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Prescription Drug Addiction: Top 18 Facts for You & Your Family

Medically reviewed on Aug 28, 2016 by L. Anderson, PharmD

Prescription Drug Abuse - A National Epidemic

Addiction starts with abuse. Abuse of prescription narcotic painkillers sits at the heart of the epidemic. Forty-five people die every day from opioid prescription painkillers – more deaths than heroin and cocaine overdoses combined.

But it's not all patient driven: research from 2016 reveals that when U.S. doctors give their patients narcotic painkillers, 99 percent of them hand out prescriptions that exceed the federally recommended three-day dosage limit.

Is Abuse of Prescription Drugs a Growing Problem?

The abuse of prescription drugs has risen to unprecedented levels. In fact, the number of people undergoing treatment for prescription painkiller drug abuse and addiction quadrupled from 2004 to 2010. In March 2014, the US Attorney General stated that the growing number of deaths from prescription painkiller overdoses is an 'urgent and growing public health crisis'. In 2012, young adults aged 18 to 25 used prescription drugs nonmedically at a rate of 5.3 percent – similar to rates in 2010-2011 rates, and lower than the 6.4 percent rate in 2009, according to SAMHSA. But opiate painkillers are not the only prescription drug subject to abuse and addiction.

Teen Statistics - What's Up?

NIH 2013 Monitoring the Future Survey.
After marijuana, prescription and over-the-counter medicines account for most of the top drugs abused by 12th graders in the past year, according to the National Institute of Health (NIH) 2013 Monitoring the Future Survey. Just over 28 percent of 12th graders in the survey had abused prescription medications in the previous 12 months. Six of the 11 drugs that were surveyed were prescription drugs. The top prescription drugs abused by teens included the ADHD stimulant Adderall (amphetamine mixed salts), Vicodin (acetaminophen/hydrocodone), and cold medicines. Unfortunately, ADHD medications and painkillers like hydrocodone are often easily accessible from the home medicine cabinet.

How Are People Getting Prescription Drugs for Recreational Use?

2012 National Survey on Drug Use and Health.
In the 2012 National Survey on Drug Use and Health, survey respondents age 12 years and older were asked how they obtained the prescription drugs they abused. More than half who used pain relievers, tranquilizers, stimulants, and sedatives got the prescription drugs 'from a friend or relative for free.' Nearly 20 percent of those surveyed received their drugs through a prescription from one doctor. Another 10.9 percent bought them from a friend or relative. In addition, 4 percent of respondents took pain relievers from a friend or relative without asking. Many abusers or addicts may also 'doctor shop' - visiting several physicians to gain access to multiple prescriptions at the same time.

The Science of Addiction - It's in Your Head

Addiction is a chronic brain disease that causes compulsive drug seeking and use, despite harmful effects to the individual and others. Drug dependence is a complex disease process and the drug abuser cannot voluntarily stop their use of illicit or prescription drugs. People who become addicted to drugs are not necessarily immoral or lacking in character; in fact, drug addiction occurs throughout the mainstream of society. Brain circuit changes may challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs. While someone who becomes addicted to drugs is always at risk for relapse, there are effective treatments for drug addiction.

How Quickly Can I Become Addicted to a Drug?

There is no easy answer to this common question, as noted by the National Institute on Drug Abuse (NIDA). If and how quickly you become addicted to a drug depends on many factors, including your biology (your genes), age, gender, and environment. While one person may use a drug one or many times and suffer no ill effects, another person may overdose with the first use, or become addicted after just a few uses. There is no way of knowing in advance how quickly this will happen - but there are some clues - for example, whether you have a family history of addiction. Each person is different in their vulnerability to drug addiction.

Which Prescription Painkillers Have a Risk of Addiction?

Any opioid-based painkiller can lead to addiction. Opioid derivatives - or narcotics - are commonly used in prescription painkillers. Morphine, oxymorphone (Opana ER), oxycodone (Oxycontin, Oxecta), hydrocodone (Zohydro ER), codeine, methadone, and fentanyl are examples of the potent opiate medications at the center of the U.S. addiction epidemic. Also concerning is that many of these medications (such as Lorcet, Tylenol with Codeine #3, Vicodin) may also contain acetaminophen, which in itself can be toxic to the liver at excessive doses. Codeine is also found in headache combinations such as Fioricet with Codeine.

How Do I Recognize an Opioid Overdose?

All opioids (narcotics) will produce various levels of central nervous system (CNS) depression and side effects such as drowsiness and sedation. In an overdose, you might notice stupor, coma, slurred speech, clammy skin, pinpoint pupils, and low blood pressure. The most dangerous side effect of an opioid overdose is slowed or arrested breathing. This risk is multiplied when the narcotic is combined with alcohol or other CNS depressants.

If you believe someone has overdosed on narcotics, call 911 immediately. A reversal agent called naloxone (Narcan, Narcan Nasal Spray Evzio) may be life-saving for patients who overdose on narcotics, although in patients dependent upon opioids, it can also cause a severe withdrawal.

What Other Clues Suggest Prescription Opioid Abuse or Addiction?

Like illicit drugs, prescription drugs may have 'street' names, as they are often sold on the black market. Common street names you may hear for prescription narcotics include:

Zohydro ER - What is the Concern?

Zohydro ER, by Zogenix, is a potent, extended-release hydrocodone product approved in October 2013. The drug was approved despite significant resistance from the FDA's own advisory committee, which voted 11-2 against Zohydro ER approval. In February 2014, consumer health groups asked the FDA to revoke the approval of Zohydro ER; some states attempted to ban it. Groups claimed the potent drug could lead to overdoses with even small doses in non-tolerant individuals; one dose could kill a child. However, in January 2015 the FDA approved a new abuse-deterrent formulation of Zohydro ER with an inactive ingredient that immediately forms a viscous gel when crushed and dissolved in liquids or solvents.

Hysingla ER: Another Abuse Deterrent Formulation

Many more abuse-deterrent formulations are entering the market. In November 2014 the FDA approved Hysingla ER (hydrocodone bitartrate), an acetaminophen-free, extended-release (ER) opioid for severe pain requiring daily, long-term treatment and for which no alternatives exist. As with other abuse-deterrent forms, Hysingla ER abuse-deterrent properties may reduce, but not totally prevent, abuse of the drug. The tablet forms a thick gel and cannot be easily prepared for injection, and is difficult to crush, break or dissolve. The most common side effects of Hysingla ER are constipation, nausea, fatigue, and dizziness.

Targiniq ER (oxycodone/naloxone), Oxycontin (oxycodone [reformulated]), Embeda (morphine/naltrexone), Zohydro ER (hydrocodone), and Troxyca ER (naltrexone/oxycodone) are other long-acting but abuse-deterrent pain medications.

Barbiturates: Another Abused Prescription Drug Class

Barbiturates are an older, but still abusable, prescription drug class. An overdose can be fatal, especially when mixed with alcohol or opiates. Examples of barbiturates, known on the street as 'barbs', 'reds', or 'phennies' include secobarbital (Seconal), pentobarbital (Nembutal), and phenobarbital. These are used for sedation; however, phenobarbital is often used for seizure control. The intoxicating effects of these drugs include drowsiness, reduced anxiety, feelings of well-being, and euphoria. However, they can also lead to severe withdrawal symptoms in chronic abusers. Barbiturates are now most often replaced by benzodiazepines for sedation or anti-anxiety in clinical practice.

Benzodiazepines: Addiction Can Lead to Difficult Withdrawal

Benzodiazepines such as diazepam (Valium), alprazolam (Xanax), triazolam (Halcion), or lorazepam (Ativan) are a drug class at high risk for abuse and addiction. These drugs are prescribed medically to lower anxiety or for sleep. Clues of abuse include a slurred speech, poor concentration, lowered inhibitions, and impaired coordination. Like opiates, slowed breathing are risks with benzodiazepines, especially when combined with alcohol and other CNS depressants. Addiction to benzodiazepines can lead to a severe withdrawal, and these drugs must often be slowly discontinued. Common street names include 'candy', 'downers', 'tranks', and 'sleeping pills'.

Not Just For Athletes: Anabolic Steroid Abuse

The unlawful use of muscle-boosting steroids as performance enhancing drugs, seen in college-level, Olympic and professional sports, has resulted in a unique set of international anti-doping standards. Anabolic steroids such as testosterone have legitimate uses like hypogonadism - the cause of "Low-T'. But steroid addiction is evidenced by continued use despite physical problems, withdrawal symptoms, and a drug-seeking behavior. Those who abuse steroids may experience side effects such as fatigue, loss of appetite, insomnia, reduced sex drive, and steroid cravings. The most dangerous of the withdrawal symptoms is depression which can leads to suicides.

Stimulant Addiction: Ritalin and Adderall

Stimulants used for attention deficit hyperactivity disorder (ADHD) - drugs like methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) - may be abused by students and others to give an edge to mental performance. Ritalin and Adderall have legitimate medical uses for ADHD. Unfortunately, these drugs may be easily accessed from the home medicine cabinet, and shared or sold among friends or coworkers. In the NIH's 2013 Monitoring the Future Survey, 2.3% of 12th graders had used Ritalin non-medically in the last 12 months, and 7.4% had used Adderall in the last 12 months. Adderall was the most commonly abused prescription drug by high school seniors; marijuana was #1 overall.

Sleep Medications: The Infamous Ambien

The nonbenzodiazepines are used short-term for trouble falling or staying asleep. These drugs, which include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) are associated with a wide array of side effects such as impaired morning driving and unusual sleep-related behaviors. They can also foster chronic use due to rebound insomnia. Physical and psychological addiction can be seen with these drugs; the best way to handle insomnia is to address what's causing your lack of sleep in the first place. If you feel you have become dependent on these drugs, work with your doctor to slowly taper off of them to help prevent unpleasant withdrawal symptoms.

Popular Among Teens: Cough Syrups

Cough suppressants that contain dextromethorphan (DXM) can be addictive, and are especially popular among high school students. When taken in large quantities, DXM produces a distorted awareness, altered time perception and hallucinations. In the 2013 National Institute on Drug Abuse’s (NIDA) Monitoring the Future Survey 4 percent of teens admitted to abusing cough medicines. Common brand names of over-the-counter DXM cough syrups include Robitussin DM, Delsym and Vicks DayQuil. "Robo", "Poor Man's Ecstasy" "Purple Drank" and "Triple C" are common street or slang names often used for DXM cocktails.

Is There a Link Between Prescription Drug Abuse and Heroin Use?

Recent statistics from the National Institute of Drug Abuse show that 1 out of 15 people who take prescription painkillers for recreational use will try heroin within 10 years. And this problem is growing - in 2004, 1.4 million people abused or were dependent on pain medications and 5 percent used heroin. By 2010, 1.9 million people abused or were dependent on pain medications and 14 precent used heroin.

Studies report heroin users are 3 times more likely to be addicted than users of prescription painkillers (54% vs. 14%). Relative to the high cost of prescription painkillers on the street, heroin is cheap - and this contributes to it's increasing popularity among addicts.

How Can We Best Help Someone Who is Addicted?

If you recognize signs of addiction in someone, take steps to help guide them to recovery. A comprehensive evaluation (medical, psychological and social) can identify the various causes of the drug abuse and addiction. The first goal is a safe detoxification (drug withdrawal). During detoxification in a hospital or clinic, the dose of the drug (or substitute) is gradually reduced to lessen the withdrawal symptoms.

Other treatment may be needed, such as behavioral therapies, counseling or group therapy that can help a person address the addiction. Consider calling the National Substance Abuse Helpline at 1-800-662-HELP (4357) for free and confidential treatment referral.

Finished: Prescription Drug Addiction - Top 18 Facts for You and Your Family

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