What is prescription drug addiction?
When used as prescribed, prescription drugs can help to improve the quality of life for people with chronic pain or chronic health conditions, such as attention deficit hyperactivity disorder (ADHD), narcolepsy, anxiety, or sleep disorders. However, when used long term, some prescription drugs can lead to drug abuse and addiction.
Most people take prescription medications as they are prescribed, but according to the National Institute on Drug Abuse, a growing number of people are taking prescription medications for nonmedical reasons, and such abuse can lead to addiction. It is unclear why prescription drug abuse is on the rise. One theory is that prescription medications have become more accessible. More drugs are being prescribed than ever before, and pharmacies on the Internet have made it easy for people to obtain prescription drugs, even without a prescription. Some people also mistakenly believe that because prescription medications are prescribed for medical reasons, they are safer alternatives to street drugs.
Opioids. When used as prescribed, opioids are intended to treat pain in persons with chronic health conditions such as cancer, back pain, arthritis, muscle or bone pain, diabetic neuropathy, phantom limb pain, and pain caused by injuries that are slow to heal. Opioids also are used to treat severe short-term pain from surgical procedures, injuries, or painful medical conditions, such as shingles.
Opioids block the nerve receptors in the body that cause a person to perceive pain. They also affect the regions of the brain that perceive pleasure, which results in an initial feeling of euphoria followed by a calm, drowsy feeling. As a result, many people use them to feel good or to get high, to relieve stress, or to relax in social situations.
Central nervous system (CNS) depressants. CNS depressants, which are used to treat anxiety disorders, sleep disorders, muscle tension, and seizure disorders, slow brain function and produce a calm, drowsy effect. They are often used to get high, to relieve stress, to relax in social situations, or to counteract the effects of other drugs, such as stimulants.
Stimulants. Stimulant medications, which are used for the treatment of ADHD or narcolepsy, increase alertness, energy, and attention. When taken as prescribed, stimulant medications slowly increase the production of dopamine—a neurotransmitter that is responsible for feelings of pleasure—in the brain. However, when taken in higher than normal doses or by routes other than oral, they can cause a rapid increase in dopamine, which results in a feeling of euphoria. Stimulant medications are often used to get high or to decrease appetite.
Risk factors for prescription drug addiction may include a genetic predisposition to addiction, but people who are not genetically predisposed to addiction can still become addicted. Other factors contribute to prescription drug addiction, including early onset of drug abuse (teenage years or early twenties); addictions to other substances, either past or present; peer pressure; and easy access to prescription drugs.
Symptoms of prescription drug addiction will depend, somewhat, on the type of drug to which the person is addicted. However, symptoms that are common to all prescription drug addictions include taking a higher dose of the medication than what the doctor prescribed or taking the medication more frequently than called for by the prescription. People who are addicted to prescription drugs may find themselves calling the doctor’s office more frequently for refills or asking the physician to prescribe higher doses.
Opioids. In addition to increasing the medication’s dose and frequency without permission from the doctor, opioid addicts have the following symptoms from use: constipation, excessive sleeping, depression, confusion, slurred speech, poor coordination, itching, tiny pupils, paranoia, excessive sweating, poor judgment, low blood pressure, and shallow breathing.
CNS depressants. Symptoms of addiction to CNS depressants may include drowsiness or excessive sleeping, slurred speech, depression, confusion, unsteady gait, lack of coordination, impaired memory, poor judgment, slowed breathing, low blood pressure, and involuntary rapid eye movements.
Stimulants. A person who is addicted to stimulant medications may experience weight loss, staying awake for long periods of time, irritability, mood swings, excessive energy, poor judgment, bloodshot eyes, high blood pressure, rapid or irregular heartbeat, dangerously high body temperatures, anxiety, paranoia, and seizures.
People who are addicted to prescription drugs may do things that they would not do otherwise. For example, to get more drugs or money to buy more drugs, people who are addicted to prescription medications might seek prescriptions from more than one doctor (a practice known as doctor shopping), steal money or items that they can sell for money, forge prescriptions, or engage in prostitution for money.
When people who are addicted to prescription drugs run out of drugs and are unable to get more, they may experience withdrawal symptoms. Symptoms of opioid withdrawal include fever, chills, shaking, stomach cramps, nausea or vomiting, diarrhea, muscle aches, increased sensitivity to pain, insomnia, watery eyes, runny nose, irritability, and panic. Symptoms of CNS depressant withdrawal include anxiety, insomnia, tremors, weakness, delirium, and seizures. Symptoms of stimulant withdrawal include intense cravings, irritability, headaches, nausea, vomiting, mood swings, anxiety, depression, increased appetite, fatigue, shaking, sweating, insomnia, and confusion.
Prescription drug addiction can lead to a number of complications, especially when the drugs are taken in large doses or combined with alcohol or other drugs. Opioids can increase a person’s risk of choking. They also can slow breathing. If taken in large doses or used in combination with alcohol, antihistamines, barbiturates, or benzodiazepines, opioids can lead to respiratory depression, a life-threatening condition that can slow a person’s breathing to a point where breathing may actually stop.
CNS depressants can cause memory problems and can also affect body temperature. If taken in large doses or used in combination with other substances that may cause drowsiness, such as alcohol, opioids, antihistamines, and some over-the-counter cold medications, CNS depressants can lead to respiratory depression, coma, and death.
Stimulant medications can cause increased blood pressure, irregular heart rate, increased body temperature, and a decrease in appetite, which can lead to malnutrition. In large doses, they can cause seizures, paranoia, or hallucinations, and stroke. If taken with certain over-the-counter cold medications, stimulant medications may raise blood pressure to a dangerously high level. They also may cause irregular heart rhythms.
Addiction to prescription medications may have other consequences, in addition to physical complications. For example, driving while under the influence can lead to a motor vehicle accident or arrest. Prescription drug addiction can also have an adverse effect on school or work performance.
Physicians are in a unique position not only to screen patients for prescription drug abuse but also to help them recognize when they have a problem, to set recovery goals, and to seek treatment. Diagnosis of prescription drug addiction is usually based on the patient’s symptoms and medical history.
Health care providers may screen patients by asking about past or present substance use or abuse, and by asking about current medication use, including the dosage, frequency, reason for use, and for what period of time the person has been taking the medication. Blood and urine tests also may be used to determine what prescription medications a patient has been taking and to track treatment progress.
Pharmacists can help screen patients for prescription drug addiction by checking prescriptions closely to see if they may have been forged or modified and by watching for multiple prescriptions from different doctors. Pharmacists also can alert nearby pharmacies when fraud or doctor shopping has been detected.
Prescription drug addiction is a treatable condition. The type of treatment will depend on the type of drug to which the person is addicted and on the needs of the individual. Successful treatment programs are usually a combination of detoxification, counseling, and, in some cases, medications. Many people go through more than one round of treatment before they are able to fully recover from their addiction.
Opioids. Initial treatment for opioid addiction may include medications to help alleviate the symptoms of withdrawal. Methadone and buprenorphine, both synthetic opioids, are the most commonly used drugs to treat symptoms of opioid withdrawal. Both are highly regulated drugs that are usually prescribed to people who are enrolled in a treatment program for opioid addiction.
Methadone and buprenorphine ease withdrawal symptoms and relieve cravings. Methadone has been used for decades to treat opioid addiction. Buprenorphine was approved by the US Food and Drug Administration for the treatment of opioid dependence in 2002. Patients will need medical supervision during treatment for opioid withdrawal.
Counseling following treatment for opioid withdrawal symptoms can help patients learn to function without drugs, handle drug cravings, and avoid people and situations that could lead to relapse. Support groups and twelve-step programs such as Narcotics Anonymous can help with the treatment of opioid addiction and with the adjustment to a new, drug-free lifestyle.
CNS depressants. People who are addicted to CNS depressants should not abruptly stop taking the medication because withdrawal from CNS depressants can be life-threatening. Instead, the medication dose must be gradually tapered until it is safe to stop taking the drug altogether. Patients will need medical supervision during treatment for withdrawal from CNS depressants. After the patient has been successfully weaned from the drug, cognitive-behavioral therapy can help the recovering addict to increase his or her coping skills, thereby eliminating the perceived need for the drug.
People who are addicted to CNS depressants often have coaddictions, such as alcoholism, so approaches to treatment must address all addictions. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of addiction to CNS depressants.
Stimulants. There are no medications to help alleviate withdrawal symptoms in patients who are addicted to prescription stimulants. One approach is to slowly decrease the dosage until the patient has been weaned. Patients will need medical supervision during treatment for withdrawal from stimulant medications. Once the patient has stopped taking the medication, behavioral therapy is often used to help patients recognize risky situations, avoid drug use, and more effectively cope with problems.
Another treatment that has been proven effective for stimulant addiction is contingency management. During contingency management, patients are given vouchers for drug-free urine tests. The vouchers can be exchanged for rewards that promote healthy living. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of prescription stimulant addiction.
Most people who take prescription medications as prescribed do not become addicted. There are some steps that people can take to decrease their risk of addiction, including the following:
• Ask if the medication being prescribed is addictive and if there are any alternative medications.
• Follow the directions on the medication label without exception.
• Avoid increasing a medication dose without discussing it with the health care provider who prescribed the medication.
• Avoid taking medication that was prescribed for someone else.
Parents too can take steps to help ensure that their children do not become addicted to prescription drugs. Preventive steps include keeping prescription medications in a locked cabinet; discussing with children the dangers of prescription medications, including the dangers of sharing medications with others; and properly disposing of prescription medications.
Pharmacists can help prevent prescription drug addiction by giving patients clear information about how medications should be taken and by providing information about potential side effects or drug interactions. Prescribers can help to prevent prescription drug addiction by noting increases in the amount of drug a patient needs to get the same therapeutic effect and by tracking frequent requests for refills.
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According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 15 million people in the United States age twelve years and older used prescription drugs for nonmedical purposes in 2014. Out of this total, 4.3 million people age twelve or older abused prescription pain relievers. Over the years, prescription drug abuse and overdose has become classified as an epidemic by health organizations—particularly regarding the abuse of pain-killers. In September 2015, the Centers for Disease Control and Prevention (CDC) announced that it would be donating $20 million to sixteen states in an effort to combat the prescription drug overdose epidemic; the program aims to provide resources needed to monitor prescriptions and train health care workers to make informed decisions when prescribing medications.
Anyone can become addicted to prescription scheduled drugs, but some persons have a greater risk. For example, alcoholics or persons who abuse illegal drugs have an elevated risk for dependence on prescribed drugs. Alcoholics may misuse drugs such as benzodiazepines to potentiate (increase) the effects of alcohol, while others addicted to stimulants such as methamphetamine or cocaine may use benzodiazepines as sedatives to fall asleep. Misuse can escalate into an addiction.
While men were historically at greater risk for prescription opioid abuse, the CDC announced in 2013 that the gender gap was narrowing as an increasing number of women were being admitted to hospitals and overdosing on prescription pain-killers, according to data from 2010. That year, more than 6,600 women died from an overdose of prescription pain-killers. In addition, incarcerated persons of both genders, particularly those in prison or on parole, have a higher risk for drug abuse and dependence than those not incarcerated or on parole.
According to the SAMHSA, 6.2 percent of youths between the ages of twelve and seventeen used nonmedical prescription pain relievers in 2014. Risk factors for addiction among adolescents include the abuse of multiple illicit drugs and the sale of illegal drugs to others. Adolescents who abuse or depend on prescription pain relievers are significantly more likely than others to have emotional or health problems and to have problems with family or friends.
An early nonmedical use of prescription drugs is predictive of adult prescription drug abuse and dependence, according to 2007 research by Sean E. McCabe and colleagues. The researchers found that nonmedical prescription drug abuse before age thirteen years was predictive for abuse and dependence of prescription drugs at age twenty-one years and older. Among early users, 25 percent became dependent on prescription drugs later in life, compared with 7 percent who initiated their prescription drug misuse at or older than age twenty-one years and then became abusers or addicts.
Some persons initially obtain dangerous prescription drugs from their physician because of a valid medical problem involving pain or a diagnosis of a psychiatric disorder. These persons may exceed the dosage recommended by the physician. To support this increased dosage, these users may seek a greater quantity of drugs from their doctors; if their doctor refuses, they often seek prescriptions through multiple physicians. This practice is referred to as doctor shopping.
In 2009 about one-half of persons who abused narcotics or psychiatric medications obtained these drugs from a friend or relative with that person’s permission. Others obtain their drugs from the Internet or from drug dealers, or they steal drugs from friends and family members. According to the SAMHSA, in 2013 and 2014, 50.5 percent of people who abused prescription pain-killers got them from a friend or relative, and 22.1 percent got them from a doctor. Some addicts steal prescription pads from doctors and write their own prescriptions, while some with legitimate prescriptions are altered to obtain a greater quantity than ordered by the doctor. For this reason, doctors who prescribe pain medications often photocopy their original prescription.
Prescribed drugs are also stolen from pharmacies. For example, between January 2000 and June 2003, about 1.4 million OxyContin tablets were stolen from pharmacies. About two-thirds of these losses were attributed to break-ins or robberies, and 16.5 percent were attributed to employee theft.
Drug dealers also sell prescription drugs. A 2008 study of prescription opioid misuse among persons taking street drugs found that, based on a sample of 586 illicit heroin users in New York City, methadone was sold to them by 64.7 percent of drug dealers and OxyContin was sold by 41.4 percent. One-half of the drug dealers selling heroin and cocaine also sold prescription opioids and 25 percent of the drug dealers sold prescription opioids only.
Some people hire patients already legitimately receiving Medicare or Medicaid to complain to their doctors about pain to obtain drugs for diversion. Doctors who participate in this type of scam (and who receive illicit payments for their participation) give the patient a prescription for a large quantity of opiates. These prescriptions are then filled, given to the person who initially hired the patient, and then retrieved by drug dealers for illegal sale.
The problem of prescription drug dependence becomes evident when the person stops taking the addictive drug, whether voluntarily or because the person cannot obtain the drug. The addict will undergo withdrawal symptoms, which may be severe. Symptoms include such reactions as headache, tremors, vomiting, seizures, and even death.
Psychological symptoms too are common with a sudden withdrawal from prescription drugs of abuse; the person may experience severe anxiety, hallucinations, and delusions. To limit the withdrawal symptoms, persons who stop taking addictive prescription drugs should be under the care of a physician.
A treating physician may taper the person off the drug of abuse and substitute a safer drug in the same category, then taper the person off that drug. Such treatments can markedly reduce withdrawal symptoms.
Psychotherapy is a helpful adjunct to treatment with medications, and therapy is often ordered by courts when prescription drug dependence is related to the commission of a crime. There are many different types of therapies, but one popular form is cognitive-behavioral therapy, in which the person is trained to identify and challenge irrational or maladaptive thoughts in an active interaction with the therapist.
Group therapy is also commonly used so that the addict can relate to and learn from the problems of others. Pills Anonymous is a twelve-step support group for persons addicted to prescription drugs, but these groups are available only in a few US states. Some prescription drug addicts must enter residential treatment programs to detoxify from their addiction.
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