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Most people who are prescribed a prescription medication for the treatment of symptoms caused by various medical and mental health disorders will be able to take that medication even if it is addictive without developing a problem. In some cases, however, routine pharmacological treatment can turn into a substance abuse problem and, in time, an addiction that can be life-threatening. It is an unfortunate myth that because a pill is prescribed by a doctor, it is inherently safe for anyone.
The National Institute on Drug Abuse (NIDA) estimates that about 52 million Americans over the age of 12 have abused prescription drugs in their lifetimes. Additionally, PBS reports that about 7 million Americans abuse prescription medications each year – that adds up to about 2.7 percent of the population. Pamela Hyde, the administrator at the Substance Abuse and Mental Health Administration (SAMHSA), said in a November 2011 CDC press release that on average about 5,500 Americans abuse a prescription medication for the first time every day. These numbers make prescription and over-the-counter drugs the third most commonly abused substances in the country among those over the age of 14 after alcohol and marijuana.
What kinds of prescription drugs are people abusing? NIDA estimates the following:
For many, addiction starts with a prescription obtained legitimately from a doctor for a medication that has potential for abuse and dependence. It is possible to become physically dependent upon a medication but not experience addiction, and for many patients who take an addictive medication long-term, this is the result. It’s a simple fix: A slow tapering down of the dose under the supervision of the doctor is all that is needed when the person is ready to stop using the medication. But when psychological dependence co-occurs – that is, when people also experience cravings for the medication and the feeling that they are unable to stop using the drug – then the diagnosis is addiction and slowly tapering off will be ineffective. Treatment is recommended in these cases.
Though some people can develop an addiction to a prescription when they take it as prescribed, most people who develop a prescription drug addiction do so after abusing that prescription. That is, they take a higher dose of the drug than prescribed, take the pills more often than prescribed, or combine them with use of other substances in order to get high. Regular abuse of a prescription medication, even if that medication is prescribed by a doctor, can lead to addiction.
In other cases, addiction starts through recreational use of medications that are prescribed to someone else. People who are prescribed painkillers for acute pain or sedatives to be used on an “as needed” basis often keep their medications in the medicine cabinet for months, unused. Others may take the pills with the intent to self-medicate a headache or other acute ailment or to get high. No matter how it is used, if the pills were not prescribed to the individual by a physician, it is prescription drug abuse, and if the behavior is repeated regularly, it can lead to addiction.
Though it is possible to become physically dependent upon a range of different medications, it is only likely to become addicted to the ones that create a euphoric high in the user. The triggering of the pleasure pathway can be psychologically addictive, and when combined with physical dependence, it can add up to addiction.
People commonly abuse the drugs that create a high in the user recreationally, often without realizing the dangers and risks. These include painkillers, stimulants, tranquilizers, sleep aids, and sedatives.
Long-term abuse of prescription drug use and abuse can lead to a number of dangers. As stated above, addiction is almost always the result. Those who regularly abuse prescription medications regularly take the risks that can occur with one-time use as well: overdose, accident, and other acute emergencies.
The dangers of long-term use and abuse of an addictive prescription medication can include:
Prescription drug addiction can be effectively treated by inpatient treatment, intensive outpatient treatment, or outpatient treatment services. The program that will be most effective will be determined based on the person’s circumstance, how long the person has been living with the drug abuse or addiction issue, if the person is living with co-occurring mental health or medical disorders, and whether or not the person has attempted to make use of a certain style of treatment in the past without success.
Ultimately, the style of treatment chosen is deeply personal. Prospective clients are encouraged to ask themselves the following questions before choosing between inpatient treatment and outpatient services.
What are the benefits of inpatient treatment?
Inpatient care, when it is comprehensive and addresses all the relevant issues as individuals begin their journey back to lives of balance in sobriety, can provide the strongest possible launch into recovery for clients and their families. Benefits of inpatient treatment include:
Is outpatient treatment effective?
Outpatient treatment can be just as effective as inpatient treatment, depending upon the needs of the client and the resources offered by the program. For example, someone who is highly motivated to stop using prescription drugs, has spent a brief time in active addiction, and does not have a co-occurring mental health disorder may do well in recovery by taking advantage of an outpatient detox program followed by therapeutic treatment defined by personal therapy, group therapy, 12-Step meetings, and other therapies on an outpatient basis.
For others, a more intensive outpatient program (IOP) will be the best fit. Most IOPs will offer:
It is important to note that detox and treatment for co-occurring disorders may be available on an outpatient basis just like treatment services for substance abuse and addiction, but all these programs may not be offered under one roof. It may be necessary to ask providers to work together to synthesize their efforts and improve the overall efficacy of treatment.
Remember that the type of treatment and level of care chosen should be made on a person-by-person basis. No one style of treatment will serve everyone equally, and no treatment program that enforces a cookie-cutter solution in which all participants take part in the same treatment and/or therapeutic regimen is likely to be the best option either.
Regular attendance in aftercare treatment and support services after intensive outpatient treatment or inpatient rehab was indicative of lower rates of drug and alcohol use and abuse six months after treatment as compared to those who did not take part in aftercare services, according to a study published in the journal Substance Use and Misuse. Aftercare serves help maintain a strong connection between the client and the sober community. They also keep the client connected to substance abuse treatment professionals and resources that will help the client to avoid relapse in the first year or more of independent living in recovery.
Aftercare treatment services often include:
How long does withdrawal last?
Everyone’s experience with detox and the associated withdrawal symptoms will vary significantly depending upon the drug of choice and the dose they are taking at the time of cessation of use as well as other factors – metabolism and body chemistry, other drugs of addiction in use, underlying medical or mental health issues. In general, however, it is important to note the difference between physical and psychological withdrawal symptoms and to understand that while physical withdrawal symptoms may pass within a few weeks for most people, the psychological withdrawal symptoms may continue intermittently for months if not years.
A physical dependence, or tolerance, can build up when taking any number of medications that are physically addictive for a period of time. Withdrawal symptoms experienced in this situation are generally dealt with by reducing the dose of the medication incrementally over time. Withdrawal symptoms may continue but at a minimum level throughout this process that will last as long as it takes to get the dose down to zero and for the remainder of withdrawal symptoms to fade.
When a person struggles with a high dose prescription drug addiction and thus is also psychologically dependent upon the drug of choice, tapering down the dose of a medication is not always an effective option and when it is deemed appropriate, it is done under the careful supervision of a medical professional and followed up by immediate and intensive therapeutic treatment.
Depending upon the prescription drug of choice, a tapering down of the dose is not an option. For example, though it may be possible to use detox medications such as buprenorphine or methadone for people who are addicted to opiate painkillers (e.g., oxycodone- or hydrocodone- based medications), there is no such detox medication available for people who are addicted to stimulant prescriptions or sedatives. Attempting to cut down the dose by about 10 percent per week as is customary in the case of physical dependence only would not be an effective choice when psychological addiction symptoms are present as well. In these cases, it is often recommended that a full stop to all use of addictive substance take place at once, followed by medical and therapeutic care for the withdrawal symptoms that occur.
The physical withdrawal symptoms associated with stimulant drug use will be far shorter in duration, often lasting about a week, as compared to the physical withdrawal symptoms associated with sedative use that can be a months-long process, usually peaking within a few days, plateauing for weeks, then tapering off over the following weeks.
Is help necessary for withdrawal?
Professional detox and addiction treatment that provides everything necessary to stabilize in recovery and avoid relapse is recommended, especially when a person experiences withdrawal symptoms due to detox. Individuals are encouraged to choose a prescription drug rehab program that offers:
What are the classes of prescription drugs?
The Food and Drug Administration (FDA) describes a range of prescription drug categories, including:
Additionally, the Drug Enforcement Administration (DEA) classifies drugs according to “schedules” based on the potential for abuse of the drug and risk of addiction. These schedules are defined as:
What are the most harmful prescription drugs?
The most harmful prescription drugs, according to the FDA, include:
Incidentally, most of these drugs are named by the National Institute on Drug Abuse (NIDA) as being among the most commonly abused addictive prescription drugs, including prescription painkillers, stimulant medications, sedatives, tranquilizers and sleep aids.
When does prescription drug use turn into abuse?
When a prescription drug is used as prescribed – or according to a doctor’s orders and following all precautions for safe use – there is very little risk of overdose or addiction. Anything outside of these very strict parameters, however, is termed abuse of the prescription drug.
Some examples include:
What is ‘doctor shopping’?
A report published in the journal Innovations in Clinical Neuroscience defines doctor shopping as the practice of acquiring multiple prescriptions for similar medications from different doctors. This practice is done with the goal of procuring a number of addictive pills for personal use or sale.
However, the implementation of statewide prescription drug databases has helped curb the practice of doctor shopping. Doctors and pharmacists document when a medication prescription is written or filled. Should the person take multiple drugs in the same class or have prescriptions written for the same drug by different physicians that would result in high daily doses of addictive medications, the pharmacist or prescribing physician will take note and intervene.
Are there concerns about mixing prescription drugs?
There is always concern about the negative interactions that can result from taking multiple prescription drugs at the same time. Even with non-addictive substances, there is potential for one drug to negate the positive effects of the other or for the two (or more) medications to work together to create a harmful reaction in the user. To limit the potential for negative interactions, patients are encouraged to disclose all the medications that they take regularly or on an as-needed basis, and to also mention any herbal supplements or vitamins they take regularly, as these too may trigger a negative reaction.
It is also important to note that alcohol use of any kind while taking medication can increase the sedation effect, render some drugs ineffective, and potentially trigger a harmful reaction. For example, patients who are taking antibiotics are encouraged to avoid alcohol, but those who are taking painkillers, barbiturates, sleep aids, and/or tranquilizers should not drink at all due to the risk of overdose and accident under the influence.
There are numerous possible health issues that may arise when a person mixes the wrong medications and/or other substances, including over-the-counter medications, certain foods, and herbal supplements. These may include:
If you are concerned that you, or someone you care about, are being exposed to any of the hidden dangers associated with prescription drugs, don’t wait to seek help. Even if prescription drug addiction is an issue, there are treatment services that can provide medical detox as well as therapeutic support.