Prescription Drug Addiction: Top Facts for You & Your Family
Medically reviewed on Mar 28, 2018 by L. Anderson, PharmD.
Prescription Drug Abuse - A National Epidemic
Addiction does not always start with abuse of illicit drugs like heroin. In fact, prescription narcotic analgesics -- pain medications that have been legally prescribed to a patient from a healthcare provider -- sits at the heart of the U.S. epidemic of fatal overdoses.
On average, 115 Americans die every day from an opioid overdose based on data from the U.S. Centers for Disease Control and Prevention (CDC). From 2000 to 2016, more than 600,000 people died from drug overdoses. In 2016 alone, there were more than 63,600 drug overdose deaths in the U.S., based on a report from the CDC released in December 2017.
Causes of addiciton are multifaceted:
- Research from 2016 reveals that when U.S. doctors give their patients narcotic painkillers, 99% of them hand out prescriptions that exceed the federally recommended three-day dosage limit.
- Plus, a 2017 study revealed many people who experience an overdose are given another prescription for an opioid with 6 months.
Misuse of Opioids: A Significant Problem
The abuse of prescription drugs has risen to unprecedented levels. It's shocking: over 115 people die everyday from opioid (narcotic) overdoses. In fact, death from narcotic prescription painkillers -- drugs like oxycodone, hydrocodone, and fentanyl -- have increased fivefold since 1999, as noted by the CDC.
According to the 2016 National Survey on Drug Use and Health from SAMHSA, 11.8 million Americans (about 4.4% of the population) have misused opioids in the previous year, with over 97% involvng prescription painkillers. These opioids primarily involved hydrocodone, oxycodone and fentanyl. Eight percent of opioid misusers used heroin.
Opioid abuse is a significant problem that must be addressed. The U.S. government has now allocated $3.2 billion in the 2018 budget to fight this war. But opioid painkillers are not the only prescription drug subject to abuse and addiction.
The Science of Addiction: A Chronic Disease That Deserves Treatment
How does addiction happen?
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. Environmental and social signals can also trigger further misuse of drugs.
While someone who becomes addicted to drugs is always at risk for relapse, there are effective treatments for drug detoxification and maintenance.
Teen Statistics - What's Up?
The Monitoring the Future Survey is a yearly survey conducted since 1975 of teen substance abuse (drugs, alcohol, cigarettes and related attitudes) funded and run by the National Institute of Health (NIH) and the University of Michigan.
The 2017 results are available. Over 43,000 students -- 8th, 10th and 12th graders -- were surveyed from 360 U.S. public and private schools.
Marijuana and hash (37.1%) are still the most widely used drugs. Roughly 5.9% of 12th graders report daily marijuana use, and it's use has held steady for the past few years. About 71% of 12th graders do not see regular marijuana use as harmful, but 64.7% disapprove of its regular use.
Synthetic marijuana (Spice or K2) use declined for 8th, 10th, and 12th graders, documented at about 3.7%.
E-vaporizer use is on the rise, with one in three 12th graders reporting use, but not usually for marijuana; they say they are inhaling primarily flavorings and nicotine. And for 12th grade students who smoke traditionally, more are smoking marijuana (5.9%) than cigarettes (4.2%).
More NIH Teen Drug Abuse Statistics
Alcohol is always a concern with teens. Binge drinking -- defined as having five or more drinks in a row in the last two weeks -- was reported by 16.6% of 12th graders and 9.8% of 10th graders. These numbers seem high, but compare this to a peak of 31.5% of 12th graders reportedly binge drinking in 1998.
What about prescription drugs, also a concern for teens. Amphetamines (5.5%) used for ADHD -- like Ritalin or Adderall -- account for the top drugs abused by 12th graders in the past year. Tranquilizers and opioids other than heroin account for 4.7% and 4.2% of prescription drugs, respectively. However, misuse of Vicodin has dropped dramatically in the last 15 years.
Overall, the top prescription drugs abused by teens included the stimulants like Adderall (amphetamine mixed salts), tranquilizers, opioids like Vicodin (acetaminophen/hydrocodone), cough medicines and sedatives.
A head's up for parents: ADHD medications and painkillers like hydrocodone (Vicodin, Lortab) are often easily accessible from the home medicine cabinet. Put them under lock and key or safely dispose of them if not needed.
In general, illicit drug use showed a decline in use for adolescents, although relatively few drugs individually exhibited a significant decline in use in 2017 based on the 2017 Monitoring the Future Survey. LSD, cocaine, MDMA, and inhalants all came in at under 3.3%; heroin was recorded as being misused by 0.4% of those teens surveyed.
Is Marijuana Use Going Up, Along With Opioids?
Marijuana use continue to be more accepted in the U.S. as additional states legalize recreational use.
In the 2016 National Survey on Drug Use and Health, illicit drug use estimates continue to be driven primarily by marijuana use and the misuse of prescription pain relievers. In 2016, 28.6 million people aged 12 or older used any illicit drug in the past 30 days. This equates to about 1 in 10 Americans age 12 and over overall, but can be as high as 1 in 4 for young adults aged 18 to 25.
Among people aged 12 or older, 24 million were current users of marijuana. The percentage of people aged 12 or older who were current marijuana users in 2016 was higher than the percentages from 2002 to 2015.
About 3.3 million people were actively misusing prescription pain medications. Lesser amounts of people were misusing drugs like cocaine, heroin, or hallucinogens.
In 2016, an estimated 11.8 million people misused opioids in the past year, according to this survey. More than half who used pain relievers stated they got them from a friend or relative, and 6 out of 10 respondents said they used them for pain.
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 or self history of addiction. Each person is different in their vulnerability to drug addiction.
If you've been prescribed an opioid for pain, for example, a hydrocodone product, try to limit use to 3 days if possible, and substitute ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) when you can. Talk to your doctor about this.
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.
- oxymorphone (Opana ER)
- oxycodone (Oxycontin)
- hydrocodone (Zohydro ER)
are examples of some of the potent opiate prescription medications at the center of the U.S. addiction epidemic.
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 like benzodiazepines or tranquilizers.
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:
In January 2015 the FDA approved a new abuse-deterrent formulation of Zohydro ER, an extended-release hydrocodone product by Zogenix.
Zohydro ER contains an inactive ingredient that immediately forms a viscous gel when crushed and dissolved in liquids or solvents by those attempting to abuse. However, it is still abusable via the oral route.
Accidental ingestion of even one dose of Zohydro ER, especially by children, can result in a fatal overdose of hydrocodone. Patients should NOT use any alcohol while taking this drug, or any opioid, for that matter.
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), Troxyca ER (naltrexone/oxycodone), Arymo ER (morphine sulfate extended-release tablet), and Vantrela ER (hydrocodone bitartrate) are other long-acting, but abuse-deterrent, pain medications.
Barbiturates: An Older Drug Class
Barbiturates are an older, but very abusable, class of prescription drug.
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:
These are used for sedation or anesthesia (to help you fall asleep for surgery). They may also be 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.
Benzodiazepines: Addiction Can Lead to Difficult Withdrawal
Benzodiazepines such as:
- diazepam (Valium)
- alprazolam (Xanax)
- triazolam (Halcion)
- lorazepam (Ativan)
are a drug class at high risk for abuse and addiction. These drugs are prescribed medically to lower anxiety, for sleep, and to lessen panic symptoms.
Clues of abuse include a slurred speech, poor concentration, lowered inhibitions, and impaired coordination. Common street names include 'candy', 'downers', 'tranks', and 'sleeping pills'.
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 symptoms, and these drugs must often be slowly discontinued over time (often months) to prevent these effects. Your doctor will help you to safely, but slowly, stop these drugs.
Common benzodiazepine withdrawal symptoms include:
- Memory impairment
- Fast heart rate
- Increased sweating or night sweats
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 can have legitimate uses like hypogonadism. 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:
- Loss of appetite
- Reduced sex drive
- Steroid cravings
The most dangerous of the withdrawal symptoms is depression which can lead 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 and legal medical uses for ADHD. Unfortunately, these drugs may be easily accessed from the home medicine cabinet, and shared or sold among friends, students, or coworkers.
In the NIH's 2017 Monitoring the Future Survey, their most recent report, 1.3% of 12th graders had used Ritalin non-medically in the last 12 months, and 5.5% had used Adderall in the last 12 months. These numbers on stimulants have declined slightly when compared to 2016. Nonetheless, mixed amphetamine salt (Adderall) was the most commonly abused prescription drug by high school seniors; marijuana and hashish was #1 overall at 37.1%, a slight increase for cannabinoids compared to 2016.
Sleep Medications: The Nonbenzodiazepines
The nonbenzodiazepines are used short-term for trouble falling or staying asleep. These drugs, which include:
are associated with a wide array of side effects such as impaired morning driving and unusual sleep-related behaviors. They can also foster long-term use due to rebound insomnia. Rebound insomnia is a difficult period of trying to get to sleep after stopping a medication used for that very purpose, such as sleeping pills.
Physical and psychological addiction can be seen with these drugs; the best way to handle insomnia is to attempt to address what's causing your lack of sleep in the first place - stress, caffeine, lack of exercise, late-night electronics.
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. They are easily accessible over-the-counter (OTC) without a prescription at most pharmacies and grocery stores.
"Robo", "Poor Man's Ecstasy" "Purple Drank" and "Triple C" are common street or slang names often used for DXM cocktails.
When taken in large quantities, DXM produces:
- a distorted awareness
- altered time perception
- possible hallucinations
As reported in the National Institute on Drug Abuse’s (NIDA) 2017 Monitoring the Future Survey 3.2% of 12th graders reported abusing cough and cold medicines in the past 12 months; a drop of about 1 percentage point from the previous year.
Common brand names of over-the-counter DXM cough syrups include:
Is There a Link Between Prescription Drug Abuse and Heroin Use?
Transitioning from prescription opioids to heroin use is not common; roughly 4 out 100 people transition from prescription opioid use to heroin within 5 years.
Recent data from the National Institute of Drug Abuse show that there are 3 paths to heroin addiction:
- Prescription opioid abuse leading to to heroin use
- Cocaine use leading to heroin use (to "come down")
- Polydrug use (that is, use of multiple substances) leading to to heroin use; the most common pathway.
Heroin is cheap relative to the high cost of prescription painkillers on the street, and this contributes to it's increasing popularity among those dependent upon opioids.
Fentanyl Deaths Are On the Rise
Fentanyl (Duragesic, Fentora, Lazanda, Subsys) is a synthetic opioid used for severe pain, often in the form of transdermal patches, lozenges, or sprays. It is typically used to treat advanced cancer pain.
Fatalities due to abuse of fentanyl are on an upward trajectory. Fentanyl is very potent; it is 50 times more potent than heroin and 100 times more potent than morphine. This makes it much more powerful than any prescription opioid.
It's abuse, illegal sale, and related-deaths in the U.S. have been increasing in recent years. According to the CDC, most of the illicit sale of fentanyl is illegally produced fentanyl, not diverted prescription fentanyl. It may be mixed with heroin or cocaine prior to sale on the streets, and users may not be aware of these additions, which can lead to a deadly overdose. Carfentanyl, a much more potent cousin to fentanyl and used as a large animal tranquilzer, has also been seen in overdose cases.
The rate of drug overdose deaths involving synthetic opioids, such as fentanyl and tramadol (ConZip, Ultram, Ultram ER) increased by 88% per year from 2013 to 2016. Between 2015 and 2016, the death rate doubled from 3.1 to 6.2 per 100,000 people.
In July 2016, the Drug Enforcement Administration (DEA) issued a new nationwide report indicating hundreds of thousands of counterfeit prescription pills have been entering the U.S. drug market since 2014, some containing deadly amounts of fentanyl and fentanyl analogs.
How Can We Best Help Someone Who is Addicted?
If you recognize signs of addiction in someone, please take steps to help guide them to recovery. It may be as simple as giving them a ride to the doctor, or providing a local recovery group phone number.
A comprehensive evaluation, including medical, psychological and social risks, can help identify the various causes of the individual's drug abuse and addiction. Other medical issues, such as hepatitis C, HIV, or depression, can also be identified and addressed.
The first goal is a safe and successful detoxification (drug withdrawal) in a medically supervised facility. During detoxification in a hospital or clinic, the dose of the drug (or another substitute) is gradually reduced to lessen the negative effects of withdrawal. Maintenance treatment can then help to prevent further abuse of potent and possibly fatal narcotics. Behavioral treatment, counseling or group therapy can add to the success medical treatment.
If you are a caregiver or housemate of someone you know with an opioid addiction or who uses high doses of opioids, get the opiate reversal agent naloxone (Narcan, Narcan Nasal) from your pharmacy to have on hand in case of an overdose emergency. Many U.S pharmacists can now provide this without a prescription.
Consider calling the National Substance Abuse Helpline at 1-800-662-HELP (4357) for free and confidential treatment referral.
Finished: Prescription Drug Addiction - Top Facts for You and Your Family
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