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:
- 1 million Americans abuse painkillers (e.g., OxyContin, Percocet)
- 2 million Americans abuse tranquilizers (e.g., Ambien, Nembutal)
- 1 million Americans abuse stimulants (e.g., Adderall, Vyvanse)
- 500,000 Americans abuse sedatives (e.g., Ativan, Xanax)
How Does Addiction Start?
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.
Commonly Abused Prescription Medications
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.
Dangers of Long-Term Prescription Drug Use and Abuse
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:
- Cravings: A constant focus on the drug of choice, getting more of it, and staying high can cause problems in every aspect of a person’s life. Psychological dependency is half of what defines addiction and arguably the largest focus in treatment.
- Tolerance: Requiring more and more of the prescription pill in order to experience the high originally felt, as well as the therapeutic effects if taken as part of an overall treatment plan, is defined as a tolerance. This physical dependence can cause withdrawal symptoms when the person is without the pills for any length of time. Depending upon the type of prescription medication at the source of the addiction and whether or not there are co-occurring medical and/or mental health disorders, these withdrawal symptoms can trigger deadly medical complications.
- An inability to stop using the drug of choice: Even if negative consequences pile up, when physical dependence and psychological dependenceadd up to addiction, the person may find it impossible to ignore the impulse to drink or get high. This can destroy everything the person has worked for in life: career status, connections with friends and family, physical and mental health, and more.
- Poor choices under the influence: Long-term use of prescription drugs increases the likelihood that the person will make choices while under the influence that are life-altering or even life-ending. Having unprotected sex that ends in a transmission of an STD or an unwanted pregnancy, drowning, getting behind the wheel of a car or in the car with someone who is also under the influence, falls, burns, and other accidents are far from uncommon.
- Financial hardship: Ongoing use of prescription medications can make it difficult to continue to perform optimally at work. Many soon lose employment or simply stop showing up due to the overwhelming nature of chronic drug abuse and, as a result, lose the income they need to pay for housing, food, and other necessities. Additionally, because there is no budget, there is no extra money to continue to pay for the high cost of the medications, which can contribute to a number of other negative consequences associated with long-term prescription drug abuse.
- Criminal behavior: Due in part to the financial difficulties that often characterize a person’s experience in addiction, criminal acts are often an issue as well. Sometimes a choice made under the influence, but almost always a choice made in the interest of getting more of the drug of choice, illegal behaviors can add up to legal fees, court dates, probation, and/or incarceration. In the case of prescription drugs, illegal criminal activities often include committing fraud (e.g., “doctor shopping” or filling a single prescription at multiple pharmacies), purchasing prescription drugs without a prescription online, patronage of illegal pain clinics, and theft of someone else’s pills or identity with the intent to get more pills.
- Health problems: Different kinds of prescription drugs will have different mechanisms in the body and thus will contribute to a wide range of health problems, some acute and some chronic. Even at therapeutic doses, prescription medications can be toxic to the body, and long-term high-dose use and abuse can add up to potentially deadly disorders. Additionally, those who chronically run out of their drug of choice due to financial issues may find that withdrawal symptoms and health problems associated with detox are common as well.
- Heroin abuse and addiction: Finances may also lead long-term prescription pill users to turn to heroin, a cheaper and easier-to-access opiate alternative. This only applies to the people who are struggling with an opiate painkiller abuse problem, since both painkillers and heroin are opiate drugs and provide users with a similar effect.
- Decreased cognitive, emotional, and behavioral functioning: Long-term prescription drug abuse – or abuse of any drug – can cause physical changes to the brain, which in turn can negatively impact a person’s growth and development in the areas of cognitive function, emotional health, and behavior.
- Relationship difficulties: Interpersonal issues with family members, longtime friends, extended family, neighbors, and coworkers can become an increasing issue as a person continues using and abusing prescription drugs. Erratic behavior, emotional ups and downs, lack of stability, and other extreme changes to a person’s usual behavior can be off-putting, and formerly positive relationships often disintegrate as a result.
- Early death: Accidents can be fatal and are an increased risk among people who chronically use prescription drugs. Drug “poisoning,” or overdose, is a big risk as well, and this is a risk that people take almost every time they take the pills. Because tolerance and body metabolism are constantly changing, the rate at which a dose of medication is processed out of the body will change as well. Someone can inadvertently take too much, overwhelming the cardiac system or respiratory system, or triggering complications with an underlying medical disorder that are fatal.
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Inpatient vs. Outpatient Treatment
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.
- Will I be able to access detox and medical care?
- Do they offer the resources I need to make a solid start in recovery?
- Do I feel comfortable with the people I have met at the program?
- Does the program offer treatment and educational resources and support for my family?
- Does the program have the ability to create a personalized treatment plan that will help to address all the areas of my life impacted by drug abuse and addiction?
- Will I have a voice in how my treatment progresses?
- If I have a co-occurring mental health disorder, will the program have the ability to treat that issue as well?
- Will my insurance program cover the costs? If not, will I be able to finance or cover the rest of the bill?
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:
- Access to both detox and addiction treatment under the same roof
- Easy transition from detox into therapeutic and holistic treatment
- Round-the-clock monitoring to manage any medical emergencies, provide medication monitoring, and decrease the risk of relapse
- Access to a range of therapeutic interventions
- Low client-to-provider ratios in high-end settings
- Support for family members
- The ability to lengthen the stay if necessary to ensure optimum conditions for the transition into independent living
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:
- 5 hours per day or more of therapeutic intervention
- Random drug tests to ensure the integrity of the program
- Family support and education
- Some co-occurring disorders treatment
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.
Aftercare Steps and Options
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:
- Continued personal therapy, especially cognitive or behavioral therapy, with a focus on relapse prevention
- Continued group therapy sessions that are moderated by a substance abuse treatment professional and that guide participants in addressing issues that are common in the first year of sobriety
- Continued 12-Step meetings that allow for an increase in the community of support available to the client and that provide structure and stability to the daily schedule in early treatment
- Holistic and alternative therapies and treatments that appeal to the individual client (e.g., acupuncture, yoga, hypnotherapy, nutritional therapy, working with a life coach or sober coach, meditation, etc.)
- Relapse prevention assistance in the event of crisis
- Support in returning to more intensive treatment should relapse occur
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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:
- Medical detox: A professional detox program dedicated to helping the person to stop using all substance of abuse including the drug of choice is highly recommended. This important first step in recovery will help to set the tone for the coming weeks, and proper medical and therapeutic care can prioritize the client’s safety during detox and beyond.
- Evaluation and diagnosis: Once stable in detox with or without medication, the focus turns to a full assessment and evaluation process with the goal of accurate and thorough diagnosis. Drug addiction may only be one of the disorders that require treatment; many people in recovery need treatment for co-occurring mental health, behavioral, or cognitive disorders as well.
- Mental health treatment: If any co-occurring disorder is identified during the evaluation and diagnostic process, directed mental health treatment should be integrated into the substance abuse treatment program. Often, the prescription drug addiction and a co-occurring mental health disorder are deeply entwined. For example, in some cases, the addiction to prescription sedatives or sleep aids began as a part of treatment for an anxiety disorder. In these cases, it is not uncommon for the person to experience a backlash of anxiety upon cessation of use of the pills. For this reason, the person is at heightened risk of relapse during the first days of recovery, and an inpatient detox program that provides 24-hour monitoring and support is recommended.
- Cognitive and behavioral therapies: Personal therapy can be behavioral therapy and/or cognitive therapy and include a thorough investigation into the assumptions, perspectives, behaviors, and thought processes that lead to the behaviors that are detrimental to the ability to stay sober. Identifying the false assumptions and unnecessary or negative kneejerk responses to others, and making changes as needed, can improve the ability to stay sober.
- Support groups: Taking part in group therapy sessions, including but not limited to 12-Step meetings, increases the connection with others who are going through the same thing, providing support as the person navigates early recovery. It also provides the opportunity to provide support in kind when others are in need.
- Holistic treatments: Everything from acupuncture and yoga to meditation, herbal supplements, and beyond fall into this category. If it enhances the ability to manage stress positively and avoid drug use and abuse, it is likely considered a holistic treatment. These treatments can increase the coping skills available to the client in recovery.
- Nutritional therapy, journaling, outdoor and adventure therapies, sports therapy, and animal-assisted therapies – interactive therapies offer clients the opportunity to explore their past, their current experience, and their future through action rather than primarily through verbal dialogue with a therapist.
- Alternative therapies: Nutritional therapy, journaling, outdoor and adventure therapies, sports therapy, and animal-assisted therapies – interactive therapies offer clients the opportunity to explore their past, their current experience, and their future through action rather than primarily through verbal dialogue with a therapist.
- Aftercare services: An ongoing connection with therapeutic treatment and sober principles is an essential part of long-term recovery. The services chosen will be based on the person’s experience during treatment and individual need for support.
What are the classes of prescription drugs?
The Food and Drug Administration (FDA) describes a range of prescription drug categories, including:
- Anti-anxiety drugs
- Sleep medications
- Antiarrhythmic drugs
- Sex hormones (male and female)
- Antibacterial drugs
- Muscle relaxants
- Immunosuppressive drugs
- Antifungal drugs
- Cytotoxic drugs
- Hypoglycemic drugs
- Antidiarrheal drugs
- Cough suppressants (narcotic)
- Antihypertensive drugs
- Antineoplastic drugs
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:
- Schedule I: Heroin, ecstasy, marijuana, peyote, LSD, and other substances are categorized as having no medical use in the United States 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.
What are the most harmful prescription drugs?
The most harmful prescription drugs, according to the FDA, include:
- Narcotic analgesics
- Anti-anxiety drugs (also called sedatives, tranquilizers, muscle relaxants, or anxiolytics)
- Barbiturates (also known as sleep aids)
- Narcotic cough suppressants
- Stimulant drugs
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:
- 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.
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:
- 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.