Prescription drug abuse has become a huge problem in the US and abroad. From tranquilizers being over-prescribed for stress and sleep issues to stimulants like Adderall and Ritalin being abused by students trying to keep up with increasing amounts of schoolwork, more and more people are finding themselves depending on prescription medications they don’t medically need to get through the day.
Most people use their prescription medications as directed. Though there is a chance that a person can become addicted to a habit-forming medication even if they follow instructions, it’s unlikely. Most addictions occur because of abuse. Prescription drug abuse is defined as any use beyond that directed by a doctor or any use by a person who does not have a prescription for that medication. According to the National Institute on Drug Abuse (NIDA), 20 percent of all Americans have taken a prescription drug for a nonmedical reason.
- Minor tranquilizers, most often benzodiazepines and barbiturates, such as Seconal, Amytal, Valium, and Rohypnol.
- Opioid painkillers: like Vicodin, Percocet, OxyContin, and Demerol
- Stimulants: like Adderall, Ritalin, and Concerta
- Nonbenzodiazepine hypnotics: (sleeping pills) like Ambien, Lunesta, Imovane, and Sonata
Each class of drug comes with its own side effects and risks, including the threat of overdose and potential long-term health problems associated with their abuse. Many people think that abusing prescription drugs is significantly safer than taking common illicit intoxicants like cocaine or heroin, but some aspects of these medications can be more dangerous, especially due to a lack of education on their effects.
Abuse and Addiction
Abuse of prescription drugs affects people of all ages, from adolescents to those over retirement age. It’s definitely on the rise among young people, including middle and high school students. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the rate of nonmedical painkiller use among teens age 12-17 was at 6.2 percent and among those 18-25, it was 11.8 percent in 2014. For the 12-17 age group, the rate of current (past-month) use of prescription drugs went from 2.2 percent in 2013 to 2.6 percent in 2014.
Stimulant abuse among these age groups has been steadily increasing in recent years. This is thought to be due in part to increasing pressures among students in the form of more schoolwork and the increasing necessity of getting into, and graduating from, college in order to secure a job that pays enough to live on. At the same time, sharp rises in tuition costs are forcing many students to work jobs at longer hours in order to afford staying in school. An increasing number of these students therefore turn to drugs like Ritalin and Adderall to give them a burst of energy and focus and to stave off fatigue.
Older Americans, those age 50 and above, are at an especially high risk of abuse of, and addiction to, prescription drugs due to the fact that they’re more likely to have problems with pain and insomnia, and more likely to be prescribed medications for these problems. A total of 25 percent of Americans in this age group use psychoactive medications like tranquilizers and opioids that can be abused and lead to addiction. This problem is increasing, which is thought to be in part due to the aging of the baby boomer generation, which is more likely to take intoxicants in general.
The problem is particularly bad among older Americans who already have an abuse problem with alcohol. According to the National Survey on Drug Use and Health (NSDUH), 19 percent of people in this group misuse both alcohol and at least one prescription medication. This is especially risky behavior, as combining any drug with alcohol increases the risks of both overdose and general adverse health effects.
The same survey found that men and women have comparable rates of prescription drug abuse: 2.6 percent for men and 2.3 percent for women. However, another study found that the rates of emergency room visits among underage girls were significantly higher than among boys, with the rates of teens aged 15-17 being 35 percent and 31 percent, respectively.
Addiction tends to start with abuse. One of the essential aspects of an addictive drug is the body’s ability to develop a tolerance to it, meaning that the user will need a higher and higher dose in order to get the same effect. The heavier and more frequent the abuse is, the more likely the individual is to develop a dependence. This can occur if a person who is given a prescription for the medication stays on it for too long. Doctors will only increase the dose to a certain point, but if the effect still isn’t enough – if the opioid isn’t taking away all of the pain, for example – the patient may resort to taking more than directed and eventually become addicted.
Signs of an Addiction
Once an addiction forms, the affected individual will find that they can’t seem to get through the day without a dose of the drug of choice. According to the National Center on Addiction and Substance abuse, 40 million people in the US alone fit the criteria to be diagnosed with an addiction disorder.
Addiction is generally described as having two different aspects: physical and psychological. Physical addiction involves a developed tolerance to the drug as the brain adjusts to the frequent presence of the intoxicant. Once intake of the drug stops and it has time to leave the body, withdrawal occurs. This consists of a number of extremely unpleasant and sometimes dangerous symptoms and intense cravings.
The specific symptoms depend on the class of drug the person has been taking, but often include:
- Nausea and vomiting
- Muscle pain
- Sleep disturbances
- Anxiety or depression
More severe symptoms can include seizures, hallucinations, and psychosis. Few people die from these symptoms, but there are cases of severe benzodiazepine or alcohol withdrawal being fatal.
Psychological addiction can develop in relation to many substances and even behaviors. This consists of cravings and general emotional distress that occur when the drug is not available. Psychological addiction is much harder to shake, and it is considered by some to last for life. It also tends to produce a number of behaviors that are universal across all substance addictions. These can include:
- Hiding the substance around the home
- General secretive or deceptive behavior
- Continuing to take the drug despite negative consequences
- Changes in social circles
- Changes in grooming habits and/or hygiene
- Loss of interest in hobbies
- Consistently taking more of the drug than intended
- Avoiding situations in which the drug is unlikely to be available
- Difficulties at work or school, or with relationships
- Using the drug to deal with problems or to feel normal
Once it’s been determined that an addiction has developed, it’s important to get into treatment as soon as possible to avoid adverse health effects and worsening dependence on the drug.
There are many options for those who find themselves addicted to prescription drugs. Because doses are easily controlled via pills, it may be straightforward to allow the addicted individual to taper off the drug rather than requiring them to detox all at once, which produces intense withdrawal symptoms. With opioid painkillers in particular, there are medications available that have been used for many years to treat addiction to this class of intoxicant.
Methadone is well known for its use in treating heroin addiction, but it also works with any kind of opioid. It’s actually an opioid itself, but produces a much less intense high and stays in the person’s system for a longer period of time, reducing its addiction potential. To someone who has already built up a tolerance to a strong opioid, methadone does not produce a significant high, but it reduces or eliminates cravings and withdrawal symptoms. After being switched onto methadone or a similar medication, it’s much easier for the addicted person to taper off the drug.
The downside to methadone is its high potential for overdose. According to the Centers for Disease Control and Prevention, the number of poisoning deaths from methadone rose sharply from 1999 to 2006, from 790 to 5,420. Doctors need special clearance to administer methadone, and it can only be given by such a medical professional at a hospital or specialized treatment center. This can be fairly inconvenient as a person on this treatment program must travel to the center every day to get a new dose. To address this issue, buprenorphine was developed for opioid addiction treatment. It’s similar to methadone but with a much lower risk of overdose. This allows doctors to write prescriptions for the medication that the client can take home to self-administer.
For tranquilizers, there’s often a less addictive and less powerful option that a client can be switched onto for tapering, though they may just have to be weaned off the current medication they’ve been taking. The same is true for stimulants and sleep medications.
Once the detoxification process is complete and the worst of the withdrawal symptoms have passed, the next recommended step is a rehabilitation program. These programs typically include frequent therapy appointments, support group meetings, and often a 12-Step program. They also offer a variety of workshops designed to help addicted persons get their lives back on track and avoid possible temptation triggers and relapse. Therapy can be in a group or one on one, and it is generally focused on the cognitive behavioral school of thought. This way, addicted individuals can learn to replace harmful thoughts and behaviors with healthier ones that are unlikely to lead back to substance abuse.
Rehab generally comes in two forms: inpatient and outpatient. Inpatient rehabilitation is what people typically picture when they think of “rehab.” It’s several weeks in a controlled facility with no access to any substances other than doctor-approved medications. Family can generally visit, but the addicted individual is not allowed to leave until the program is completed. This is perhaps the most effective form of rehab, but it is very restrictive and not accessible to everyone. Outpatient rehab allows people to go to work and take care of their children, but requires them to come in daily or a few times a week for treatment, workshops, and drug tests to keep them honest.
When it comes to prescription drug addiction, it’s especially important to pay attention to any co-occurring disorders the addicted person may have. If the individual has chronic pain, an anxiety disorder, chronic insomnia, or ADHD, it’s not an option to leave them without medical treatment. Underlying illnesses and disorders are very likely to lead an untreated person right back into substance abuse. According to the National Alliance on Mental Illness, around half of all people who abuse drugs report experiencing a mental illness of some kind.
For those with mental illnesses, inpatient treatment is often the best choice. This way, they’ll have nearly constant access to mental health professionals who can help clients discover underlying issues that could have led to the substance abuse in the first place. However, physical illnesses like those involving pain can make inpatient rehabilitation impossible if the afflicted persons need to see a doctor, physical therapist, or other specialist regularly who is not onsite. Whatever the situation, it’s very important that the co-occurring disorder get as much attention as the addiction disorder.
Abuse and addiction involving prescription drugs is spreading fast, in part due to a lack of proper education around the problem. Signs may be ignored because people are unaware of how addictive prescription medications can be or how dangerous their abuse can be to one’s health. Fortunately, more and more research is being done on this issue, including on how to best treat this problem that is largely affecting already vulnerable populations – young and elderly persons and those who are already struggling with illnesses. With the proper care and support, anyone can get back on the path to living a normal, healthy life.