Prescription drug abuse

Definition

Prescription drug abuse is the use of prescription drugs — most commonly painkillers, sedatives and stimulants — in ways not intended by the prescribing doctor. The definition for prescription drug abuse includes everything from taking a friend's prescription painkiller for your backache to snorting ground-up pills to get high.

According to a 2007 survey conducted for the National Institute on Drug Abuse, prescription drug abuse occurs in more than 15 percent of U.S. high school seniors. The types of drugs most popular for prescription drug abuse are codeine-based painkillers such as oxycodone (OxyContin) and those containing hydrocodone (Vicodin).

Symptoms

Prescription drug abuse rarely happens in people who need commonly abused painkillers, sedatives or stimulants to treat a medical condition. But it can be difficult for a doctor to distinguish between a person who needs a larger dose to control his or her pain and a person who's abusing prescription painkillers.

In general, the following behaviors are warning signs of prescription drug abuse:

• Continually "losing" prescriptions, so more prescriptions must be written
• Seeking prescriptions from more than one doctor
• Taking higher doses despite warnings
• Stealing, forging or selling prescriptions
• Excessive mood swings

Symptoms by type of drug
The most commonly abused prescription drugs are:

• Opioid painkillers, such as oxycodone (OxyContin) and those containing hydrocodone (Vicodin)
• Sedatives and tranquilizers, such as diazepam (Valium) and lorazepam (Ativan)
• Stimulants, such as methylphenidate (Ritalin) — commonly used to treat attention-deficit/hyperactivity disorder (ADHD)

Each category has its own specific symptoms of use or abuse.

Opioid painkillers

• Constipation
• Depression
• Low blood pressure
• Decreased respiration rate
• Confusion

Sedatives and tranquilizers

• Drowsiness
• Confusion
• Unsteady gait
• Impaired judgment
• Involuntary and rapid movement of the eyeball

Stimulants

• Weight loss
• Agitation
• Irritability
• Insomnia
• High blood pressure
• Irregular heartbeat

When to see a doctor
Talk to your doctor if you think anyone in your family, including yourself, may be abusing prescription drugs.

Causes

According to the National Institute on Drug Abuse, prescription drug abuse has increased as the drugs have become easier to obtain.

For example, U.S. prescriptions for stimulants — including those taken for ADHD — increased from around 5 million in 1991 to almost 35 million in 2007. Prescriptions for opioid painkillers such as oxycodone (OxyContin) and hydrocodone (Vicodin) increased from 40 million in 1991 to 180 million in 2007.

Most prescriptions are written for people who have a true medical need for these drugs. But many households have a drawer filled with old prescription bottles containing leftover drugs. Because prescription drugs have medical uses, teens often believe they are a safe alternative to street drugs.

In some cases, a doctor's prescription isn't even needed. Some countries don't require prescriptions for opioid painkillers or other commonly abused drugs, so they can be obtained from some Web sites without a prescription.

Risk factors

Risk factors for prescription drug abuse include:

• Past or present addictions to other substances, including alcohol
• Younger age, specifically the teens or early 20s
• Working in a health care setting, where access to drugs is easier

Complications

Because the medications associated with prescription drug abuse activate the brain's reward center, it's easy to become addicted to them. Addicts continue to use their drug of choice even when this use makes their lives worse — just like nicotine addicts continue smoking cigarettes even when it harms their health and they want to quit.

In addition to the risk of addiction, other complications of prescription drug abuse may vary, depending on the drug category.

Opioid painkillers

• Increased risk of choking
• Loss of menstrual periods and fertility
• Slowed breathing rate, potential for breathing to stop

Sedatives and tranquilizers

• Memory problems
• Abnormal temperature regulation
• Overdose can cause coma or death

Stimulants

• Hallucinations
• Seizures or tremors
• Increased risk of stroke

Combining alcohol with prescription drugs, particularly sedatives and tranquilizers, is even more dangerous.

Preparing for your appointment

You may feel embarrassed to talk to your family doctor about prescription drug abuse, but it's a very common problem. And it's easier to treat the problem before you become addicted. Your family doctor may refer you to an addiction specialist or to a facility that specializes in helping people withdraw from drugs.

What you can do

• Make a list of all the medications you're taking, including the amount of medicine in each dose and how often you take each one
• Write down any symptoms you may be experiencing
• Write down key personal information, including any major stresses or recent life changes

Questions to ask your doctor may include:

• What are my treatment options?
• Should I see a specialist?
• How can we manage my other health conditions during treatment?

What you can expect your doctor to do
Your doctor will perform a physical exam and may ask some of the following questions:

• 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?
• Has anyone in your family had a history of drug abuse or addiction?

Tests and diagnosis

The use of many types of drugs can be detected by blood or urine tests. These types of tests can help track the progress of a person undergoing treatment.

Treatments and drugs

If it were easy to stop abusing prescription drugs, no one would become addicted to them. So don't hesitate to get help in conquering your abuse or addiction. Your doctor may suggest that you be admitted to a residential facility that can provide specialized treatment for your specific problem.

Medications

• Opioid withdrawal. Buprenorphine and methadone may be used to ease the symptoms of withdrawal from opioid painkillers. However, the use of these agents to ease withdrawal from opioid addiction in the absence of pain problems is tightly regulated and subject to very strict guidelines and at times special licensure. Other drugs — including clonidine (Catapres), a medicine primarily used for high blood pressure — can be used to help manage opioid withdrawal symptoms.
• Sedative withdrawal. In general, tapering sedatives can be medically complicated and should be done only after a consultation with a doctor comfortable with assessing and managing these issues. If you've used prescription sedatives for a long time, it may take weeks or even months to slowly taper off them. Mood-stabilizing drugs at critical points in the withdrawal process may help. Symptoms of withdrawal can mimic rebound anxiety, so your choice of doctor is critical in withdrawal from this class of drugs.
• Stimulant withdrawal. There are no approved drugs used for the management of stimulant withdrawal. Treatment typically focuses on relieving withdrawal symptoms — such as sleep, appetite and mood disturbances.

Therapies
Counseling — whether it be individual, group or family counseling — is often useful. In addition to helping determine what factors may have led to the prescription drug abuse, counseling can also help people learn the skills needed to help prevent its recurrence.

Coping and support

Participation in regular meetings of a 12-step program, such as Narcotics Anonymous, is highly recommended.

Prevention

To reduce the availability of potentially addictive prescription drugs to teens, adults should secure such medications in a locked cabinet, and dispose of any unused pills properly. The federal government recommends flushing opioid painkillers down the toilet. Other unused medications can be taken out of their original containers, mixed with coffee grounds or with used kitty litter and then disposed of in the trash.

Doctors can reduce the likelihood of prescription drug abuse by taking thorough histories and providing careful follow-up for the people they've prescribed opioid painkillers, sedatives, tranquilizers or stimulants.

Drug manufacturers also are investigating ways in which commonly abused drugs can be made less addictive. The approaches being studied include:

• Controlled-release drugs. Slowing the speed at which drugs enter the brain appears to reduce the effect that the drugs have on the brain's reward center.
• Aversive ingredients. Adding secondary ingredients to drug formulations can provoke unpleasant side effects if the dose is too high, or if the pills are ground up and snorted or injected — a delivery system much more likely to result in addiction.
• Digestive enzymes. Some drugs may eventually require exposure to digestive enzymes to be activated. This would greatly reduce the chances of these pills being taken in any way other than by mouth.