Abuse of certain prescription drugs is a serious problem that goes back hundreds of years, practically to the beginning of the existence of this type of substance. Each time another drug is found to be addictive and restricted due to the popularity of its abuse, another one seems to pop up to take its place.
People tend to think that substances prescribed by a doctor are significantly safer than illicit drugs; however, many intoxicating prescription medications have just as much potential for abuse, addiction, and long-term health problems as street drugs like cocaine and heroin. This is compounded by the fact that there is much less stigma against the use of prescription medications than there is against illicit substances, and obtaining them can often be as easy as sneaking them out of someone else’s medicine cabinet.
According to National Institute on Drug Abuse (NIDA), 20 percent of people in the United States have used prescription medications for nonmedical purposes in their lifetime. Any intentional use of a prescription medication outside of what the doctor has ordered is considered abuse, whether an individual is using it recreationally without a prescription or taking more than prescribed, either to get high or in an attempt to manage symptoms that are not being eliminated by the current dose.
The most commonly abused prescription medications include opioid painkillers, central nervous system (CNS) depressants, and stimulants used to treat ADHD or certain sleep disorders. Each of these can cause a high comparable to illicit drugs and has the potential to be addictive. Most people will not become addicted to these medications if they take them as directed. However, the more they are abused, the higher the risk of tolerance development and addiction becomes.
Common brand names for these drugs include:
Each of these medications can be very effective, especially in the short-term. However, due to their addictive nature and the fact that they have become popular for recreational use, some of them are highly controlled by the government.
Who Abuses Prescription Drugs?
Recreational use of prescription drugs is often found among young adults, especially among those who are in college. NIDA reports that the highest rate of regular (within the past month) prescription drug abuse is found among the 18-25 age group at 5.9 percent. Men are more likely than women to abuse these medications except in the 12-17 age group. However, abuse rates depend on the type of drug involved.
Prescription stimulants are most likely to be abused by those in college or high school, as young people perceive that the energy and hyper focus caused by these medications can help them deal with progressively more daunting workloads and tight schedules. According to a survey produced by the Partnership for Drug-Free Kids, one in five college students reported abusing these drugs compared to one in seven young adults not in college. The abuse rates increase for those who have been in college longer. Adderall was found to be the most commonly abuse prescription stimulant among this group, with 60 percent of users turning to this drug.
The same survey found that half of all users of prescription stimulants abused them in an attempt to improve academic performance. Forty-one percent reported using them just to stay awake. It’s becoming clear that stress due to excessive expectations placed on college students is a factor in this increasingly normalized problem.
The abuse of prescription opioids has been a significant problem for several decades now. Yet the number of prescriptions dispensed only peaked in 2011, with 219 million prescriptions being given out that year in the US alone. Many of the people given these drugs suffer from chronic pain, which can affect people of all ages, though women are more likely to suffer from it than men. While people over the age of 65 are more likely to be given these kinds of medications by doctors, especially as a long-term solution, they are not more like to abuse these drugs than people in other age groups. Younger people are more likely to be given unused prescription opioids by a friend or family member, which is actually more common that purchasing these drugs from a dealer. There were about 467,000 nonmedical users of prescription painkillers in 2014 among adolescents (12-17).
CNS depressants are often referred to as sedatives or tranquilizers. These drugs slow activity in the central nervous system, slowing heart and breathing rates, and quickly reducing anxiety. They include barbiturates and benzodiazepines (benzos) that became popular treatments for anxiety and sleep disturbances in the early to mid 1900s. They were more likely to be prescribed to women and white individuals than men or people of color. Today, they are under much stricter control due to their addictive nature and evidence on potential long-term damage to the brain from extensive use.
Many of these depressants are still used to sedate patients before surgery or other invasive medical procedures. Barbiturates can be very effective in treating certain seizure disorders, while benzos are effective for short-term treatment of acute stress and panic disorders. These and other non-benzo sleep medications are often prescribed for severe insomnia.
Benzos are more likely to be prescribed today than barbiturates because they are less addictive and dangerous, yet they still have a high potential for abuse and addiction, especially when used with alcohol or opioids. In 2008, there were over 60,000 admissions to addiction treatment centers for benzo abuse problems. Of those, 56 percent of people admitted were men. This is a significantly smaller gap, however, than is seen with other intoxicants. The most common age group was 25-34, and 84.8 percent were non-Hispanic white individuals, compared to 59.7 percent with all types of substances.
Signs of Addiction
Specific signs of prescription drug abuse and addiction depend on the type of medication being used. Obviously, the effects of a stimulant are going to be rather different than the effects of a depressant. However, there are some universal behavioral signs that can point to developing dependence and addiction, and all physical addictions come with unpleasant withdrawal symptoms.
When it comes to stimulants like Ritalin and Adderall, constant abuse shows itself through continuous manic behavior and the negative side effects of being filled with energy all the time. Insomnia, agitation, irritability, anxiety, restlessness, paranoia, and aggression can all result from abuse of this drug. These stimulants also suppress the appetite, so unexplained weight loss can be a sign of abuse.
On the other side of the spectrum, CNS depressants cause a person to slow down. A person abusing drugs like Xanax or Valium will likely be drowsy, have difficulty concentrating, speak slower than normal or have slurred speech, and/or experience lapses in memory and coordination. Depressants also tend to lower inhibitions and increase impulsive behavior.
Opioid abuse typically acts similarly to depressant abuse, but opioids come with their own unique symptoms. Taking more than the recommended amount will often produce a euphoric high similar to that of heroin, since all opioids are derived from the same plant. After that, users will, of course, have a seriously diminished ability to feel pain as well as be generally sedated. Slurred speech and reduced coordination are common, as are smaller than normal pupils. Over the long-term, chronic constipation can become a serious problem.
Abuse is one thing, but once a person has been abusing a drug for an extended period of time, tolerance will begin to develop. This means the individual will need to take more and more of the drug to get the same effect. Eventually, withdrawal symptoms will begin to appear whenever the drug leaves the system. This includes physical and psychological effects as well as an intense craving for the substance.
In order to avoid these unpleasant experiences, people will often go out of their way to keep themselves within reach of their drug of choice. This usually comes with a number of universal signs:
- Changes in social circles
- Secretive behavior
- Avoiding social situations in which the drug will not be available
- Neglecting work, school, and family responsibilities, as well as personal hygiene
- Continuing to use the drug despite financial, social, or even legal consequences
- Inability to quit despite trying
- Unwillingness to attempt quitting
Once a person experiences withdrawal symptoms when off the substance and cannot seem to psychologically handle being without it, a full-blown addiction has occurred. Every year, around 2.6 million people will seek out treatment for substance addiction.
As abuse of and addiction to prescription drugs have increased over the years, so have research and treatment centers dedicated to treating the problem. Treatment for addiction typically follows the same formula no matter which intoxicant the person is addicted to: detox, rehabilitation, and long-term treatment.
Detox refers to letting the body rid itself of the substance naturally and waiting out the most intense withdrawal symptoms. This can take a few days or even weeks, depending on the substance involved, and symptoms also vary. For prescription medications, these symptoms often include:
The most dangerous withdrawal syndromes among these commonly abused prescription medications are from barbiturates. Intense barbiturate withdrawal can cause hyperthermia and circulatory failure, leading to death. Withdrawal from the other prescription medications can include psychosis, which can produce aggressive and erratic behaviors that can cause injury to the self or others.
Due to these dangers and the general difficulty of quitting on one’s own, it’s generally recommended that the individuals undergo medically supervised detox. This involves checking the individual into a medical facility for the duration of the detox process so medical professionals can monitor the person for dangerous symptoms as well as any discomfort, which can be managed with any number of safe, non-addictive medications. This generally makes the process much easier, which is helpful since the realities of physical withdrawal can be a significant deterrent to anyone who wants to quit.
With certain medications, including some opioids, barbiturates, and benzos, it may be better to have the individual slowly weaned from the medication or switch to a similar but less intense and addictive medication and then taper off the dosage. This reduces cravings and makes withdrawal symptoms much more manageable. For opioid addiction, medications like methadone have been used for decades for this purpose.
After this, it’s highly recommended that the individual go through an inpatient or outpatient rehabilitation program. Relapse is a very real and ever-present danger, and that risk increases if the person fails to follow detox with rehab. Cravings do not end when the other withdrawal symptoms fade, and they can reappear years down the line due to stress or simple access to the drug.
This remains true long after rehab is completed. Attending support groups and/or therapy on a long-term basis significantly reduces the high risk of relapse. During a recent study, short-term abstinence rates for those who received alcohol addiction treatment were 62 percent, compared to 43 percent for those who were not treated. After the first three years, 61 percent of the non-treated group relapsed within the following 16 years compared to 43 percent of the treated group.
Relapse does not mean that treatment has failed. Prescription drugs can be difficult to avoid as many people are provided with them. The point is to stay dedicated to keeping one’s life on track and seeking support in difficult times. Treatment might need to be ongoing in some form for life, even if this only means attending periodic therapy sessions, since addiction can never be cured. Thankfully, support is always available for those who want it.