs (PHP), intensive outpatient programs (IOP), and standard outpatient programs. The primary differences in outpatient levels of treatment are how many days a week and how many hours per day you attend.
  • Support Groups—Before, during, or after treatment you can attend support groups, which are designed for people suffering from alcohol abuse, drug addiction, or both. Although these groups originated as in-person meetings, there are now resources online that you can access too. In the 12-step model, you follow specific recovery steps to help moveyourself through treatment and beyond.


  1. National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions.
  2. University of Michigan. (2017). The Effects of Combining Alcohol with Other Drugs.
  3. National Institute on Alcohol Abuse and Alcoholism. (2014). Alcohol Facts and Statistics.
  4. McCabe, S. E., Cranford J. A., Morales, M. & Young, A. (2006). Simultaneous and Concurrent Polydrug Use of Alcohol and Prescription Drugs: Prevalence, Correlates, and Consequences. Journal of Studies on Alcohol67(4), 529–537.
  5. Midanik, L. T., Tam, T. W. & Weisner, C. (2007). Concurrent and Simultaneous Drug and Alcohol Use: Results of the 2000 National Alcohol Survey. Drug and Alcohol Dependence90(1), 72–80.

Flexeril Overdose

Flexeril, a branded form of cyclobenzaprine, is a muscle relaxant that can treat musculoskeletal pain and stiffness such as that associated with muscle spasms. This drug works by decreasing somatic motor activity 1, thereby relieving the discomfort of strain or injury in the affected musculoskeletal region. It is available by prescription only and is supposed to be used in conjunction with rest, physical therapy, and other methods of treatment to relieve pain from strains, sprains, and other muscle injuries 2.

Is Flexeril Safe?

Misuses of this drug can be extremely dangerous and, in some instances, life-threatening.

While Flexeril is intended for short-term use, muscle relaxants are often used chronically and prescribed to populations potentially at risk of experiencing overdose or other adverse reactions.

Muscle relaxants such as Flexeril account for 18.5% of all prescriptions written to manage chronic back pain 3. Currently, it is estimated that 2 million American adults use muscle relaxants, with 2/3 of this group taking additional medication to manage some sort of pain 4. While Flexeril is intended for short-term use, muscle relaxants are often used chronically and prescribed to populations potentially at risk of experiencing overdose or other adverse reactions.

Signs and Symptoms of Overdose

It is very important to be aware of the signs and symptoms of a Flexeril overdose. Drowsiness is one of the most common indication of overdose, as is an irregular heartbeat that can be fast, pounding, or uneven 1,2,3. Anxiety and difficulty breathing often accompany the latter symptom.

Less often experienced signs of overdose may include 1:

  • Agitation.
  • Slurred speech.
  • Confusion.
  • Dizziness.
  • Nausea or vomiting.
  • Hallucinations.

Extremely rare overdose symptoms could include 1,5:
  • Heart attack (and the accompanying chest pain).
  • Seizures.
  • Neuroleptic malignant syndrome: a drug reaction characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction).

Don’t let another day pass by without treatment.
Learn how to begin living a new life in recovery.

Risk Factors

Flexeril Overdose

There are several personal factors that increase an individual’s likelihood of experiencing an overdose, including 2,3:

  • Height and weight (your body can only handle so much—pushing this limit can lead to overdose or death).
  • Dose and time span of use.
  • Pre-existing heart or breathing problems, such as recent heart attack, heart rhythm disorder, congestive heart failure.
  • Other pre-existing health conditions, such as overactive thyroid, trouble urinating, enlarged prostate, glaucoma, liver disease.

Using additional drugs can also be life-threatening or cause an overdose. Known as polysubstance use—using multiple drugs to attain the desired high—this practice can be deadly. Some drugs that should not be taken in addition to Flexeril are alcohol, cold or allergy medicine, and sleeping aids since the combination may create mental impairment that can make activities such as driving perilous 1.

Flexeril may augment the effects of the following drugs as well, making the interaction dangerous 1:

  • Narcotic pain medication.
  • Medicine for seizures, depression, or anxiety.
  • Bladder or urinary medications.
  • Irritable bowel medications.

As always, it is very important to speak with your doctor before taking any medication.

What to Do If You Overdose on Flexeril

Seek medical attention immediately if you or someone you know has taken too much, since an overdose can be fatal. Overdose signs and symptoms should not be treated at home or anywhere other than a medical facility.

Going to the hospital or to a specialized facility not only increases your chances for recovery but can also assist in future recovery efforts 1.

Preventing Flexeril Overdose

There are steps you can take to prevent Flexeril overdose. First, it is important to consult with your doctor before taking the medication to ensure you take the correct dose. Never take prescription medications, including Flexeril, that have not been prescribed to you. Also, consult with your doctor about any medications you are currently taking before beginning Flexeril 1.


A Flexeril addiction is treatable and it is never too late to reach out for help to begin the recovery process. Different types of treatment are available to fit your specific needs.

Outpatient therapy occurs anywhere from 1 to 2 hours a day, 1 to 2 days a week to 4-8 hours a day for 5 days a week. You continue to live at home while meeting with therapists and attending groups for education and support in your recovery. Many people begin their treatment here, while others step down to outpatient therapy after completing more intensive treatment programs. Variations of this include Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programs (PHPs).

Group therapy can occur from 1 hour, 1 day a week to 3 hours a few times a week, depending on the type of group therapy. Typically, 1 to 2 therapists facilitate the session for a group of peers who are also struggling with abuse.

Holistic therapy is a specialized treatment that aims to treat the client’s body, spirit, and mind to achieve optimal health and wellness. This is done to avoid any imbalances in physical, emotional, or spiritual wellness that can negatively impact overall health and recovery efforts.

Inpatient treatment provides around-the-clock therapeutic and medical support in a hospital or residential setting. During inpatient treatment, you live at the facility for a set time (typically 30 to 90 days) and engage in regular programming that consists of individual therapy, therapeutic and educational groups, and organized outings.

There is help available for you or someone you love who is addicted to Flexeril and may have overdosed. Call us now at 1-888-744-0069Who Answers? to speak with a treatment consultant about your recovery options.


  1. Food and Drug Administration. (2001). Flexeril (Cyclobenzaprine HCI) Tablets.
  2. MedlinePlus. (2010). Cyclobenzaprine.
  3. Chabria, S. (2006). Rhabdomyolysis: a manifestation of cyclobenzaprine toxicity. Journal of Occupational Medical Toxicology. 1(16).
  4. Dillion, C., Paulose–Ram, R., Hirsch, R. & Gu, Q. (2004). Skeletal muscle relaxant use in the United States: data from the Third National Health and Nutrition Examination Survey (NHANES III). Spine (Philadelphia, Pa 1976) 29(8), 892–896.
  5. Berman, B.D. (2011). Neuroleptic Malignant Syndrome. The Neurohospitalist. 1(1), 41–47.

Drugs and Cancer Risk

Drugs and increased cancer risk

Despite the declines in the death rate over the last 20 years, cancer continues to be one of the most prevalent public health issues in the US. According to the National Cancer Institute 1:

  • More than 68 million people will receive a cancer diagnosis in 2016 (with breast, lung, prostate, colon, and bladder cancer being the most common).
  • About 40% of all people will be diagnosed with cancer in their lifetime.
  • Nearly 600,000 people are expected to die from the disease in 2016 alone.

Risk factors for cancer are wide-ranging. Certain factors like age, family history, and hormonal fluctuations are outside of individual control. However, there are numerous other risk factors like diet and sun exposure that can be controlled, and a major preventable contributor to cancer is substance abuse 2.

Tobacco/Cigarette Smoking

According to the American Cancer Society, approximately 30% of all cancer deaths are attributed to tobacco use. Smoking causes 87% of lung cancer deaths in men and 70% of lung cancer deaths in women.

The risk does not end with lung cancer, however. Tobacco use has been linked to cancers of the 3, 4.


  • Mouth.
  • Throat.
  • Larynx.
  • Esophagus.
  • Stomach.
  • Colon.
  • Rectum.
  • Pancreas.
  • Liver.
  • Kidneys.
  • Bladder.
  • Cervix.
  • Blood.

Tobacco smoke contains hundreds of harmful chemicals, and about 70 of them are known to cause cancer. Once ingested, the toxic effects of tobacco smoke can potentially damage every organ system in the body, which explains the vast variety of cancers triggered by use of the substance 4.

Because of this, there is no safe level of smoking, and there is no safe method of using tobacco products. Cigarettes are not the only method to confer these health dangers. You are also at risk if you use 4:

  • Smokeless tobacco like chew, snuff, or snus.
  • Pipes.
  • Cigars.
  • Hookahs.

Even electronic cigarettes have been found by some tests to have cancer-causing chemicals in the aerosol 22.

Fortunately, current smokers can significantly lower their risk for cancer by quitting. Cancer risk will significantly decrease within a few years after the last use 4.


According to the National Cancer Institute, about 3.5% of cancer deaths are caused by heavy alcohol use (more than 4 drinks per day/14 per week for men and more than 3 drinks per day/7 per week for women).

The risk of developing cancer from drinking alcohol increases with:

  • Higher volume use.
  • Use over a long period.

Heavy alcohol use is linked to higher levels of 5,6:

  • Liver cancer.
  • Esophageal cancer.
  • Head and neck cancers, especially of the mouth, throat, and voice box.
  • Breast cancer.

In the body, heavy use of alcohol is known to cause cancer in several ways including the following 5, 6:

  • As the body processes alcohol, it becomes acetaldehyde – a fleeting, yet highly toxic carcinogen capable of damaging genetic material and causing cellular injury.
  • Through a process called oxidation, alcohol triggers increased production of free radicals that damage DNA, proteins, and fats.
  • Alcohol increases the levels of estrogen in the blood, which is linked to an increased risk of certain types of breast cancer.
  • Alcohol hinders the body’s natural capacity for converting and absorbing helpful nutrients like folate (which may lower the risk of certain cancers).
  • Drinking alcohol adds excess calories to the diet, increasing the risk of obesity, another risk factor for cancer.

How alcohol causes cancer

Combining Alcohol and Tobacco

While both tobacco and alcohol individually raise cancer risk, smoking and drinking in combination heightens the risk exponentially. This is especially true for cancers of the:

  • Oral cavity.
  • Pharynx.
  • Larynx.
  • Esophagus.

According to the American Cancer Society, alcohol functions as a solvent that enables other harmful toxins like tobacco smoke to more easily enter the cells in the upper digestive tract. This has been discussed as a possible explanation for why drinking and smoking in combination appears to significantly raise the risk of mouth and throat cancers. Additionally, alcohol makes it more difficult for the body to rid itself of certain toxins 6.


Though marijuana is commonly seen as safe and is increasingly legalized, it may be a factor in the development of certain cancers. There have been reports of increased incidents of cancers of the lungs, head, neck, and respiratory tract as a result of carcinogens and toxins 7.

Marijuana use also increases the risk of testicular cancer, especially in younger people. The evidence shows that males who smoke marijuana during adolescence have greater chances of developing a specific type of testicular cancer called non-seminomatous germ cell tumor 8. Studies indicate that marijuana smoke may contain a testicular carcinogen 21.

Anabolic Steroids

Anabolic steroids are a class of substances with androgenic, or testosterone-like effects, frequently used by those seeking to increase their muscle mass or improve performance in a physical activity or sport. Steroids also are linked to a number of unwanted effects including cancer.

Since the liver is the primary organ responsible for processing and clearing steroids from the body, this organ is subjected to damage in the form of 9:

  • Liver tumors.
  • Adenomas.
  • Peliosis hepatitis.

With the hormonal changes triggered by steroid use, the formation of other cancers becomes more probable.

  • In men, prostate cancer risk is increased 10, 11.
  • In women, the danger of cervical and endometrial cancer grows 10.

Your health can’t wait. Call 1-888-744-0069Who Answers? to get help for addiction now. 


Khat is a plant native to Eastern Africa and the Arabian Peninsula and used by 10 million people worldwide. In the US, the drug is used predominantly by people from or with cultural connections to countries like Somalia 12.

The plant can be chewed in a way similar to tobacco or brewed into a tea. Khat has been linked to a number of physical and mental health problems including cancer of the mouth. It appears that the risk increases when khat use is combined with alcohol and/or tobacco 13.

Other Cancer Risks

Drug injection and increased cancer risk

The above shows the specific substances of abuse that have been found to increase a user’s susceptibility to cancer. However, there are other factors that may also raise your risk if you’re abusing drugs.

The method of use, the mixture, or the manufacturing can indirectly expose the user and others to increased cancer risks.

Injection Drug Use

Most substances of abuse can be ingested in a variety of ways. Smoking, snorting, and swallowing all carry their own set of risks. One method of delivery that causes increased risk is injection.

Hepatitis B and hepatitis C are regularly transferred through sharing needles 14. This practice can spread disease by increasing the person’s contact with blood of infected individuals.

Without treatment, hepatitis can progress to cirrhosis and a particular form of liver cancer called hepatocellular carcinoma (HCC). Liver cancer causes more than 20,000 deaths each year in the US alone 14.

Illicit Drugs Containing/ Combined With Carcinogens

Toxins involved in the manufacturing or illicit distribution of certain drugs can increase cancer risk for those who handle the chemicals. There are several examples of this, including:

  • Methamphetamine/crystal meth. Many toxic chemicals are used in the illicit manufacture of meth. One of these chemicals is the same carcinogen found in cigarettes and gasoline, benzene. The risk does not end there, however, as there are many chemicals used during meth production that are known to be toxic and cancer-causing 16.
  • Cocaine. It is a common practice of cocaine dealers to add or mix in other substances to the drug in order to create more of the product and boost profits. At times, the product used to “cut” the cocaine can be carcinogenic. This was the case when phenacetin was found in some cocaine sold in the United Kingdom. Exposure to this substance is shown to increase the risk of cancer and kidney issues 17.
  • MDMA. This substance poses risks associated with cancer that mirror issues associated with meth. During the manufacturing process, substances like safrole may be used 19. This substance has an unclear relationship to cancer in humans but has a history of producing cancerous tumors in rats 18.

Secondhand Risk

Secondhand contact with certain substances may also increase cancer risk in some individuals. Two examples of particularly concerning secondhand exposures are:

  • Secondhand smoke. According to the Centers for Disease Control and Prevention, 58 million nonsmokers were exposed to secondhand smoke between 2011 and 2012. This frequency of exposure has led to about 7,300 nonsmokers dying from lung cancer each year. Just like firsthand smoke, there is no safe level of contact with secondhand smoke. It is known to increase the risk of multiple forms of cancer 20.
  • Meth lab exposure. Anyone living in or visiting a meth lab is at risk of being exposed to many dangers including chemical contamination from the carcinogenic toxins used during production. These toxins will be difficult to remove from the area with a simple cleaning, so many items around the house may stay contaminated for some time. Additionally, if the materials used during manufacturing are not disposed of thoroughly, others in the community may be put in harm’s way should they come in contact with these byproducts 16.

Reducing the Risk

The list of reasons to avoid abusing alcohol and other substances is long. The risk of cancer is rarely the first thing that comes to mind when you think of the perils of drug use; however, it is a major risk factor for several substances of abuse.

To learn about treatment options to end use of alcohol, tobacco, or any other substance, call 1-888-744-0069Who Answers?.


  1. National Cancer Institute. (2016). Cancer Statistics.
  2. National Cancer Institute. (2015. Risk Factors.
  3. American Cancer Society. (2014). Tobacco-Related Cancers Fact Sheet.
  4. National Cancer Institute. (2014). Harms of Cigarette Smoking and Health Benefits of Quitting.
  5. National Cancer Institute. (2013).  Alcohol and Cancer Risk.
  6. American Cancer Society. (2014). Alcohol Use and Cancer.
  7. Substance Abuse and Mental Health Services Administration. (2015). Cannabis.
  8. National Institute on Drug Abuse. (2016). What are marijuana’s effects on general physical health?
  9. Hoffman, J. R., & Ratamess, N. A. (2006). Medical Issues Associated with Anabolic Steroid Use: Are They Exaggerated? J Sports Sci Med, 5(2): 182–193.
  10. New York State Department of Health. (2008). Anabolic Steroids and Sports: Winning at any Cost
  11. National Institute on Drug Abuse. (2106). Anabolic Steroids.
  12. Drug Enforcement Administration. (2013). Khat.
  13. Kassie F, Darroudi F, Kundi M, Schulte-Hermann R, Knasmüller S. Khat (Catha edulis) consumption causes genotoxic effects in humans. (2001).  Int J Cancer, 92(3):329-32
  14. National Institute on Drug Abuse. (2013). Viral Hepatitis-A Very Real Consequence of Substance Use.
  15. American Cancer Society. (2016). Benzene and Cancer Risk.
  16. Home Office. (2015). Fact Sheet: Cutting Agents.
  17. Department of Health and Human Services. (n.d.). Report on Carcinogens: Safrole.
  18. Drug Enforcement Administration. (n.d.). Advisories to the Public.
  19. Centers for Disease Control. (2015). Secondhand Smoke (SHS) Facts.
  20. Lacson, J. C., Carroll, J. D., Tuazon, E., Castelao, E. J., Bernstein, L., & Cortessis, V. K. (2012). Population-Based Case-Control Study of Recreational Drug Use and Testis Cancer Risk Confirms Association between Marijuana Use and Non-Seminoma Risk. Cancer, 118(21): 5374–5383
  21. NIDA for Teens. (n.d.). Tobacco, Nicotine, & E-Cigarettes.

Prescription Opioid Addiction: What is Causing the Epidemic?

Read time: 30 minutes

Prescription opioids are semi-synthetic medications that derive from the active opiate alkaloids found in the opium poppy. In their numerous formulations, they are prescribed to relieve various levels of pain. With a similar method of action as heroin, they reduce the intensity of pain signals and are capable of producing positive, reinforcing effects in the user.

On a neurological level, prescription opioids work to dampen pain signals from the body, but the ensuing psychological effects—like euphoria and extreme relaxation—serve as the primary building blocks for the development of abuse and addiction. The summation of these effects prove intensely rewarding to those abusing them—eliciting persistent alterations in brain chemistry that may further compel an individual to use the drug, time and again.

In 2014, the United States alone saw nearly 4.3 million people age 12 or older using prescription painkillers non-medically, which accounts for almost 2% of the population in the country.1 Of these, roughly 2 million suffered from a substance use disorder related to their abuse of these medications. 

The rates of non-medical prescription opioid abuse have remained relatively steady since 2002,1 and it is becoming clear that this is a problem that must be addressed.

Due to their status as drugs of medical value, the dangers of prescription opioid abuse are often overlooked. Many users disregard the risk of dependency in favor of the blissful high, unknowingly getting themselves started on a path toward opioid addiction.

At what point does prescription opioid use evolve into substance abuse, and why have prescription opioids become so widely abused?

Heroin Users In The US

To answer this question, we must consider all aspects of the problem, from:

  • Individual motivations and constraints.
  • Public health issues (like regulating physician guidelines).
  • Psychological correlations between pain and drug abuse.

What is Prescription Opioid Abuse?

Man with fatigued eyes looking straight on

The cognitive effects of prescription opioids can be very alluring, as they extend beyond diminishing pain signals and into areas of the brain involved with emotional control and reward.2

When taken in higher doses, a user may experience pleasurable opioid side effects: euphoria, relaxation, and, in accordance with their intended effects, less bodily pain.

These gratifying sensations positively reinforce the drug use behavior that led to them. When persistently experienced, they serve to co-opt or otherwise alter reward pathways in the brain—a person is likely to want to keep using in order to experience the intensely pleasurable effects.

Essentially, this pattern of use tricks the brain into believing that taking high doses of these drugs is good for you. Because of the activation of reward pathways in the cortex, the user’s feelings with respect to opioids may slowly begin to change from simple enjoyment to anxious hunger as substance dependence develops.

To say that a person is dependent on opioid medications means that their pattern of use has a significant psychological and physiological component. Psychologically, they have begun to crave the drug and want to consume it despite being aware of the negative consequences. Physiologically, the body reacts poorly to the absence of opioids—a phenomenon known as acute opioid withdrawal syndrome.

The dual duress of craving opioids and fearing withdrawal often leads to escalating patterns of abuse, such as:

  • Increase in doses.
  • Rise in frequency of use.
  • Changes in method of ingestion.

When a person takes more than the prescribed dose or uses an opioid medication without a prescription, patterns in their brain may begin to change. As a user progresses into opioid dependence, their brain becomes less responsive to the drugs—requiring ever-increasing doses in order to achieve the same desired effect.3 This is called tolerance.

Beyond escalating doses, abuse of prescription opioids can entail any number of use habits. For many, abuse involves taking the pills in a way that will hasten and enhance the euphoric effects. This can involve:

  • Crushing pills into powder to be nasally insufflated (snorted).
  • Dissolving pills into solution to be used via injection routes.
  • Using them in combination with other substances, such as alcohol.

Prescription opioid abuse is a widespread issue, so distinguishing between opioid abuse, dependence and addiction is a vital part of understanding the scope of the problem.

Opioid abuse encompasses a pattern of use behaviors that indicate the drug is not being used as prescribed. This includes:

  • Increasing the amount that should be taken.
  • Using alternative methods of ingestion.
  • Using with other drugs.

Opioid dependence reflects a physiologic state wherein the user begins to require the drug in order to avoid withdrawal.

Opioid addiction is characterized as persistent, compulsive drug-seeking behaviors and thoughts, despite the adverse consequences of the associated drug use.

The lack of consensus on what constitutes opioid addiction is one of the reasons public health guidelines and physician education on this topic are so difficult to regulate.

Although physical dependence can indicate an addiction, it can also occur without the presence of psychological problems like craving and compulsive use—it may just be that a person has been using the drug therapeutically for a long time.

This occurs with many individuals who use opioids for pain—they develop a physical dependence on them but do not have the accompanying psychological symptoms that constitute an addiction. From a physician’s point of view, it is very difficult to discern who is experiencing a legitimate side effect of long-term use and who may be misusing opioids.

Both prescription opioid dependence and abuse are contributing factors to the development of an addiction, which can become intensely consuming. If a person begins using opioids for medical reasons, it is more likely that a dependency will develop first, potentially escalating into abuse behaviors. On the illicit market, abuse is generally the starting point for dependency. No matter how you cut it, opioid misuse is a dangerous habit with far-reaching consequences.

Why Are Opioid Analgesics Prescribed?

For many, prescription opioid abuse begins with a doctor’s recommendation. These medications get prescribed to treat moderate to severe pain, be it the result of injury, surgery, a chronic health condition (such as pain related to cancer) or a dental procedure.

When taken as prescribed, opioid medications can make a world of difference for a person in pain. They can markedly

improve quality of life—helping those otherwise consumed by their painful conditions to get through their daily life without experiencing constant agony.

Prescription opioid dosing is (or should be) carefully determined for each person in order to avoid the development of dependence.

Taking painkillers beyond the doctor-prescribed dose, or without a doctor’s prescription altogether, greatly increases the potential for abuse.

Non-medical users have a variety of reasons behind their opioid use. Some do not readily have access to the healthcare that they need, and so obtain these medications to self-treat pain, anxiety, loneliness, or even to temper the side effects of other drugs. Other users simply take them to achieve the blissful high.

No matter the motivation, prescription opioid abuse has undeniably swept the nation.Overdose Deaths Involving Opioids


The epidemic of opioid abuse and dependency has even caught the attention of some government agencies. The Centers for Disease Control and Prevention (CDC) revised their opioid prescribing guidelines in 2016—now discouraging doctors from prescribing opioid medications for chronic, long-lasting pain.5

In 2012 alone, 259 million opioid prescriptions were doled out—that’s enough pills for every adult in the United States to have their own bottle!4

Even high government offices have taken steps to ease the prescription opioid abuse problem. In 2016, President Obama established a special budget to expand access to substance abuse treatment for opioid users, promote research on effective opioid abuse treatment, and increase the availability of naloxone, a drug used to treat opioid overdose.6

While opioids undeniably have their place in the medical world, the use of them is becoming increasingly more focused on recreational pleasure, perhaps due in part to the perception of these drugs as “safe” because of their doctor-prescribed origins. The more these drugs are viewed as medically safe, the riskier their abuse becomes.

Who is at Risk for Developing Prescription Opioid Addiction?

Some people begin using prescription opioids strictly to experience their psychoactive effects. Others follow a more protracted course, beginning with a legitimate medical need that devolves into recreational fun. Regardless of the user’s motivation to begin abusing the drugs, the results can be detrimental. Because the dangers can run so high, it is important to recognize risk factors for prescription opioid abuse.Who's At Risk For Developing Opioid Abuse


A wide range of individuals—together representing a diverse cross-section of demographic variables—are bearing the brunt of the opioid abuse epidemic. A number of these differing individual characteristics may play a hand in the development of an opioid drug abuse problem.

The user’s gender, age, race, socioeconomic status, geographical area, and medical or clinical history can all factor in to the progression of opioid abuse. It is important to note that risk factors are correlational; they do not definitively predict that a person will develop an addiction to opioids.

Risk factors play an important role in the development of addiction; they are critical to understanding the different stages of addiction and relapse.

Genetics, for example, can underlie personality traits like impulsivity that lead to initiation of drug use. Furthermore, psychological predispositions can influence an individual’s specific stress-response, which may itself determine if and how that individual eventually develops problematic patterns of use.

Understanding the various, distinct vulnerabilities to opioid addiction can help us map out the problem.


Women are prescribed abuse-prone medications more often than men,7,8 yet men have been found to use opioid medications non-medically at significantly higher rates than women.9,10 Death from prescription drug overdose also occurs at higher rates in men than women.11Number Of Deaths From Opioid Drugs


Despite these seemingly oppositional facts, men and women have been admitted to the emergency department at approximately equal rates for complications relating to opioid abuse.12

Death from prescription drug overdose occurs at higher rates in men than women. However, this gap is closing as overdose rates in women is increasing.

It may seem like women would have a higher risk of abusing opioid medications, but the data indicate that men report more problems associated with opioid use. The abuse gap between men and women has been closing up, however, as women have seen a 400% increase in overdose death rates from 1999 to 2013.13

Significantly fewer women have received substance abuse treatment than men,10 emphasizing the need for more substance abuse care outreach and education. Understanding gender specific trajectories of opioid addiction can help in the assessment of:

  • Treatment utilization and success.
  • Relapse prevention.


Rates of long-standing opioid medication use without a prescription are highest among younger users between the ages of 18 and 25,1,9 yet overdose rates are highest among users between 45 and 54 years old.11Past Misuse Of Opioids


The biggest increase in non-medical use of prescription pain relievers occurred in users 50 years and older—average rates of use in this group increased by 60% between 2003 and 2010.9

Younger people have a higher risk of abusing prescription opioids, but rates among older users are on the rise. Middle-aged users have the highest risk of overdose, which may reflect more frequent, higher dosing.

Studies into the age-related effects on prescription opioid addiction might aid in the prevention of over-prescribing by spotlighting the problems that cause it. Many providers have concerns about the effects of opioids in older adults or the potential for addiction or the diversion of medications. Clarification in this area can help develop proper sanctions and training interventions to improve the use of opioid analgesic therapy.


People of different races can have opioid addiction issues
There is a marked association between race and prescription opioid problems.

Rates of opioid prescriptions have been found to be highest among white patients, followed by black patients, Hispanic patients, and Asian or other race patients, regardless of socio-economic status.14,15

In addition, opioid overdose rates are nearly three times higher among American Indians/Alaska Natives and non-Hispanic whites than among blacks and Hispanic whites.11 These trends may reflect some underlying difference between races, but the more likely explanation is that they demonstrate the disparity between different races when it comes to health care.

Race has been shown to have a major impact on doctor-patient care,16,17 and the majority of physicians in the U.S. are white— only 6.4% identify as black or African American, 6.4% as Hispanic or Latino, and 18.4% as Asian.18

A white physician may be more likely to prescribe opioid pain medications to their white patients than patients of a racial background different than their own.

Racial disparities outline the need for a better understanding and education regarding the effect of race on health care and prescribing practices.

Socioeconomic Status

There is some preliminary evidence that socioeconomic status (SES), or what a person’s income and education level is, may be related to prescription opioid problems.

People from high SES areas suffering from moderate-to-severe pain are prescribed more opioid medications than those in the low SES neighborhoods.14

Education has also been associated with rates of opioid prescriptions. Patients with higher education levels are three times less likely to receive an opioid medication prescription than those with lower education levels.19,20

This means that the less schooling a person has, the more likely they are to be prescribed opioid medications to treat pain.

Socioeconomic status can affect substance abuse by:21

  • Shaping drug use habits.
  • Influencing the availability of health resources.
  • Affecting adherence to medication.

While the association is not yet fully vetted, it is clear that socioeconomic status and opioid medication prescribing and abuse are intertwined.

Geographical Area

Interestingly enough, abuse of prescription opioids has been found to have a regional component.

In the United States, abuse rates are highest in the Southeastern states, Appalachian area, and Northwest.11,22,14 Rural regions also tend to have higher rates of prescription opioid overdose than urban areas.23

These areas have the highest rates of opioid prescription problems, but interestingly, the higher rates do not reflect a higher incidence of injury, surgery, or chronic pain.

This discrepancy may reflect a lack of consensus among healthcare professionals as to the proper prescribing guidelines for opioid medications—a problem that the CDC’s new mandate hopes to address.

Medical and Clinical History

Long-term medical use of prescription opioids to treat chronic pain is one of the leading risk factors for overdose.

People struggling with chronic pain at the same time as they are coping with a substance use or mental health disorder have the highest risk for misusing prescription opioids, especially with higher prescribed doses.24

In addition, long-term medical use of prescription opioids to treat chronic pain is one of the leading risk factors for overdose. Those with long-term medical need are actually at higher risk of experiencing an overdose than those “using without a prescription”.25

Common psychological disorders, such as mood disorders, have shown a clear link with the development of opioid abuse.26 Even the abuse of other substances, including alcohol, has been found related to opioid medication use problems.26

Any prescription opioid user who is dealing with these issues faces an increased risk of falling into a pattern of abuse.

One of the most dangerous problems with prescription opioids is that, all too often, they are viewed as a “safe” drugs due to their status as pharmaceutically manufactured substances with legitimate medical uses. Unfortunately, the underestimation of their dangers can lead people towards risky patterns of abuse and, ultimately, very harmful outcomes.

Reasons for Prescription Opioid Abuse

Prescription opioid abuse can occur for a multitude of reasons:

  • Self-medication.
  • Recreational highs.
  • Compulsory habits due to dependence or addiction, or even for dealer profit.

No matter the root cause, there are numerous factors underlying the rise of prescription opioid problems, and a lot of them have to do with how these drugs are viewed in the social sphere. Once these perceptions are recognized, we can begin to understand how to address this escalating problem.

Social Acceptability

Social context may contribute to the structuring of prescription opioid use norms and acceptability.27

In fact, non-medical prescription drug users are more likely to have positive expectations about the effects of use,28,29,30 and many younger users do not recognize the extent of risks associated with abuse of opioid medications.31

Viewing prescription opioid abuse as a socially acceptable practice has a particularly potent impact on adolescents.

Young people may gain their understanding of prescription opioid use by observing older people in their lives taking pills on a frequent basis.32 In addition, social media has expanded the scope of community connection, allowing for substance-using teens to develop a network of like-minded peers.32

The use and abuse of prescription drugs may be viewed as more socially acceptable than use and abuse of illicit substances like cocaine.

A surprising majority of college students underestimate the prevalence of non-medical use of prescription drugs.33

College students may prefer prescription medications for:

  • Recreational highs, because they are easy to hide.
  • Producing effects that last longer than other substances.
  • Enhancing the feeling of drunkenness.
  • Potentially less severe repercussions if caught using them.31

When people believe that their peers are engaging in a particular behavior, such as opioid medication abuse, they often normalize it, which only serves to expand the problem’s scope.

If we can gain a better understanding of how prescription opioids are rationalized as a socially acceptable drug of abuse, we may begin to find ways to counteract this misunderstanding and reduce the high rates of abuse.

Perceptions of Safety

Prescription drugs have become an accepted, sometimes medically necessary part of society. Some of the factors that contribute to their widespread acceptance, and further their perception as “safe” drugs include:

  • Authoritative source.
  • Easy consumption.
  • Easy accessibility.
  • Frequency of prescription.
  • Marketing.

Authoritative Source

Because these medications often come recommended by a trusted authority source (a doctor), the risks associated with abuse can be easily overlooked. Some users may not realize that they have a problem until something drastic happens, such as overdose.

Easy Consumption

Opioid medication abuse doesn’t necessarily involve routes of administration that are highly stigmatized or associated with negative health effects such as smoking or injecting,34,35 which may contribute to the widely-held assumption that they are safe.36

Easy Accessibility

On top of this, prescription opioids can be obtained through safer outlets—getting a prescription from a doctor or pills for a friend is probably safer than going to a dealer.

doctor giving a prescription to his patient

Frequency of Prescription

The staggering number of opioid prescriptions being written sends the wrong message to consumers regarding the dangers of opioid abuse. Not only has the number of opioid prescriptions nearly quadrupled since 1999, the average dose prescribed has risen dramatically.38

In fact, the most damage is seen in users who are taking these medications exactly as their doctor recommends: 60% of deaths related to opioid use occur in those who were given a prescription based on physician guidelines, and the other 40% occur in people who get their opioids through diverted prescriptions, doctor shopping, or multiple prescriptions.38,39


A major contributing factor to the perceived halo of safety is the aggressive marketing by major pharmaceutical companies.

The amount of money these companies have spent promoting their drugs has increased dramatically in recent years,40 and this type of direct-to-consumer marketing may communicate the message that opioid medications, like all prescription pharmaceuticals, are not only good for you, but safe to use and without negative consequence.41

Fortunately, the new CDC guidelines for opioid prescribing practices are a step in the right direction. Encouraging as the changes may be, fewer prescriptions cannot guarantee lower rates of abuse. Further steps will need to be taken in order to improve the safety of users.

Ensuring that all opioid prescriptions are accompanied by education regarding the risks and dangers of misuse may help to curb the high rate of health problems associated with these medications.

Both physicians and consumers should be well-informed in order to ensure the medications are rightfully prescribed, properly dosed, and taken according to specific guidelines in order to avoid adverse consequences.


The mere fact that these potent drugs are so readily available poses a danger to opioid users. Some drug abusers take advantage of their legal status as substances with legitimate medical value. They may fake symptoms or otherwise find a way to obtain opioid prescriptions from their doctors will the sole intent of recreational use.

Some users may even resort to “doctor shopping” wherein they visit different doctors in order to get multiple prescriptions for opioids.

While not common, this practice has been found to skew prescribing rates, with average patients that are presumed to be doctor shoppers encompassing 0.7% of the opioid prescription populace but obtaining almost 4% of the weighted opioid medication amounts.41

On average, extreme doctor shoppers were able to get 32 opioid prescriptions acquired through 10 different prescribers in 2008 alone.42 There is a good chance that many of these people are selling the drugs to people without a medical need for them.

Practitioners need a better system for tracking and accessing patient medication monitoring to watch for suspicious prescription acquisition patterns.

Surprisingly, while these types of misrepresentation and doctor shopping techniques do take place, most who abuse opioid medications do not obtain their drugs this way. Most non-medical users get the drugs from a friend or relative, often for free but occasionally buying or stealing them.1

Only 22.1% of non-medical users “legitimately” got their drugs from a doctor in 2014, indicating that diversion of these medications is a major concern.1

Friends and relatives are unlikely to have a full understanding of the dangers associated with opioid medications. When users get the drugs from their peers and family, they may unknowingly be taking an unsafe dose for their body and health status.

The availability of opioid medications has contributed greatly to the abuse problem. The widespread overprescribing of opioids has led to the diversion and exploitation of these medications, and unfortunate abusers suffer the consequences.

Motivations (Self-treatment Vs. Recreational)

While it may be true that prescription opioids are viewed as more safe and more socially acceptable than other substances, it is important to understand why people are abusing these drugs in the first place.

Some users may be taking these opioids, with or without a prescription, to treat a variety of problems. Managing acute pain, chronic pain, stress, and emotional problems are common motivations behind this self-treatment.43,44,45 This type of use is especially common among athletes coping with both short and long term sports injuries.46

Coping with psychological distress may also play a large role in the abuse of opioid medications. The specific psychological issues being “medicated” differ across gender lines.

Women are more likely to take these medications to deal with stress, conflict, and anxiety relating to their social circle,47 while men are more likely to be using them to cope with depression.48

Perhaps the most obvious motivation for prescription opioid abuse is recreational pleasure. Opioids can produce a euphoric high where the user feels relaxed and at peace.49 Different methods of consumption can enhance this high by producing faster and more intense effects. Snorting, for example, produces a rapid and intense high followed by a faster comedown. Many opioid abusers take the medications in a way other than the intended method of ingestion in order to achieve the desired recreational gratification.

Understanding why people are abusing prescription opioid medications can help professionals take better preventative measures to reduce the harm that these drugs can cause.

For users that are taking opioids to cope with emotional or psychological distress, increased availability of behavioral interventions may help to preclude their use.

Stricter guidelines for prescribing opioids (such as those offered by the new CDC recommendations) as well as lowering the available doses of these prescriptions may help decrease rates of recreational abuse, as these practices may ultimately reduce the supply of (and average dose of) opioid medications available on the illicit market.

Mental Health Correlations


There have been strong correlations found between prescription opioid abuse and mental health issues.People With Co Occurring Mental Disorders And Substance Disorders

In fact, nearly 45% of people struggling with an opioid medication use disorder meet the DSM-IV criteria for either depression or anxiety.50 Depression and anxiety are even more strongly associated with prescription opioid use than other substance use disorders,50 and almost 80% of non-medical opioid medication users have a history of depression and anxiety.51

People who struggle with the issues of severe anxiety or depression are more likely to underestimate the dangers of prescription opioid abuse,52 and it has been suggested that adolescents with acute anxiety may be at particular risk for prescription drug abuse.53

In some cases, problematic drug use may “uncover” or lead to the development of these mental health issues. In other instances, it may be that pre-existing psychological disorders predispose a person to later develop substance abuse problems.

Ensuring that all doctors consider a person’s mental health history when prescribing medications, especially opioids, may be an effective strategy in reducing non-medical prescription drug abuse. As part of their patient assessment, physicians must consider all the risk factors associated with prescription opioid abuse so that they may make more carefully considered decisions to administer these potent medications.

Other Substance Use Disorder

Poly-substance abuse in association with the prescription opioids is not uncommon. Problem drug use in general, including that of alcohol abuse, has been associated with higher rates of prescription opioid use.50

In 2011, more emergency department visits involved people using prescription opioids in combination with other substances than using them on their own.12

Benzodiazepines are a particularly dangerous part of this mix, and account for nearly 30% of the drug combination emergency room complications. This alarming percentage indicates more ER complications than those seen in association with the next two culprit substances combined—with alcohol at nearly 15% and marijuana at 10%.12

Teens are also showing patterns of problematic multi-substance abuse. Nearly 7 out of 10 teens that use prescription opioids non-medically take them with another substance.54 Marijuana is the most popular addition, followed closely by alcohol—both of which are co-abused with opioids in more than 50% of reported cases.

Co-abuse of opioid medications with central nervous system depressants such as alcohol and benzodiazepines is especially dangerous. Depressant drugs like these can slow a person’s breathing and heart rate to lethal levels, as well as compounding other physical effects that dangerously compromise a user’s health.55,56,57

Considering how many opioid-using individuals are combining the drugs with other substances, education regarding the effects of co-use should be emphasized to physicians and patients alike. Adolescent substance education is of particular importance, as rates of co-abuse are alarmingly high among this population.

Prescription Opioids and Heroin


Prescription opioids and heroin are in the same class of drugs. While they exhibit some pharmacodynamic differences, they all act on the same sub-population of opioid receptors and are capable of eliciting similar neurological effects. Furthermore, the cascade of molecular events that they initiate in the brain impacts a characteristic set of neurotransmitters systems.58 All of these substances have a high abuse and addiction potential in part because they influence areas of the brain related to processing and reward regulation.

Some of the prescription opioids—such as oxycodone and fentanyl—have abuse potential that rivals (or exceeds) that of heroin due to their sheer potency and pharmaceutical purity.59,60

It has even been theorized that prescription opioid abuse is leading some users into heroin use because heroin is cheaper to buy, sometimes easier to obtain and, via an injectable route, is capable of providing relatively quicker and more intense highs than its prescription opioid counterparts.

User reports corroborate these assumptions.58 In fact, the majority of current heroin users abused prescription opioids before initiating heroin use. It is important to note that the reverse is not necessarily true—rates of heroin abuse among those who abuse prescription opioids are low.58 This indicates that prescription opioid abuse is a major risk factor for heroin use. To clarify, not all individuals with an addiction to prescription opioids will develop an addiction to heroin, but prescription opioid abuse creates physiological and psychological vulnerabilities that may make heroin seem desirable.

Considering that these medications may not only be more abuse-prone than heroin, but may even lead some users into heroin use, it is a wonder that are perceived as a safer, alternative high. In fact, overdose rates for prescription opioids were nearly twice the overdose rates for heroin in 2014.61

There is widespread misunderstanding regarding the relationship and similarities between opioid medications and heroin, leading to the incorrect assumption that prescription opioids are safe to use and abuse. As evidenced by these reports, this is simply not the case.

Prescription opioid abuse is inherently dangerous and may lead users down a path towards serious, illicit drug abuse and addiction problems.

The Problem of Pain


The fact that opioid medications provide unparalleled benefits for people suffering from extreme pain makes addressing the prescription abuse problem a tricky endeavor.Opioid Prescriptions Filled

On the one hand, the number of opioid prescriptions has skyrocketed,38 which runs directly counter to allegations that pain has been largely undertreated by the medical community.62 On the other hand, the over-prescribing of opioid medications to treat chronic pain has proven to be a major societal concern.63

How can these seemingly opposing problems be reconciled?

Many believe we need alternative options for treating chronic, non-cancer related pain. This may involve:

  • Decreasing or stopping the effectiveness of higher doses.
  • Producing negative effects if the drug is taken outside of doctor-recommended parameters.
  • Developing a physical or chemical barrier to methods of abuse.

These deterrent efforts might include the development of crush-resistant pills, adding a gelatin chemical so that the pills cannot be dissolved in water, or including an agent that may react negatively in the presence of alcohol or other substances.

One such formulation, extended-release oxycodone, was made to be tamper-resistant so that users could not abuse the drug by crushing or dissolving the pills. It has shown very promising results after its release on the market in 2010, reducing abuse rates by 41% (65).

The creation of abuse-resistant medications may help curb the problem by maintaining the availability of effective pain treatment while at the same time drastically reducing the potential for alternative use or increasing doses.

Patient Screening

The CDC revised their opioid prescription screening guidelines in 2016, no longer promoting opioids as a treatment for chronic non-cancer pain.5

These new recommendations discourage using opioids as a first line of defense against painful conditions, especially long-lasting pain. They encourage frequent doctor-patient check-ins to ensure that the drugs are being taken only as prescribed, as well as the promotion of substance abuse treatment in the event that a patient develops an abuse problem.

By revising patient screening, the medical community can more effectively prescribe and dose these potent medications to the people that will derive the most benefit with the least amount of risk.

These new guidelines may help reduce the amount of prescription opioids available for non-medical use in addition to exposing more treatment options for patients struggling with opioid abuse and addiction.

Provide Education

With growing recognition regarding the risks of opioid abuse, it is vital that all physicians that may be prescribing these medications have a thorough understanding of the dangers and likelihood of misuse. Many health providers are not fully aware of just how high the abuse potential of these vital medications is, leading to overprescribing practices that are well-intended but poorly realized.

When medical practitioners are provided adequate, up-to-date information on the risks associated with opioid medications, they can more judiciously administer these medications and clearly communicate concerns to their patients regarding appropriate and safe opioid use.

Because painful conditions can be so debilitating, it is imperative that all aspects of prescription opioid medications be analyzed and considered before being prescribed to a patient.

The balance between pain management and a substance abuse problem relies on the delicate scale of medical necessity. Alternative options for pain management may be a less risky option for most patients, and physicians must be provided the information and education necessary to determine whether or not a patient should be prescribed such a potent drug. Fortunately, locales that have taken pivotal action to reduce prescription opioid abuse have seen very promising results, including fewer opioid prescriptions being given and lower rates of overdose deaths.58

Alternative Pain Management Approaches

Managing pain is a necessary part of life for many people. Because opioid medications come with such high risks, finding alternate methods to cope with and treat painful conditions can help alleviate the opioid epidemic. There are many alternative options for pain management that have shown promising results.


The insertion of very thin needles into certain points on the body. Has demonstrated positive results in back pain and headache issues.66

Stress Reduction

Pain conditions can cause a lot of stress in a person’s life. Stress reduction practices can help alleviate the sense of pain through a variety of methods: mindfulness meditation,74,75 Yoga,76,77,78 music therapy,79,80,81 massage,82,83,84 and biofeedback85 have all shown positive results in the management of pain.

Exercise/Physical Therapy

Regular physical activity can provide major benefits for people suffering with painful conditions. Physical activity regimens that are tailored to the particular condition have shown the best results.6,68,697

Psychological Therapy

Nearly one half of chronic pain patients develops depression.70 Engaging in therapy, especially cognitive-behavioral therapy, has been shown to help patients minimize the impact that pain has on their life, including thoughts and emotions, which can result in reduced perceptions of pain.71,72,73


A state of concentration that is very focused. Has been found to help with pain related to post-surgery, arthritis, cancer, headaches, and fibromyalgia.66

Medical Marijuana

There is a lot of controversy surrounding the medical use of marijuana. This substance has been found to help many people cope with pain,86,87,88 but may have adverse health effects so it is important to consult with a medical professional.

The best results for alternative pain treatment involve a combination of multiple approaches.89,90 Non-opioid pain management is possible for many people, and it’s important to consider these options before resorting to high-potency opioid medications.

Conclusion/Concluding Thoughts

Efforts to curb the prescription opioid abuse problem are challenged by numerous factors that all relate to the way that these medications are perceived in the public sphere. Despite their legal status, opioid medications have a very high potential for abuse and addiction and are being overprescribed at alarming rates.

Fortunately, the steps that are being taken have shown promising results. With a better understanding of the underlying causes of this epidemic, both professionals and consumers will be better equipped to address the major public health concerns arising from opioid abuse. Continued determined efforts to educate society, prevent abuse and diversion, and acknowledge factors that play into opioid abuse will help expose the truth behind these powerful drugs.


1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50).

2. Merrer, J.L., Becker, J.A., Befort, K., & Kieffer, B.L. (2009). Reward processing by the opioid system in the brain. Physiological Review, 89(4). 1379-1412.

3. Kosten, T.R. & George, T.P. (2002). The neurobiology of opioid dependence: Implications for treatment. Science and Practice Perspectives, 1(1). 13-20.

4. Centers for Disease Control and Prevention. (2014). Opioid Painkiller Prescribing, Where You Live Makes a Difference. Atlanta, GA: Centers for Disease Control and Prevention.

5. Centers for Disease Control and Prevention. (2016). Guideline for prescribing opioids for chronic pain. Atlanta, GA: Centers for Disease Control and Prevention.

6. The White House. (2016). Fact sheet: President Obama proposes $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic. Office of the Press Secretary.

7. Raofi, S. & Schappert, S.M. (2006). Medication therapy in ambulatory medical care; United States, 2003-2004. Vital Health Statistics, 13(163). 1-40.

8. Simoni-Wastila, L., Ritter, G., & Strickler, G. (2004). Gender and other factors associated with the nonmedical use of abusable prescription drugs. Substance Use and Misuse, 39(1). 1-23.

9. Jones, C.M. (2012). Frequency of prescription pain reliever nonmedical use: 2002-2003 and 2009-2010. Archives of Internal Medicine, 172(16). 1265-1267.

10. Back, S.E., Payne, R. L., Simpson, A.N., & Brady, K.T. (2010). Gender and prescription opioids: findings from the National Survey on Drug Use and Health. Addiction and Behavior, 35(11). 1001-1007.

11. Paulozzi, L.J., Jones, C., Mack, K., & Rudd, R. (2011). Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999-2008. MMWR Morbidity and Mortality Weekly Report, 60(43). 1487- 1492.

12. Substance Abuse and Mental Health Services Administration. (2015). Emergency department visits involving narcotic pain relievers. Drug Abuse Warning Network: The CBHSQ Report.

13. Centers for Disease Control and Prevention. (2013). Prescription Painkiller Overdoses. Atlanta, GA: Centers for Disease Control and Prevention.

14. Joynt, M., Train, M.K., Robbins, B.W., Halterman, J.S., Caiola, E., & Fortuna, R.J. (2013). The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine, 28(12). 1604-1610.

15. Pletcher, M.J., Kertesz, S.G., Kohn, M.A., & Gonzales, R. (2008). Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA, 299(1). 70-78.

16. Berger, J.T. (2008). The influence of physicians’ demographic characteristics and their patients’ demographic characteristics on physician practice: implications for education and research. Journal Association of American Medical Colleges, 83(1). 100–105.

17. Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A.B. (1996). The role of black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine, 334(20). 1305–1310.

18. U.S. Bureau of Labor Statistics. (2015). Labor force statistics from the current population survey.

19. Platts-Mills, T.F., Hunold, K.M., Bortsov, A.V., Soward, A.C., Peak, D.A., Jones, J.S., … McLean, S.A. (2012). More educated emergency department patients are less likely to receive opioids for acute pain. Pain, 153(5). 967-973.

20. Krebs, E.E., Lurie, J.D., Fanciullo, G., Tosteson, T.D., Blood, E.A., Carey, T.S., & Weinstein, J.N. (2010). Predictors of long-term opioid use among patients with painful lumbar spine conditions. The Journal of Pain, 11(1). 44–52.

21. Galea, S. & Vlahov, D. (2002). Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Report, 117(1). S135-S145.

22. McDonald, D.C., Carlson, K., & Izrael, D. (2012). Geographic variation in opioid prescribing in the U.S. Journal of Pain, 13(10). 988-996.

23. Centers for Disease Control and Prevention. (2013). Addressing prescription drug abuse in the United States: current activities and future opportunities. Washington, DC: U.S. Department of Health and Human Services.

24. Sehgal, N., Manchikanti, L., & Smith, H.S. (2012). Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician, 15(3). ES67-ES92.

25. Centers for Disease Control and Prevention. (2012). CDC grand rounds: prescription drug overdoses – a U.S. epidemic. MMWR Morbidity and Mortality Weekly Report, 61(1). 10- 13.

26. Sullivan, M.D., Edlund, M.J., Zhang, L., Unutzer, J., & Wells, K.B. (2006). Association between mental health disorders, problem drug use, and regular prescription opioid use. Archives of Internal Medicine, 166(19). 2087-2093.

27. Galea, S., Nandi, A., & Vlahov, D. (2004). The social epidemiology of substance use. Epidemiological Review, 26. 36-52.

28. Boyd, C.J., Teter, C.J., West, B.T., Morales, M., & McCabe, S.E. (2009). Non-medical use of prescription analgesics: a three-year national longitudinal study. Journal of Addictive Diseases, 28(3). 232-242.

29. McCabe, S.E., Boyd, C.J., & Young, A. (2007). Medical and non- medical use of prescription drugs among secondary school students. Journal of Adolescent Health, 40(1). 76-83.

30. McCabe, S.E., Teter, C.J., Boyd, C.J., Knight, J.R., & Wechsler, H. (2005). Nonmedical use of prescription opioids among U.S. college students: prevalence and correlates from a national survey. Addictive Behaviors, 30(4). 789-805.

31. Lord, S., Brevard, J., & Budman, S. (2011). Connecting to young adults: an online social network survey of beliefs and attitudes associated with prescription opioid misuse among college students. Substance Use and Misuse, 46(1). 66-76.

31. Compton, W.M. & Volkow, N.D. (2006). Abuse of prescription drugs and the risk of addiction. Drug and Alcohol Dependence, 83(1). S4-S7.

32. Hanson, C.L., Cannon, B., Burton, S., & Giraud-Carrier, C. (2013). An exploration of social circles and prescription drug abuse through twitter. Journal of Medical Internet Research, 15(9). E189.

33. McCabe, S.E. (2008). Misperceptions of non-medical prescription drug use: a web survey of college students. Addictive Behaviors, 33. 713–724.

34. Foltin, R.W. & Fischman, M.W. (1992). Self-administration of cocaine by humans: choice between smoked and intravenous cocaine. Journal of Pharmacology and Experimental Therapeutics, 261(3). 841-849.

35. Des Jarlais, D.C., Arasteh, K., Perlis, T., Hagan, H., Heckathorn, D.D., McKnight, C., Bramson, H., & Friedman, S.R. (2007). The transition from injection to non-injection drug use: long- term outcomes among heroin and cocaine users in New York City. Addiction, 102(5). 778-785.

36. Keyes, K.M., Cerda, M., Brady, J.E., Havens, J.R., & Galea, S. (2014). Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States. American Journal of Public Health, 104(2). E52-E59.

37. Johnston, L.D., O’Malley, P.M., Bachman, J.G., & Schulenberg, J.E. (2010). Monitoring the Future. National Survey Results on Drug Use, 1975—2009. Vol. 2: College Students and Adults Ages 19-50. Bethesda, MD: National Institute on Drug Abuse; 2010. NIH Publication 10-7585.

38. Manchikanti, L., Helm II, S., Fellows, B., Janata, J.W., Pampati, V., Grider, J.S., & Boswell, M.V. (2012). Opioid epidemic in the United States. Pain Physician, 15. ES9-ES38.

39. Letter to Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, U.S Food and Drug Administration, from Physicians for Responsible Opioid Prescribing RE Docket No. FDA- 2011-D-0771, Draft Blueprint for Prescriber Education for Long Acting/Extended Release Opioid Class-Wide Risk Evaluation and Mitigation Strategies. 2 December, 2011.

40. Ventola, C.L. (2011). Direct to Consumer Pharmaceutical Advertising: Therapeutic or Toxic? Pharmacy and Therapeutics, 36(10). 669-684.

41. Netemeyer, R., Burton, S., Delaney, B., & Hijjawi, G. (2015). The legal high: factors affecting young consumers’ risk perceptions and abuse of prescription drugs. Journal of Public Policy and Marketing, 34(1). 103-118.

42. McDonald, D.C. & Carlson, K.E. (2013). Estimating the prevalence of opioid diversion by “doctor shoppers” in the United States. PLOS ONE 8(7). e69241.

43. Young, A., McCabe, S.E., Cranford, J.A., Ross-Durow, P., & Boyd, CJ. (2012). Nonmedical use of prescription opioids among adolescents: subtypes based on motivation for use. Journal of Addictive Disorders, 31(4). 332-341.

44. Garland, E.L., Hanley, A.W., Thomas, E.A., Knoll, P., & Ferraro, J. (2015). Low dispositional mindfulness predicts self-medication of negative emotion with prescription opioids. Journal of Addiction Medicine, 9(1). 61-67.

45. Merlo, L.J., Singhakant, S., Cummings, S.M., & Cottler, L.B. (2013). Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. Journal of Addiction Medicine, 7(5). 349–353.

46. King, S. (2014). Beyond the war on drugs? Notes on prescription opioids and the NFL. Journal of Sport and Social Issues, 38. 184-193.

47. Back, S.E., Lawson, K.M., Singleton, L.M., & Brady, K.T. (2011). Characteristics and correlates of men and women with prescription opioid dependence. Addictive Behaviors, 36(8). 829-834.

48. Green, T.C., Grimes Serrano, J.M., Licari, A., Budman, S.H., & Butler, S.F. (2009). Women who abuse prescription opioids: Findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database. Drug and Alcohol Dependence, 103. 65-73.

49. National Institute on Drug Abuse. (2014). Prescription drug abuse: how do opioids affect the brain and body?

50. Sullivan, M.D., Edlund, M.J., Steffick, D., & Unu?tzer, J. (2005). Regular use of prescribed opioids: association with common psychiatric disorders. Pain, 119(1). 95–103.

51. Green, T.C., Black, R., Serrano, J.M.G., Budman, S.H., & Butler, S.F. (2011). Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment. PloS one, 6(11). e27244.

52. Viana, A.G., Trent, L., Tull, M.T., Heiden, L., Damon, J.D., Hight, T.L., & Young, J. (2012). Non-medical use of prescription drugs among Mississippi youth: constitutional, psychological, and family factors. Addictive Behaviors, 37(12). 1382-1388.

53. McCabe, S.E. & Cranford, J.A. (2012). Motivational subtypes of nonmedical use of prescription medications: results from a national study. Journal of Adolescent Health, 51(5). 445-452.

54. McCabe, S.E., West, B.T., Teter, C.J., & Boyd, C.J. (2012). Co-ingestion of prescription opioids and other drugs among high school seniors: results from a national study. Drug and Alcohol Dependence, 126(1-2). 65-70.

55. Cone, E.J., Fant, R.V., Rohay, J.M., Caplan, Y.H., Ballina, M., Reder, R.F., & Haddox, J.D. (2004). Oxycodone involvement in drug abuse deaths. II Evidence for toxic multiple drug-drug interactions. Journal of Analytical Toxicology, 28. 217–225.

56. Kreek, M.J. (1984). Opioid interactions with alcohol. Advances in Alcohol and Substance Abuse, 3(4). 35-46.

57. Jones, J.D., Mogali, S., & Comer, S.D. (2012). Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug and Alcohol Dependence, 125(1-2). 8-18.

58. Compton, W.M., Jones, C.M., & Baldwin, G.T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. The New England Journal of Medicine, 374. 154-163.

59. Ternes, J.W. & O’Brien, C.P. (1990). The opioids: abuse liability and treatments for dependence. Advances in Alcohol and Substance Abuse, 9. 27-45.

60. Comer, S.D., Sullivan, M.A., Whittington, R.A., Vosburg, S.K., & Kowalczyk, W.J. (2008). Abuse liability of prescription opioids compared to heroin in morphine-maintained heroin abusers. Neuropsychopharmacology, 33. 1179-1191.

61. National Institute on Drug Abuse. (2015). Overdose Death Rates.

62. National Academy of Sciences. (2011). Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington DC: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education.

63. Volkow, N.D. (2014). America’s addiction to opioids: heroin and prescription drug abuse. National Institute on Drug Abuse, Senate Caucus on International Narcotics Control.

64. U.S. Department of Health and Human Services, Food and Drug Administration. (2015). Abuse-deterrent opioids – evaluation and labeling: Guidance for industry. Center for Drug Evaluation and Research (CDER).

65. Butler, S.F., Cassidy, T.A., Chilcoat, H., Black, R.A., Landau, C., Budman, S.H., & Coplan, P.M. (2013). Abuse rates and routes of administration of reformulated extended-release oxycodone: initial findings from a sentinel surveillance sample of individuals assessed for substance abuse treatment. The Journal of Pain, 14(4). 351-358.

66. U.S. National Library of Medicine. (2013). Alternative medicine – pain relief. Medline Plus.

67. Nija, J., Kosek, E., Van Oosterwijck, J., & Meesus, M. (2012). Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician, 15. ES205-ES213.

68. Hayden, J.A., van Tulder, M.W., & Tomlinson, G. (2005). Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine, 142(9). 776-785.

69. Silvano, M. (2001). Exercise in the treatment of chronic pain. Clinical Journal of Pain, 17(4). S77-S85.

70. Flor, H. & Turk, D.C. (2011). Chronic pain: An integrated biobehavioral approach. Seattle: IASP Press.

71. Wilson, J.J. & Gil, K.M. (1996). The efficacy of psychological and pharmacological interventions for the treatment of chronic disease-related and non-disease-related pain. Clinical Psychology Review, 16. 573-597.

72. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80. 1-13.

73. Turner, J.A. & Jensen, M.P. (1993). Efficacy of cognitive therapy for chronic low back pain. Pain, 52(2). 169-177.

74. Rosenzweig, S., Greeson, J.M., Reibel, D.K., Green, J.S., Jasser, S.A., & Beasley, D. (2010). Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68. 29-36.

75. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4. 33-47.

76. Tilbrook, H.E., Cox, H., Hewitt, C.E., Kang’ombe, A.R., Chuang, L., Jayakody, S., Aplin, J.D., … Torgerson, D.J. (2011). Yoga for chronic low back pain: a randomized trial. Annals of Internal Medicine,155(9). 569-578.

77. Williams, K.A., Petronis, J., Smith, D., Goodrich, D., Wu, J., Ravi, N., Doyle Jr, E.J., … Steinberg, L. (2005). Effect of Iyengar yoga therapy for chronic low back pain. Pain, 115. 107-117.

78. Galantino, M.L., Bzdewka, T.M., Eissler-Russo, J.L., Holbrook, M.L., Mogck, E.P., Geigle, P., Farrar, J.T. (2004). The impact of modified hatha yoga on chronic low back pain: a pilot study. Therapies in Health and Medicine, 10(2). 56-59.

79. Guetin, S., Coudeyre, E., Picot, M.C., Ginies, P., Graber-Duvernay, B., Ratsimba, D., Vanbiervliet, W., … Herisson, C. (2005). Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial. Annales de Readaptation et de Medecine Physique, 48(5). 217-224.

80. Magill, L. (2001). The use of music therapy to address the suffering in advanced cancer pain. Journal of Palliative Care, 17(3). 167-172.

81. Schorr, J.A. (1993). Music and pattern change in chronic pain. Advances in Nursing Science, 15(4). 27-36.

82. Plews-Ogan, M., Owens, J.E., Goodman, M., Wolfe, P., & Schorling, J. (2005). Brief report: A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. Journal of General Internal Medicine, 20(12). 1136-1138.

83. Walach, H., Guthlin, C., & Konig, M. (2003). Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. The Journal of Alternative and Complementary Medicine, 9(6). 837-846.

84. Hernandez-reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106(3-4). 131-145.

85. Turner, J.A. & Chapman, C.R. (1982). Psychological interventions for chronic pain: a critical review. I. Relaxation training and biofeedback. Pain, 12(1). 1-21.

86. Hill, K.P. (2015). Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA, 313(24). 2474-2483.

87. Ware, M.A., Wang, T., Shapiro, S., Robinson, A., Ducruet, T., Huynh, T., Gamsa, A., Bennett, G.J., & Collet, J. (2010). Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ, 182(14). E694-E701.

88. Martin, B.R. & Lichtman, A.H. (1998). Cannabinoid transmission and pain perception. Neurobiology of Disease, 5. 447-461.

89. Turk, D.C., Swanson, K.S., & Tunks, E.R. (2008). Psychological approaches in the treatment of chronic pain patients- when pills, scalpels, and needles are not enough. The Canadian Journal of Psychiatry, 53(4). 213-223.

90. Turk, D.C., Zaki, H.S., & Rudy, T.E. (1993). Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. The Journal of Prosthetic Dentistry, 70(23). 158-164.

View More Expert Guides