Prescription Drug Abuse

One unfavorable or unintended response of medical treatment is addiction to a prescription drug. A number of drugs used as medicines can lead to addiction or abuse in some people. These drugs include opioids, antihistamines, and steroids, among others. The most commonly abused prescription drugs are those used to treat psychological problems. Barbiturates and amphetamines have the highest potential for abuse. Others, such as the antipsychotics, antidepressants, and lithium salts, have a lower abuse potential.

According to the National Household Survey on Drug Abuse, 3.8 million people ages 12 and older were using prescription drugs for nonmedical reasons in 2000. This represents 1.7 percent of the population aged 12 and older, about the same rate as in 1999 (1.8%). Nonmedical use of prescription drugs increased among youths aged 16 and 17 between 1999 and 2000, from 3.4 percent to 4.3 percent. Adolescent girls were somewhat more likely to use prescription drugs nonmedically than boys (3.3% compared to 2.7%). Amphetamines are somewhat more likely to be abused by young people than other prescription drugs.

Barbiturates

Barbiturates have depressant effects. In the past they were commonly prescribed as tranquilizers and sleeping pills. Although barbiturates have been replaced by newer drugs, the problem of addiction to barbiturates has not been eliminated. People who abuse barbiturates may take large quantities by injection into a vein or muscle. Injections often leads to abscesses. Other users take large amounts by mouth, sometimes on a binge. Users quickly develop tolerance and physical dependence , and stopping the drugs suddenly can result in severe and life-threatening withdrawal .

Amphetamines

Amphetamines have stimulant effects. They increase the user's sense of well-being, energy, and alertness, and they also decrease appetite. In the past amphetamines were prescribed in pill form for people with mild depression or weight problems. They were also given to people whose jobs required that they stay awake and alert for long periods, such as medical interns or long-distance truck drivers.

Some laboratories illegally manufacture amphetamines, especially methamphetamine, which is relatively easy to create in the lab. The intravenous use of methamphetamine quickly produces tolerance, and the user requires larger and more frequent doses to achieve the desired effect. The user then typically experiences toxic (poisonous) effects, including repetitive face and hand movements and a repeated chain of behaviors—for example, the user may assemble and dismantle mechanical objects. Users may develop paranoid psychosis , in which individuals lose touch with reality and feel that other people are persecuting them.

Benzodiazepines

Benzodiazepines have replaced barbiturates for the treatment of anxiety and sleeping disorders. They are very effective and produce few side effects. They are also less likely to produce addiction. When benzodiazepines are used properly, the risk of addiction is extremely small. Nevertheless, some cases of abuse of benzodiazepines such as diazepam (Valium) and lorazepam (Ativan) have occurred. Abusers may take the benzodiazepine alone or in combination with other drugs. The combination of alcohol and benzodiazepines has a particularly powerful effect. Other users may take benzodiazepines to ease the crash from the high of cocaine use. Some benzodiazepine abuse occurs when the person obtains the drug legally from a doctor. About 50 percent of abusers of benzodiazepines were introduced to the drug as a medical treatment. Other users obtain the drug from illegal sources.

Appetite Suppressants

Another type of prescription drug abuse involves appetite suppressants. Most of these drugs are stimulants, but one, fenfluramine, is a sedative . Abusers may take them in binges and use large quantities rather than the typical dose of one per day. As a general rule, the more an appetite suppressant resembles an amphetamine, the more likely it is to be abused.

Stopping the use of appetite suppressants may produce withdrawal symptoms such as fatigue, discomfort, or depression. Because of these problems and growing doubts about the drugs' effectiveness at maintaining weight loss, many doctors have stopped prescribing appetite suppressants.

In the early to mid-1990s, two prescription diet drugs, fenfluramine (often taken with phentermine and popularly known as fenphen) and dexfenfluramine (Redux), became popular. These drugs increased the amount of the brain chemical serotonin, creating a feeling of being full or satisfied. Stories in the news media depicted fenphen and Redux as cures for obesity. By 1996 millions of prescriptions had been written for these diet pills.

In 1997 reports of heart valve disease in women taking fen-phen or Redux began to surface. The Food and Drug Administration issued a Public Health Advisory describing the drugs' dangers. By September 1997 the manufacturer withdrew these drugs from the U.S.

market. In December 1999 the company agreed to compensate thousands of people who took either drug in a $3.75 billion settlement of a nationwide class action suit .

Opioids

Addiction and abuse are extremely rare outcomes when doctors use opioid drugs, such as morphine, to relieve the pain of cancer patients. Most experts agree that the risk of addiction during opioid treatment for cancer pain is so small as to have no influence on the decision to use these drugs.

Treatment for prescription drug abuse often involves a combination of:

• gradual weaning from the abused drug
• antidepressants or sedatives to help decrease withdrawal symptoms
• cognitive-behavioral therapy to work on slowly changing the user's attitudes, feelings, emotions, and behaviors with regard to drug use
• support groups to help the user connect with other substance abusers who have been through similar challenges

see also Barbiturates; Benzodiazepines; Drugs of Abuse; Opiate and Opioid Drug Abuse; Sedative and Sedative-Hypnotic Drugs.

PRESCRIPTION FOR PROBLEMS

Some people have called prescription drug abuse a hidden epidemic because there is no way to keep accurate tallies. Yet millions of people who begin to take drugs for medical reasons end up addicted to their medications.

Here are some guidelines for avoiding addiction of a prescribed medicine:

Follow the instructions printed on the drug label.

Always take only the prescribed dose at the prescribed time interval, and only for the length of time prescribed.

Ask your doctor or pharmacist about any concerns and questions.

Know which drugs are most addictive. In general, stimulants, opiates, and painkillers are the most addictive types of drugs. Within these categories, specific drugs have different abuse potentials or likelihood of someone ending up addicted.