The 2018 National Survey on Drug Use and Health estimates that about 16.9 million Americans over the age of 12 have misused prescription psychotherapeutic drugs in the past year.1
In fact, prescription pain relievers (i.e., high-potency opioids) were the third-highest substance with the largest number of initiates of use or misuse (behind only alcohol and marijuana) with 1.9 million new misusers.1
What Prescription Drugs Do People Abuse?
Controlled medications—those which are regulated and scheduled by the U.S. Drug Enforcement Agency (DEA)—are increasingly misused.2
The DEA classifies drugs according to five distinct “schedules” based on the potential for abuse of the drug and risk of addiction. These schedules are defined as:2
- Schedule I: Heroin, ecstasy, marijuana, peyote, LSD, and other substances are categorized as having no medical use in the U.S. and a high potential for drug abuse and dependence.
- Schedule II: Adderall, cocaine, oxycodone, methamphetamine, hydrocodone, and other substances – many of them prescription drugs – are approved for medical use in certain situations but prescribed and used with caution as they are also highly addictive with a high potential for abuse.
- Schedule III: Ketamine, drugs with less than 90 milligrams of codeine in each dosing unit, anabolic steroids, testosterone, and other drugs are also approved for medical use, though they are also addictive and deemed to have a moderate to low risk of abuse.
- Schedule IV: Xanax, Valium, Ativan, and other prescription drugs are classified as having a low abuse potential but still a risk for addiction.
- Schedule V: Robitussin AC, Lyrica, Motofen, and other prescription drugs fall into the fifth schedule and are considered to have the least abuse potential and the lowest risk of addiction.
Misuse can include taking more than the prescribed dose of a medication; co-ingesting a medication with alcohol or other psychoactive drugs; using medication prescribed for another person; or taking the medication for the purpose of sensation seeking (i.e., to get “high”).3 Medications may also be given or sold to others—this is called “diversion.”3 Medical misuse or abuse of medication puts an individual at risk of addiction and/or potential overdose and death.3
Medications most often misused are opioid analgesics (e.g., opioids such as OxyContin, etc.), tranquilizers (e.g., benzodiazepines such as Xanax, etc.), and stimulants (e.g., Adderall or Ritalin).3
How Does Misuse and Addiction Start?
Prescription drugs that are abused can come from a variety of sources, including prescriptions received from a doctor, diversion from friends and family, or they may be purchased illicitly.4
Surveys of teenage prescription drug abusers show that they often receive prescription medication for free from a friend or relative.4
When surveyed regarding their source, prescription opioid abusers cited—from most to least often—drug dealers, sharing/trading, legitimate medical sources (e.g., physicians, hospitals, etc.), illegitimate medical sources (e.g., “pill mills”), and theft.5
Motives for misusing prescription drugs are as varied as the sources of prescription drugs that are misused. Reasons cited in surveys often include the following motives, with greater problems of use associated with individuals have multiple motives for use:4
- Getting high (i.e., recreational use).
- Regulating pain.
- Decreasing unpleasant emotions or physical discomfort.
- Improving sleep.
- Managing withdrawal.
- Enhance social experiences.
Risk factors for initiation of prescription drug abuse mirror that of substance use in general:4
- Earlier age of initiation of use
- Presence of psychiatric and medical conditions
- Higher severity of psychiatric conditions
- Exposure to violence.
- Exposure to stress.
Patterns of prescription drug misuse have emerged for certain classes of medications. For example, individuals with chronic pain who abuse their medications usually have higher pain sensitivity, perceive or interpret pain more catastrophically, and experience more psychiatric symptoms vs. those who don’t abuse their medication.4 Conversely, studies examining the risk for stimulant abuse suggested that medication for the management of attention deficit hyperactivity disorder actually protects against the development of a substance use disorder.4
Commonly Abused Prescription Medications
The three classes of medication that are most commonly misused include:5
- Opioids, which are usually prescribed to treat pain.
- Central nervous system depressants (e.g., tranquilizers, sedatives, and hypnotics), which are used to treat anxiety and sleep disorders.
- Stimulants, which are typically prescribed to treat attention-deficit hyperactivity disorder (ADHD).
When does prescription drug use turn into abuse?
Prescription drugs should only be used as prescribed—or according to a doctor’s orders—and following all precautions for safe use. Anything outside of these parameters, however, is misuse of the medication.
Some examples include:3
- The use of a prescription drug without a prescription.
- Buying prescription medications illegally online.
- Altering a written prescription and increasing the dosage or number of pills ordered.
- Filling a prescription at more than one pharmacy.
- Acquiring multiple prescriptions for similar medications from different doctors.
- Crushing pills before ingesting them.
- Snorting or injecting pills after crushing them.
- Using alcohol, marijuana, other prescription drugs, or other illicit substances with a prescription medication with the intent to augment its effect.
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.6
However, the implementation of statewide prescription drug databases has helped to 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.6
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.3 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 to doctors 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 sedation effects, 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, benzodiazepines, and sleep aids, should not drink at all due to the risk of overdose and accident under the influence.3
As another example, those taking prescription stimulants risk overstimulation of the sympathetic nervous system when the medication is taken with a monoamine oxidase inhibitor—a class of antidepressants that also enhance catecholamine activity. This could lead to a potentially deadly interaction that could result in cardiac arrhythmia, hypertension, seizure, or cardiovascular collapse.3
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:7
- The prescription medication being rendered useless or even harmful.
- Side effects or worsened side effects of one or more of the substances.
- Medical emergency including overdose.
- Sudden death.
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.
- Center for Behavioral Health Statistics and Quality. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- U.S. Drug Enforcement Agency. (2019). Drug Scheduling.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- McHugh, R. K., Nielsen, S., & Weiss, R. D. (2015). Prescription drug abuse: From epidemiology to public policy. Journal of Substance Abuse Treatment, 48(1), 1–7.
- National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs: Overview.
- Sansone, R. A., & Sansone, L. A. (2012). Doctor shopping: A phenomenon of many themes. Innovations in Clinical Neuroscience, 9(11-12), 42–46.
- U.S. Food and Drug Administration. (2013). Drug Interactions: What You Should Know.