What image comes to mind when you think of a drug addiction? Do you picture someone smoking crack or shooting heroin? You'd be wrong. A typical person with substance use disorder could easily be your next-door neighbor, the teen who babysits your kids or the grandmother you chat with at the grocery store. That's because people with substance use disorders could be using the medication they bought at the local pharmacy.
About 9.3 million Americans misuse prescription drugs.
Most people don't become addicted to the prescription drugs they take. But there are many who get drugs without a prescription or use prescription drugs to get high. It's especially common among young people.
In addition, misuse of prescription pain relievers appears to be on the rise among people of all ages, educational levels and ethnicities. While it is often perceived to be a problem in the inner city, substance use and misuse have long been prevalent in rural areas. Prescription drug misuse has grown in towns of every size.
Most commonly misused prescription drugs
When prescriptions are taken as directed, it's not necessary to worry about becoming so dependent on a drug that you crave more. But it is easier to get hooked on certain types of drugs.
According to the National Institute on Drug Abuse (NIDA), there are three types of commonly misused prescription drugs: opioids, depressants that affect the central nervous system (CNS) and stimulants that enhance brain activity.
Opioids
These painkillers are prescribed to patients in severe pain after surgery or for people who suffer from chronic conditions. They include:
Morphine
Codeine
Oxycodone (OxyContin)
Propoxyphene (Darvon)
Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Meperidine (Demerol)
In addition to dulling pain, opioids can also cause feelings of euphoria, even at prescribed doses. Possible side effects of taking opioids include:
Slowed breathing
Constipation
Nausea
Sleepiness
Dizziness
Vomiting
Headache
Dry mouth
Sweating
Combining different types of opioids or taking one large dose can cause death. Although rare, a large overdose of opioids can slow your breathing to a dangerously low level.
Central nervous system depressants
These drugs slow the brain's ability to function and are used to treat anxiety problems, acute stress and sleep disorders. They include:
Barbiturates such as mephobarbital (Mebaral)
Benzodiazepines such as diazepam (Valium)
Lorazepam (Ativan)
Clonazepam (Klonopin)
Temazepam (Restoril)
Chlordiazepoxide HCI (Librium)
Alprazolam (Xanax)
Experts at NIDA caution against using depressants in combination with other drugs -- especially alcohol -- because this can have serious side effects. Users may not realize that alcohol and some over-the-counter allergy medications are also CNS depressants. For example, taking benzodiazepines with alcohol has an addictive effect, which makes people drowsier and more uncoordinated than they might realize, and puts them at risk when driving.
Mixing alcohol with barbiturates is even more dangerous. This combination can slow your breathing and heart rate, and possibly lead to death. Doctors now rarely prescribe barbiturates, because benzodiazepines are considered more effective.
Stimulants
These drugs do the opposite of CNS depressants. Instead of slowing your brain, they enhance activity, making you more alert, anxious and energetic. They include dextroamphetamine (Dexedrine) and methylphenidate (Ritalin), which are used to treat attention-deficit hyperactivity disorder.
The National Drug Rehab Referral Alliance says stimulants are usually safe when taken as directed. But users can develop a range of uncommon side effects, including dangerously rapid heartbeat, burst blood vessels, fever and fatal seizures.
How do you know if you're addicted?
A report from NIDA says only four of every 12,000 patients taking opioids for pain become addicted; if you're following your doctor's directions, you shouldn't have to worry. But if you need larger amounts of a drug to produce the same effects, or if you're asking your doctor for larger doses, that may be a sign that you're developing a tolerance.
If you're concerned about being addicted, ask yourself a few simple questions:
Have you ever felt the need to reduce your prescription drug use?
Have you ever felt annoyed when friends or loved ones made remarks about your prescription drug use?
Have you ever felt guilty about taking prescription drugs?
Have you ever used prescription drugs as a way to pep yourself up or to calm down?
If you answered "yes" to any of these questions, have a frank discussion with your doctor to see if you have a problem.
Work with your doctor if you think you're becoming more tolerant of a drug or even if you think you no longer need it. Becoming tolerant of a drug isn't a good reason to stop taking it. It may mean your disease is worsening and you need a higher dose.
Don't try to go off prescription medications on your own -- your doctor can help you taper them slowly so you don't develop severe withdrawal symptoms.
Recognizing signs of addiction in others
If you're concerned that a loved one may be misusing prescription medication, be alert for certain warning signs. According to Cancer Pain Release, a publication of the World Health Organization, the following changes in behavior may signal an addiction:
Taking drugs compulsively to alter one's mood
Lying about drug use
Stealing drugs and/or forging prescriptions
Buying prescription medicine illegally
What is withdrawal?
Once a person becomes physically dependent on a drug, certain symptoms -- called withdrawal -- will set in if the body doesn't get the drug. For people who are addicted, that may be reason enough to continue taking drugs illegally, even when they know it's harming them.
The Center for Substance Abuse Treatment says opioid users in particular shouldn't stop taking the drug abruptly. Instead, they should seek professional treatment to determine how best to taper off the drug.
When a person withdraws from a painkiller such as OxyContin, for example, he may feel:
Restless
Muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goosebumps
Involuntary leg movements
Withdrawal from benzodiazepines is generally mild. The most common symptoms are insomnia, nervousness, and restlessness, which can be eased by quitting the drug gradually. Rarely people taking benzodiazepines at very high doses for prolonged periods will experience extreme anxiety, a psychotic reaction or a seizure if they go off the drug abruptly.
Withdrawal from other less commonly prescribed depressants, such as barbiturates, can be life-threatening. Symptoms that appear 12 to 20 hours after the last dose may include:
Elevated heart and respiration rate
Tremors
Hallucinations
Confusion
Seizures
Possibly death
Withdrawal from amphetamines can result in:
Depression
Drowsiness and lack of alertness
Increased appetite
Intense cravings for the drug
Treating addiction
Because addiction involves both psychological and physical dependence, treatment often requires a combination of behavioral modification therapy and medication. Behavioral modification focuses on helping people function without drugs and teaches them how to combat cravings and avoid situations where they might be inclined to fall back into addiction.
Doctors may prescribe medications to relieve withdrawal symptoms, counteract the effects of the misused drug, and help lessen cravings -- particularly in cases of opioid addiction. Methadone has been used for over 30 years to manage opioid addiction but requires daily trips to a methadone clinic.
The Food and Drug Administration (FDA) has also approved using another drug called buprenorphine to manage opioid addiction. This drug can be prescribed in a doctor's office. It appears to produce a lower level of dependence and is less likely to cause overdose problems.
Methadone programs are usually not the first course of action for treating an addiction to prescription opioids. These approaches were designed primarily to prevent street users of heroin from resorting to crime to support their habit, and such maintenance programs are not ideal because they create a low-level dependence on a "replacement" opiate for as long as someone remains in the program.
Most people who are addicted to prescription opioids should ease off the drug gradually with the supervision of a medical professional. Doctors often prescribe naloxone hydrochloride, a drug that blocks the effects of opioids. This way, patients are less likely to fall back into addiction if they have a relapse.
Who's more likely to misuse prescription drugs?
NIDA cites four groups that are most at risk for misusing drugs:
The elderly. Seniors are three times more likely to take prescription medications than other people and are less likely to follow the instructions on the bottle. According to data from the Veterans Affairs Hospital system, they also are prescribed higher doses of some medications -- like benzodiazepines -- for more extended periods. All of these factors combine to make prescription drug abuse more likely.
Teens and young adults. Teens and young adults make up one of the fastest-rising groups of prescription drug users. In the 1990s, Ritalin use grew among high school students, and the recreational use of pain relievers such as Percodan (oxycodone with aspirin) and Vicodin (hydrocodone) increased among college students, according to NIDA. In the last available statistics, over 12 percent of teens aged 12 to 17 reported using prescription drugs for non-medical purposes. Over the last decade, the recreational use of Oxycontin and Vicodin increased among high school sophomores, while that of Ritalin appears to have declined.
Women. According to NIDA, women are more at risk for prescription drug misuse because they're more likely to be prescribed an addictive drug, such as an opioid or anti-anxiety medication. Researchers have found that when they are given opioids in similar numbers, men and women are equally likely to become addicted.
Healthcare workers. Physicians, nurses, pharmacists and other healthcare workers with easy access to prescriptions on the job may be at risk for prescription drug abuse.
The truth is, there is no typical person with substance use disorder. Among the old and young, prescription misuse is rising in America. The best way to prevent addiction and death is to take prescription medications responsibly.
