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Prescription Drug Addiction: Top Facts for You and Your Family

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Mar 24, 2020.

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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.

Over 70,000 drug overdose deaths occurred in the United States in 2017. Opioids were involved in roughly 47,600 of these overdose deaths in 2017, or about 68% of all drug overdose deaths.

Causes of addiction are multifaceted:

  • Research from a few years ago revealed that when U.S. doctors gave their patients narcotic painkillers, 99% of them handed out prescriptions that exceed the federally recommended three-day dosage limit.
  • Plus, research reveals many people who experience an overdose are given another prescription for an opioid with 6 months.
  • Some peope who become addicted started their addiction with a legal prescription given to them by their doctor.
  • Leftover pain medications left in medicine cabinets or around the house can be stolen or given to friends or other family members.

Misuse of Opioids: A Significant Problem

The abuse of prescription drugs has risen to unprecedented levels. It's shocking: on average over 130 people die everyday from opioid (narcotic) overdoses. In fact, death from narcotic prescription painkillers -- drugs like oxycodone, hydrocodone, and fentanyl -- have increased sixfold since 1999, as noted by the CDC.

Opioid abuse is a significant problem that must be addressed. In fact, the U.S. government allocates billions of dollars to fight this war each year.

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 on Vaping, Marijuana

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 partners.

The 2019 results are the most recent. Year over year -- thousands of 8th, 10th and 12th graders -- are surveyed from hundreds of U.S. public and private schools.

Marijuana and hashish were the top abused drug in teens overall at 35.7%, a very slight decrease for cannabinoids compared to 2018 (35.9%).

From 2008 to 2018 daily marijuana use was mostly steady among 8th, 10th, and 12th graders. In 2019, daily marijuana use for each grade was:

  • 8th grade: 1.3% - up from 0.7% in 2018 (almost doubled, a concerning trend in a very young age group)
  • 10th grade: 4.8% - up from 3.4% in 2018
  • 12th grade: 6.4% - up from 5.8% in 2018

A significant rise in marijuana use is evident in the 8th and 10th grade groups compared to the previous year.

On a positive trend, opioid misuse are at record lows for teens.

E-vaporizer ("vaping") use is on the rise, and a significant concern. Nearly 2 in 5 students in 12th grade report past-year tobacco vaping, raising concerns about the impact on brain health and potential for addiction. Both marijuana and tobacco can be vaped. The FDA and the American Academy of Pediatrics are working on significant regulations to help curtail this rapid rise in teen vaping.

In 2019, past-year vaping of marijuana for each grade was:

  • 8th grade: 7%
  • 10th grade: 19.4%
  • 12th grade: 20.8%

Alcohol and Opioid Use in Teens

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 13.8% of 12th graders and 8.7% of 10th graders. These numbers seem high, but compare this to a peak of 31.5% of 12th graders reportedly binge drinking in 1998. Binge drinking continues on a downward trend since the mid- to late 1990s.

What about prescription drugs, also a concern for teens.

  • Sedatives and tranquilizers topped the list at 5% of 12th graders in 2018, a switch from 2017 when it was amphetamines.
  • What about opioids? Past-year misuse of Vicodin and OxyContin among 12th graders has dropped dramatically in the past 15 years, from 10.5% in 2003 to 1.1% in 2019 for Vicodin, and from 4.5% in 2003 to 1.7% in 2019 for OxyContin.

Amphetamines used for ADHD such as Adderall have seen a significant drop in abuse among 10th and 12th graders, but a rise for 8th graders from 1.3% in 2014 to 2.5% in 2019.

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.

How Quickly Can I Become Addicted to a Drug?

There is no easy answer to this 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.

are examples of some of the potent opiate prescription 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.

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.

Learn More: Know Your Naloxone: Save a Life

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

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 to help curb the abuse of immediate-release products. 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. Other long-acting, but abuse-deterrent, pain medications include:

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, and possible death when combined with alcohol.

Barbiturates are now most often replaced by benzodiazepines or non-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)
  • 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, memory loss, 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:

  • Depression
  • Memory impairment
  • Anxiety
  • Insomnia
  • 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:

  • Fatigue
  • Loss of appetite
  • Insomnia
  • Reduced sex drive
  • Steroid cravings
  • Depression

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 2019 Monitoring the Future Survey, their most recent report, 3.9% of 12th graders had abused Adderall in the previous year, down from 6.8% in 2014.

Sleep Medications: The Nonbenzodiazepines

The nonbenzodiazepines are used short-term for trouble falling or staying asleep. These drugs include:

and 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) 2018 Monitoring the Future Survey 3.4% of 12th graders reported abusing cough and cold medicines in the past 12 months; a rise of about 0.2 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 heroin use; the most common pathway.

Heroin is cheap illicit drug relative to the high cost of prescription painkillers on the street. This low costs 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. In the intravenous form it is used as an adjunct in surgery.

Fatalities due to abuse of fentanyl are on an upward trajectory. In fact, in 2018 it was reported by the CDC that fentanyl was the top opioid leading to overdose deaths in the U.S.

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.

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, cocaine, or pressed into counterfeit pills prior to sale on the streets. 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 cut into drugs in overdose cases.

Learn More: Fentanyl Abuse: Top 11 Facts About This Potent and Deadly Opioid

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. Maintenance medications may include: Sublocade, Vivitrol, Bunavail, or Suboxone.
  • Behavioral treatment, counseling or group therapy can bolster a successful 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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Further information

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