For some time now, the abuse of illicit substances such as marijuana, cocaine, methamphetamine and heroin has been a persistent national problem. In more recent years, however, our country has seen an alarming rise of prescription drug abuse – now sharing the dubious limelight with the old standby street drugs are otherwise controlled substances, such as those prescribed to relieve pain and anxiety.
Many of these drugs continue to be prescribed legitimately, yet continue to end up in the hands of those intent on abusing them. As would be expected, the resale value of some of these medications can be quite high. The price to society as a whole, however, is also taking its toll, as more and more people find themselves in the ER or hospitals for prescription drug overdoses or worse, deaths.
Video: Mind Your Meds
Credit: Partnership for Drug-Free Kids
Most Commonly Abused Prescription Drugs
The broad classes of drugs that are most prone to non-medical use or abuse are the ‘painkillers’ or opiate analgesics such as oxycodone (Oxycontin), the ‘sleeping pills’ or ssedative-hypnotics such as zolpidem (Ambien), ‘anti-anxiety medication’ or sedative-anxiolytics such as alprazolam (Xanax), and, lastly, stimulants such as dextroamphetamine (Adderall) and methylphenidate (Ritalin).
Numbers from SAMHSA’s 2013 National Survey on Drug Use and Health (NSDUH) included non-medical usage statistics for these prescription-type drug classes for American’s ages 12 and older. The survey defines ‘non-medical use’ as the use of the drugs for the effect or feeling that they produce, as opposed to for some medical indication. The survey reports an alarming 6.5 million nonmedical users of prescription-type drugs (2.5% of the entire population, ages 12 and up), with a majority of those (4.5 million – or 1.7% of Americans) having misused the aforementioned ‘painkillers’ (opiate analgesics).
Prescription drug abuse (and painkiller abuse, in particular) is a huge problem. Indeed, prescription opioid drugs are now the second-most used illicit substance (behind marijuana) if and when America’s youth make a first foray into drug experimentation.
Abused Prescription Drugs
Prescription Painkillers – Most prescribed pain medications have an opiate or opiate derived (from the opium poppy) component. Others might contain synthetic opioids that, to some degree, mimic the effects of the opiates. These medicines modify pain signaling, and are frequently prescribed for a variety of types of moderate to severe pain relief. Drugs in this class include:
- Hydrocodone (Lortab, Norco, Vicodin)
- Oxycodone (OxyContin, Percocet)
- Oxymorphone (Opana)
- Ultram (Tramadol)
Prescription Sleeping Pills – At one point in time, the barbiturate depressants were prescribed as sleep aids. Since then, barbiturates have been replaced by the benzodiazepines and, more recently, the non-benzodiazepine sleep aids have gained favor as the prescription of choice for insomnia. The benzodiazepines and non-benzodiazepine sleeping pills exert their effects by modulation of the GABA (gamma amino butyric acid) neurotransmitter system in the brain. Drugs prescribed for sleep include:
- Ambien (Zolpidem)
- Lunesta (Eszopiclone)
Prescription Anxiety Medication – As mentioned before, the GABA modifying effects of the benzodiazepine medications work well as prescription anti-anxiety medications. Because of their habit-forming propensity, many of these medications are now prescribed for temporary bouts of anxiety rather than as a nightly sleep aids. Some anti-anxiety medications include:
Prescription Stimulants – Amphetamines and amphetamine derivatives make up the prescription stimulant class. These types of medications, while once widely used for appetite control, are now prescribed for attention deficit hyperactivity disorder (ADHD), narcolepsy or other vigilance-related disorders. Common prescription stimulants include:
- Adderall (Amphetamine)
- Concerta (Methylphenidate)
- Dexedrine (Dextroamphetamine)
- Ritalin (Methylphenidate)
Abused Medications by Classification
While all of the prescription drugs mentioned here are beneficial to many as prescription medications, their pleasurable, calming and/or performance enhancing effects lead some to abuse them. When taken in larger doses or for longer periods than intended by prescription, many of them lead to the development of tolerance (needing more and more to get the same effect), as well as a marked withdrawal syndrome should they be stopped.
Both of these phenomena can lead to increasingly large doses of the drug being taken to overcome the tolerance, or to prevent the uncomfortable symptoms or potential medical complications of withdrawal. One should also keep in mind that the effects of these medications can be even more dangerous if taken simultaneously with alcohol.
The sedating, respiratory slowing effects of the opiate painkillers can lead to serious problems or death in overdose situations. Similarly, excessive doses of benzodiazepines can result in respiratory depression and slowed heart rate, especially when used with alcohol or other drugs. At the other end of the overdose spectrum, too many stimulant drugs can lead to dangerously elevated blood pressure, irregular heartbeat and seizure – a perilous mixture of symptoms that can result in death.
Physician supervision and appropriate use is critical for all prescription drugs to avoid abuse and misuse, especially for those with a history of substance abuse disorders. Whenever possible, medications which do not have an addiction potential should be considered as the first treatment option for those with a history of drug abuse.
The safety of the drug is based on taking the drug exactly as prescribed. Abusing prescription drugs is a sure way to disregard these safeguards, and is a recipe for disaster.
Video: Prescription Drug Abuse: A Public Health Epidemic
Credit: Robert Wood Johnson Foundation
Combating the Prescription Drug Abuse Problem
The National Institute on Drug Abuse (NIDA), along with several health organizations, has launched a national initiative to educate the public about the growing danger of prescription drug abuse and its associated problems. Their website contains a wealth of prescription drug abuse information. The non-medical use of prescription drugs and their potential for abuse and addiction are quite complex problems to address, as they involve not only patient misconduct in obtaining and abusing these drugs, but physician prescribing issues as well.
Risk assessment surveys such as the Prescription Drug Use Questionnaire have been developed and tested as tools to assist clinicians with the decisions that go into prescribing commonly abused medications. The hope is that with continued awareness of the problem, and with heightened scrutiny for both over-prescribing and patient misconduct, progress against the prescription drug abuse problem will be made.
If you or someone you know suffers from a prescription drug abuse problem, you can receive the help you need 24 hours a day and 7 days a week by calling our Drug Abuse Helpline at . Our friendly staff can counsel you and help you find the perfect program or support group for your specific needs. All calls are toll-free and confidential.