Prescription drug abuse

Overview

Prescription drug abuse is the use of a prescription medicine in a way not intended by the prescriber. Prescription drug abuse, also called prescription drug misuse, includes everything from taking a friend's prescription painkiller for your backache to snorting or injecting ground-up pills to get high. Prescription drug abuse may become ongoing and compulsive, despite the negative consequences.

An increasing problem, prescription drug abuse can affect all age groups, including teens. The prescription drugs most often misused include opioid painkillers, anti-anxiety medicines, sedatives and stimulants.

Early identification of prescription drug abuse and early intervention may prevent the problem from turning into an addiction.

Symptoms

Signs and symptoms of prescription drug abuse depend on the specific drug. Because of their mind-altering properties, the most misused prescription drugs are:

• Opioids used to treat pain, such as medicines containing oxycodone (Oxycontin, Percocet) and those containing hydrocodone (Norco)
• Anti-anxiety medicines, sedatives and hypnotics used to treat anxiety and sleep disorders, such as alprazolam (Xanax), diazepam (Valium) and zolpidem (Ambien)
• Stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) and certain sleep disorders, such as methylphenidate (Ritalin, Concerta, others), dextroamphetamine-amphetamine (Adderall XR, Mydayis) and dextroamphetamine (Dexedrine)

Signs and symptoms of prescription drug abuse

Opioids

• Constipation
• Nausea
• Feeling high
• Slowed breathing rate
• Drowsiness
• Confusion
• Poor coordination
• Increased dose needed for pain relief
• Worsening or increased sensitivity to pain with higher doses

Anti-anxiety medicines and sedatives

• Drowsiness
• Confusion
• Unsteady walking
• Slurred speech
• Poor concentration
• Dizziness
• Problems with memory
• Slowed breathing

Stimulants

• Increased alertness
• Feeling high
• Irregular heartbeat
• High blood pressure
• High body temperature
• Reduced appetite
• Insomnia
• Agitation
• Anxiety
• Paranoia

Other signs

• Forging, stealing or selling prescriptions
• Taking higher doses than prescribed
• Being hostile or having mood swings
• Sleeping less or more
• Making poor decisions
• Being unusually energetic, high or revved up
• Being drowsy
• Requesting early refills or continually "losing" prescriptions, so more prescriptions must be written
• Trying to get prescriptions from more than one prescriber

When to see a doctor

Talk with your health care provider if you think you may have a problem with prescription drug use. You may feel embarrassed to talk about it — but remember that medical professionals are trained to help you, not judge you. It's easier to face the problem early before it becomes an addiction and leads to more-serious problems.

Causes

Teens and adults abuse prescription drugs for many reasons, such as:

• To feel good or get high
• To relax or relieve tension
• To ease pain
• To reduce appetite
• To increase alertness
• To experiment with mental effects of the substance
• To maintain an addiction and prevent withdrawal
• To be accepted by peers or to be social
• To try to improve concentration and school or work performance

Risk factors

Some people fear that they may become addicted to medicines prescribed for medical conditions, such as painkillers prescribed after surgery. But you can reduce your risk by carefully following your health care provider's instructions on how to take your medicine.

Prescription drug abuse is highest among teens and young adults.

Risk factors for prescription drug misuse include:

• Past or present addictions to other substances, including alcohol and tobacco
• Family history of substance abuse problems
• Certain preexisting mental health conditions
• Peer pressure or a social environment where there's drug use
• Easier access to prescription drugs, such as having prescription medicines in the home medicine cabinet
• Lack of knowledge about prescription drugs and their potential harm

Older adults and prescription drug abuse

Prescription drug abuse in older adults is a growing problem, especially when they combine drugs with alcohol. Having multiple health problems and taking multiple drugs can put people at risk of misusing drugs or becoming addicted.

Complications

Abusing prescription drugs can cause a number of problems. Prescription drugs can be especially dangerous — and even lead to death — when taken in high doses, when combined with other prescription drugs or certain over-the-counter medicines, or when taken with alcohol or illegal or recreational drugs.

Medical consequences

Here are examples of serious consequences of prescription drug abuse:

• Opioids can cause a slowed breathing rate and potential for breathing to stop. Opioids can also cause coma. An overdose can lead to death.
• Anti-anxiety medicines and sedatives — medicines to help you feel calm or less anxious — can cause memory problems, low blood pressure and slowed breathing. An overdose can cause coma or death. Abruptly stopping the medicine may cause withdrawal symptoms that can include an overactive nervous system and seizures.
• Stimulants can cause an increase in body temperature, heart problems, high blood pressure, seizures or tremors, hallucinations, aggressiveness, and paranoia.

Physical dependence and addiction

Because commonly abused prescription drugs activate the brain's reward center, it's possible to develop physical dependence and addiction.

• Physical dependence. Physical dependence, also called drug tolerance, is the body's response to long-term use of a drug. People who are physically dependent on a drug may need higher doses to get the same effects and may experience withdrawal symptoms when cutting back or abruptly stopping the drug.
• Addiction. People who are addicted to a drug can have physical dependence, but they also compulsively seek a drug and continue to use it even when that drug causes major problems in their lives.

Other consequences

Other potential consequences include:

• Engaging in risky behaviors because of poor judgment
• Using illegal or recreational drugs
• Being involved in crime
• Being involved in motor vehicle accidents
• Showing decreased school or work performance
• Having troubled relationships

Prevention

Prescription drug abuse may occur in people who need painkillers, sedatives or stimulants to treat a medical condition. If you're taking a prescription drug that commonly leads to drug misuse, here are ways to reduce your risk:

• Make sure you're getting the right medicine. Make sure your health care provider clearly understands your condition and the signs and symptoms. Tell your health care provider about all your prescriptions, as well as over-the-counter medicines, herbs and supplements, and alcohol and other drug use. Ask your doctor whether there's another medicine with ingredients that have less potential for addiction.
• Check in with your health care provider. Talk with your health care provider on a regular basis to make sure that the medicine is working and you're taking the right dose.
• Follow directions carefully. Use your medicine the way it was prescribed. Don't stop or change the dose of a drug on your own if it doesn't seem to be working without talking to your health care provider. For example, if you're taking a pain medicine that isn't adequately controlling your pain, don't take more.
• Know what your medicine does. Ask your health care provider or pharmacist about the effects of your medicine, so you know what to expect. Also check if other drugs, over-the-counter products or alcohol should be avoided when taking this medicine.
• Never use another person's prescription. Everyone is different. Even if you have a similar medical condition, it may not be the right medicine or dose for you.
• Don't order prescriptions online unless they're from a trustworthy pharmacy. Some websites sell counterfeit prescription and over-the-counter drugs that could be dangerous.

Preventing prescription drug abuse in teens

Prescription drugs are commonly misused substances by young people. Follow these steps to help prevent your teen from abusing prescription medicines.

• Discuss the dangers. Emphasize to your teen that just because drugs are prescribed by a health care provider doesn't make them safe — especially if they were prescribed to someone else or if your child is already taking other prescription medicines.
• Set rules. Let your teen know that it's not OK to share medicines with others — or to take drugs prescribed for others. Emphasize the importance of taking the prescribed dose and talking with the health care provider before making changes.
• Discuss the dangers of alcohol use. Using alcohol with medicines can increase the risk of accidental overdose.
• Keep your prescription drugs safe. Keep track of drug quantities and keep them in a locked medicine cabinet.
• Make sure your child isn't ordering drugs online. Some websites sell counterfeit and dangerous drugs that may not require a prescription.
• Properly dispose of medicines. Don't leave unused or expired drugs around. Check the label or patient information guide for disposal instructions. You can also ask your pharmacist for advice on disposal.

Diagnosis

Doctors generally base a diagnosis of prescription drug abuse on medical history and answers to other questions. In some cases, certain signs and symptoms also provide clues.

Blood or urine tests can detect many types of drugs. These tests can also help track the progress of a person who's getting treatment.

Treatment

Treatment options for prescription drug abuse vary, depending on the type of drug used and your needs. But counseling is usually a key part of treatment. Treatment may also require withdrawal, also called detoxification, addiction medicine and recovery support.

Counseling

A licensed alcohol and drug counselor or other addiction specialist can provide individual, group or family counseling. This can help you:

• Determine what factors may have led to the prescription drug abuse, such as an underlying mental health problem or relationship problems
• Learn the skills needed to resist cravings, avoid abuse of drugs and help prevent recurrence of prescription drug problems
• Learn strategies for developing positive relationships
• Identify ways to become involved in healthy activities that aren't related to drugs
• Learn the steps to take if a relapse happens

Withdrawal

Depending on the prescription drug and usage, detoxification may be needed as part of treatment. Withdrawal can be dangerous and should be done under the guidance of a health care provider.

• Opioid withdrawal. Opioid tapering involves gradually decreasing the dose of medicine until it's no longer used. Other medicines — such as clonidine (Catapres), a drug mainly used for high blood pressure — can help manage opioid withdrawal symptoms. In the United States, health care providers prescribe buprenorphine, buprenorphine-naloxone (Suboxone) or methadone under specific, legally regulated and monitored conditions to ease symptoms of withdrawal from opioid painkillers. Drugs given by injection once a month by a health care professional may help people stay off opioids during their recovery. Examples include naltrexone (Vivitrol) and buprenorphine (Sublocade).
• Withdrawal from anti-anxiety medicines and sedatives. If you've used prescription sedatives or anti-anxiety drugs for a long time, it may take weeks to slowly taper off them. Because of withdrawal symptoms, it can take that long for your body to adjust to low doses of the medicine and then get used to taking none at all. You may need other types of medicine to make your moods more stable, manage the final phases of tapering or help with anxiety. You'll need to work closely with your health care provider.
• Stimulant withdrawal. The U.S. Food and Drug Administration has not approved any drugs for the treatment of stimulant withdrawal. Treatment usually focuses on tapering off the medicine and relieving withdrawal symptoms — such as sleep problems, tiredness and depression.

Coping and support

Overcoming prescription drug abuse can be challenging and stressful, often requiring the support of family, friends or organizations. Here's where to look for help:

• Trusted family members or friends
• Your health care provider, who may be able to recommend resources
• Self-help groups, such as a 12-step program
• Your church or faith group
• School counselor or nurse
• Support groups, either in person or from a trustworthy website
• An employee assistance program, which may offer counseling services for substance abuse problems

You may be embarrassed to ask for help or afraid that your family members will be angry or judgmental. You may worry that your friends will distance themselves from you. But in the long run, the people who truly care about you will respect your honesty and your decision to ask for help.

Helping a loved one

It can be difficult to approach your loved one about prescription drug abuse. Denial and anger are common reactions, and you may be concerned about creating conflict or damaging your relationship with that person.

Be understanding and patient. Let the person know that you care. Encourage your loved one to be honest about drug use and to accept help if needed. A person is more likely to respond to feedback from someone who is trusted. If the problem continues, more intervention may be necessary.

Intervention

It's challenging to help a loved one struggling with drug abuse or other destructive behavior. People who struggle with addictive behaviors are often in denial or unwilling to seek treatment. And they may not realize how their behavior is affecting themselves and others. An intervention can motivate someone to seek help for addictive behaviors.

An intervention is a carefully planned process involving family and friends and others who care about a person struggling with addiction. Consulting an intervention professional, an addiction specialist, a psychologist or a mental health counselor can help you plan an effective intervention.

This is an opportunity to confront the individual about the consequences of addiction and ask the person to accept treatment. Think of an intervention as giving your loved one a clear opportunity to make changes before things get really bad.

Preparing for an appointment

Your primary care provider may be able to help you overcome prescription drug abuse. But if you have an addiction, your provider may refer you to an addiction specialist or to a facility that specializes in helping people withdraw from drugs.

What you can do

To prepare for your appointment, make a list of:

• All the medicines you're taking, including over-the-counter drugs, herbs and supplements, as well as the dose and frequency
• Any symptoms you're experiencing
• Key personal information, including any major stresses or recent life changes
• Questions to ask your doctor

Questions to ask your doctor may include:

• What are my treatment options?
• How long does it take for treatment to work?
• Should I see a specialist?
• How can we manage my other health conditions during treatment?
• Do you have any brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your health care provider may ask these questions:

• What prescription medicines do you take? How much and how often do you take them?
• How long have you had this problem?
• What, if anything, prompted it?
• How severe are your symptoms?
• Do you have a past history of drug abuse or addiction?
• Do you use recreational or illegal drugs? Do you smoke?
• Has anyone in your family had a history of drug abuse or addiction?

Be ready to answer these questions so that you can focus on points you want to spend more time on. Preparing and anticipating questions will help you make the most of your time with the health care provider.