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Prescription drug abuse is defined as using a prescription medication for non-medical purposes or taking a prescription drug in a way other than as prescribed. Aside from marijuana, which is the most-abused drug in the U.S., prescription drugs are abused more than any other category of drugs in the country, according to the Office of National Drug Control Policy.1

A common misperception that may contribute to the high prevalence of prescription drug abuse is that since prescription drugs are prescribed by a physician, they’re safer than illicit drugs. However, nothing could be further from the truth. Although prescription medications are safe and effective when taken as directed, abusing them is just as dangerous as abusing illegal drugs. Drug abuse was responsible for 51 percent of all drug-related visits to U.S. emergency departments in 2011, representing an increase of 132 percent from 2004.2

“A common misperception … is that since prescription drugs are prescribed by a physician, they’re safer than illicit drugs. Nothing could be further from the truth.”

The Scope of Prescription Drug Abuse in the U.S.

The most commonly abused prescription drugs are opiate painkillers, central nervous system depressants and central nervous system stimulants.

Although the United States accounts for only five percent of the world’s population, we consume 75 percent of its prescription drugs.3 In 2010, doctors prescribed enough opiate painkillers to medicate every adult in America every four hours for an entire month.

According to the National Institute on Drug Abuse, around 52 million people—20 percent of the population of Americans aged 12 and older—have used prescription medications for non-medical reasons at least once in their lifetime.4 Among high school seniors, pharmaceutical drugs account for six out of ten of the most-abused substances.

The 2010 National Survey on Drug Use and Health found that around 2.4 million Americans used prescription drugs for non-medical purposes for the first time in the past year, amounting to nearly 6,600 new users every day.5 More than half of these were female, and around a third were between the ages of 12 and 17. While prescription drug abuse can affect anyone of any age, adolescents, older adults and women may be at a particularly high risk of prescription drug abuse.

Consequences of Prescription Drug Abuse

The economic cost of prescription opiate abuse alone in the U.S. exceeds $50 billion each year, mostly in terms of lost productivity and crime, according to a study published in the Clinical Journal of Pain.6

Additionally, the Coalition Against Insurance Fraud estimated in 2008 that prescription opiate abuse costs insurers $72.5 billion annually, mostly due to the cost of treatment, emergency room visits, associated health problems and “doctor shopping,” which is the practice of visiting a number of doctors to get several prescriptions for the same drug.7 Doctor shopping costs insurers up to $15,000 a year per shopper.

The societal costs of prescription pill abuse may be high, but the consequences to the individual can be devastating. Involvement in crime and the resulting legal troubles, including incarceration, are a serious risk for anyone abusing prescription medications. Automobile accidents resulting from driving under the influence cause injury, death and serious legal problems, and clouded judgment can lead to engaging in other risky behaviors, such as unsafe sex, which may result in a number of serious consequences.

“The societal costs of prescription pill abuse may be high, but the consequences to the individual can be devastating.”

Prescription drug abuse is associated with decreased academic and work performance and relationship problems, and chronic abuse leads to serious health problems, including an increased risk of dangerous or fatal overdose and a high risk of developing an addiction or dependence on prescription drugs.

How Prescription Drug Abuse Leads to Addiction and Dependence

Although each category of prescription drug acts on the brain in its own way, the mechanics of developing an addiction or dependence is essentially the same regardless of the substance.

Addiction is characterized by the inability to stop using a drug despite negative consequences. Even if you have the desire to stop abusing the drug, you’ll likely find that you’re unable to. Addiction is a complex brain disease that affects thought and behavior, and it generally takes more than willpower and good intentions to beat it.8

Addiction is a complex brain disease that affects thought and behavior, and it generally takes more than willpower and good intentions to beat it.”

Dependence isn’t the same thing as addiction. When you abuse any type of drug, your brain changes the way it functions chemically in order to compensate for the drug’s presence. The activity of certain neurotransmitters may be increased or decreased, and this leads to a buildup of tolerance, which means that it takes increasingly higher doses of the drug to achieve the desired effects.

At some point, the changes in brain function may reach a tipping point of sorts, and your brain will begin to function more “normally” when drugs are present than when they’re not. When the drug is withheld, brain function rebounds, and withdrawal symptoms set in. This is an indication that you have developed a physical dependence on a substance.

General Signs and Symptoms of Prescription Drug Abuse

While each type of prescription drug has its own indicators of abuse, some of the general signs and symptoms of prescription drug abuse include taking higher doses of a drug than prescribed, building up a tolerance, experiencing excessive mood swings, making poor decisions while under the influence and appearing to be either unusually sedated or particularly energetic. Someone who abuses prescription drugs may also steal, forge or sell prescriptions, and they may engage in doctor shopping to get a number of prescriptions from more than one physician.

The Most Commonly Abused Prescription Drugs

Opiate painkillers are the most commonly abused—and the most dangerous—prescription drugs. Emergency department admissions associated with prescription pain relievers increased 183 percent between 2004 and 2011, and in 2011, over 29 percent of all emergency department admissions for prescription drug misuse involved opiates.2

According to the Centers for Disease Control, the number of painkillers prescribed in the U.S. has quadrupled since 1999, but there hasn’t been a significant increase in the amount of pain reported by Americans.9

“Opiate painkillers are the most commonly abused—and the most dangerous—prescription drugs.”

Prescription sedatives and prescription stimulants are also commonly abused. Each of these three types of drugs has its own signs of abuse, long-term health effects, withdrawal symptoms and methods of treating dependence.

Sedative Abuse

Prescription sedatives are also known as hypnotics, tranquilizers and central nervous system depressants. These drugs are used to treat anxiety and panic disorders, and in some cases, they’re prescribed for the short-term treatment of insomnia.

Sedatives include benzodiazepines like Valium, Xanax and Klonopin, which have a high risk of addiction and dependence; non-benzodiazepine sleep aids like Ambien and Lunesta, which are considered to be less addictive than benzodiazepines but have high rates of abuse nonetheless; and barbiturates like Nembutal and Mebaral, which are effective for treating seizure disorders but are rarely used to treat anxiety or sleep problems due to their high risk of overdose, addiction and dependence.

Sedatives work by increasing the activity of the neurotransmitter GABA, which produces feelings of calm and relaxation and inhibits brain activity to reduce anxiety or promote sleep.

Signs & Symptoms of Sedative Abuse

Abusing sedatives may cause a reduced appetite and insomnia, and it may lead to unpleasant psychological effects like agitation and paranoia. Sedatives can also increase body temperature and cause an irregular heartbeat.

Long-Term Health Effects of Sedative Abuse

The chronic abuse of sedatives can cause long-term memory problems as well as dangerously low blood pressure, respiratory depression, headaches and muscle weakness. Abuse also increases the risk of overdose, which can lead to coma or death.

Withdrawal from Sedatives

Quitting using certain sedatives abruptly can cause serious withdrawal symptoms, including seizures and dangerous shifts in blood pressure, body temperature and heart rate. In some cases, withdrawal can be life-threatening, and the National Institute on Drug Abuse stresses the importance of supervised medical detox for quitting sedatives.10

Treating Sedative Dependence

Withdrawing from sedatives is typically a tapering off process that’s supervised by medical personnel. Reducing doses over time prevents the onset of potentially dangerous withdrawal symptoms and keeps cravings at bay.

Stimulant Abuse

Prescription stimulants are used to treat ADHD and narcolepsy. These medications include Adderall, Ritalin and Concerta, all of which are commonly taken recreationally by adolescents and young adults or used in an attempt to improve academic performance. In 2010, around 1.1 million people abused stimulant medications.11

Stimulants increase alertness and promote wakefulness by enhancing the effects of the neurotransmitters norepinephrine and dopamine, which causes an increase in blood pressure and heart rate, constricts the blood vessels and raises blood glucose levels.

Signs & Symptoms of Stimulant Abuse

Signs of stimulant abuse include confusion, slurred speech, dizziness, memory problems, respiratory depression and a loss of coordination. High doses of stimulants can cause hallucinations, panic attacks, nausea, insomnia, dangerously high body temperature and convulsions or seizures.

Long-Term Health Effects of Stimulant Abuse

Long-term abuse of stimulant medications can cause high blood pressure and permanent damage to blood vessels, which increase the risk of heart attack and stroke. It may also cause liver, lung and kidney damage. A decreased appetite associated with chronic stimulant abuse can lead to malnutrition, weight loss and, in severe cases, anorexia nervosa.

Withdrawal from Stimulants

Withdrawal symptoms associated with stimulant dependence include heightened anxiety, insomnia, irritability and a deep depression that may be accompanied by suicidal thoughts.

Treating Stimulant Dependence

Although no drugs have been approved by the FDA to treat stimulant withdrawal, bupropion may be administered during medical detox to help alleviate severe depression and reduce cravings. Depending on the severity of the dependence, doses may be tapered off rather than abruptly stopped to help ease the intensity of withdrawal symptoms.12

Opiate Abuse

Opiates are potent medications that relieve mild, moderate or severe pain. In some cases, they’re used to treat coughs and severe diarrhea. Commonly abused opiates include OxyContin, Vicodin, Percocet and Fentanyl.

Opiates attach to proteins known as opioid receptors, which are found in the brain, spinal cord and other organs in the body. When they attach to these receptors, opiates increase feelings of well-being and reduce the perception of pain. In many cases, they produce a marked euphoria, which is one reason why they’re so commonly abused.

Signs & Symptoms of Opiate Abuse

Signs and symptoms of opiate abuse include chronic constipation, drowsiness, slurred speech, poor coordination and confusion. The low blood pressure and slowed breathing associated with opiate abuse can be dangerous.

Long-Term Health Effects of Opiate Abuse

One of the most dangerous risks of long-term opiate abuse is overdose. Every day, 44 Americans die from an accidental overdose of prescription painkillers.9 An opiate overdose carries a significant risk of death due to the severe respiratory depression that occurs with high doses. Adding to the risk of overdose is the fact that in many cases, it’s difficult to know how much of the drug is contained within a single pill. For example, a single OxyContin pill may contain as much oxycodone as 16 tablets of Percocet.13

Other long-term health effects associated with opiate abuse include sexual dysfunction and brain damage due to a condition known as hypoxia, which occurs when the brain doesn’t get enough oxygen. Hypoxia can lead to short- and long-term psychological and physiological problems. Studies have shown that opiate abuse also leads to deterioration of the brain’s white matter, which can result in the ability to regulate behavior, make decisions and respond appropriately to stress.14

Withdrawal from Opiates

While withdrawal from prescription opiates is rarely dangerous, symptoms can be severe enough to send someone right back to using drugs again just to make the discomfort stop. Withdrawal symptoms associated with opiates include intense cravings, cold sweats and goosebumps, nausea and vomiting, abdominal cramps and diarrhea and intense muscle aches.

Treating Opiate Dependence

Medical detox is almost always essential for opiate withdrawal, since most who try to detox on their own are unsuccessful. During medical detox, a number of medications may be used to reduce the intensity of withdrawal symptoms and even shorten the duration of the detox process. In many cases, medications like methadone and buprenorphine will be used for short-term or long-term maintenance to prevent the onset of withdrawal symptoms altogether and ease cravings so that those with an opiate addiction can focus on restoring their lives.

Treating Prescription Drug Addiction

Medical detox effectively takes care of the physical dependence on a prescription medication, but it doesn’t treat the addiction, which is far more complex.

A professional treatment program is the most effective way to treat a prescription drug addiction. A holistic program will address issues of the body, mind and spirit to help those struggling with addiction regain control of their lives, learn to enjoy a life without drugs, and improve their overall health and sense of well-being. A high-quality treatment program will use research-based treatments and adhere to the Principles of Effective Treatment, which were developed by the National Institute on Drug Abuse.15

“A professional treatment program is the most effective way to treat a prescription drug addiction.”

Successful addiction treatment requires a variety of behavioral therapies to help addicted individuals address the complex underlying psychological and behavioral issues.16 High-quality, holistic programs typically include both alternative and traditional research-based therapies in their treatment protocol.

The most commonly used traditional behavioral treatments for prescription drug abuse or addiction include cognitive-behavioral therapy, which helps individuals learn to identify and change harmful thoughts and behaviors associated with drug use; contingency management, which rewards abstinence with vouchers or cash; family counseling, which helps restore function to the household and improve communication; and group therapy, which provides a high level of peer support and personal accountability and reduces feelings of isolation.

Alternative therapies are effective for improving a sense of well-being, reducing stress, and alleviating cravings, all of which help reduce the risk of relapse. These therapies include acupuncture, massage therapy, aqua therapy and biofeedback, which helps those in recovery learn how to change their physiological responses to stress.

The aftercare program that’s set in place once treatment is complete is essential for ensuring long-term, successful recovery from a drug addiction. Aftercare plans are highly individualized and include components like ongoing therapy, participation in a support group and continued family therapy.

Other aftercare programs may include a stint in a sober living facility to help ease the transition from rehab back to the community; vocational rehab to increase employability; and ongoing monitoring of any co-occurring mental illnesses and the medications used to treat them.

There is Hope

Without professional help, it’s likely that an addiction will only get worse. But with the help of a high-quality treatment program, you can regain control over your life, restore your physical and mental health and enjoy a higher overall sense of well-being. Treatment works, and many people who enter a rehab program emerge with a higher self-esteem and a greater sense of purpose.

Taking the first step and entering treatment is often the hardest part of recovery. You may fear that life will be boring without drugs, or you may be afraid of who you’ll be without them. The fear of the unknown is a common barrier to treatment, but recovery is a gradual process of change from the inside out that almost always leads to a higher quality of life. Recovery isn’t easy, but through a high-quality treatment program that offers compassionate care and a high level of support, you can begin to enjoy and even embrace a life of sobriety.

References:

  1. A Response to the Epidemic of Prescription Drug Abuse. (2011, April). Retrieved from https://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/prescription_drug_abuse_fact_sheet_4-25-11.pdf
  2. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. (2013, May). Retrieved from http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf
  3. Popping Pills: Prescription Drug Abuse in America. (2014, January). Retrieved from http://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america
  4. Volkow, N. D. (2014, November). Prescription Drug Abuse. Retrieved from http://www.drugabuse.gov/publications/research-reports/prescription-drugs/director
  5. Prescription Drug Abuse: How Many People Abuse Prescription Drugs? (2014, November). Retrieved from http://www.drugabuse.gov/publications/research-reports/prescription-drugs/trends-in-prescription-drug-abuse/how-many-people-abuse-prescription-drugs
  6. Hansen, R. N., Oster, G., Edelsberg, J., Woody, G. E., & Sullivan, S. D. (2011, March-April). Economic Costs of Nonmedical Use of Prescription Opioids. The Clinical Journal of Pain, 27(3), 194-202. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21178601
  7. Prescription for Peril: How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs. (2007, December). Retrieved from http://www.insurancefraud.org/downloads/drugDiversion.pdf
  8. Understanding Drug Abuse and Addiction. (2012, November). Retrieved from http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction
  9. Injury Prevention and Control: Prescription Drug Overdose. (2015, September 16). Retrieved from http://www.cdc.gov/drugoverdose/
  10. Prescription Drug Abuse: Treating Addiction to CNS Depressants. (2014, November). Retrieved from http://www.drugabuse.gov/publications/research-reports/prescription-drugs/treating-prescription-drug-addiction/treating-addiction-to-cns-depressants
  11. Types of Commonly Misused or Abused Drugs. (2015, October 27). Retrieved from http://www.samhsa.gov/prescription-drug-misuse-abuse/types
  12. Prescription Drug Abuse: Treating Addiction to Prescription Stimulants. (2014, November). Retrieved from http://www.drugabuse.gov/publications/research-reports/prescription-drugs/treating-prescription-drug-addiction/treating-addiction-to-prescription-stim
  13. Lester, M., and Tschakovsky, K. OxyContin: Straight Talk. Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/oxycontin/Pages/oxycontin_straight_talk.aspx
  14. Prescription Drug Abuse: What are the Possible Consequences of Opioid Use and Abuse? (2014, November). Retrieved from http://www.drugabuse.gov/publications/prescription-drugs-abuse-addiction/opioids/what-are-possible-consequences-opioid-use-abuse
  15. Principles of Drug Addiction Treatment: A Research-Based Guide. (2012, December). Retrieved from http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  16. Prescription Drug Abuse: Treating Prescription Drug Addiction. (2014, November). Retrieved from http://www.drugabuse.gov/publications/research-reports/prescription-drugs/treating-prescription-drug-addiction

 

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Prescription Drug Abuse in America
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