Prescription Drug Addiction: Top 18 Facts for You & Your Family
Medically reviewed on Feb 9, 2017 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 US Attorney General stated that the growing number of deaths from prescription painkiller overdoses is an 'urgent and growing public health crisis'.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA) most recent report, 4.3 million Americans engaged in non-medical use of prescription painkillers in the last month. Plus, over 50% of people who misused prescription painkillers got them from a friend or relative for free, and over 22% got them from a doctor. But opiate painkillers are not the only prescription drug subject to abuse and addiction.
Teen Statistics - What's Up?
After marijuana and hash (36%), amphetamines (6.7%) like Ritalin or Adderall account for most of the top drugs abused by 12th graders in the past year, according to the National Institute of Health (NIH) 2016 Monitoring the Future Survey. Past year abuse of Vicodin and all prescription opioids had dropped dramatically in the last 5 years, from 7.5% to 2.9% among 12th graders.
Five of the 12 drugs that were surveyed among high school seniors were prescription drugs. The top prescription drugs abused by teens included the stimulants like Adderall (amphetamine mixed salts), tranquilizers, opioids like Vicodin (acetaminophen/hydrocodone), sedatives and cough medicines. A head's up for parents: ADHD medications and painkillers like hydrocodone are often easily accessible from the home medicine cabinet.
How Are People Getting Prescription Drugs for Recreational Use?
In the 2015 National Survey on Drug Use and Health, an estimated 119 million Americans aged 12 or older used prescription psychotherapeutic drugs in the past year, representing 44.5 percent of the population. More than half who used pain relievers, tranquilizers, stimulants, and sedatives got the prescription drugs 'from a friend or relative for free.' Nearly one-third 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, 5 percent of respondents bought pain relievers from a drug dealer or stranger. 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.
How does this happen? 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 or self 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 addition, 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 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.
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: 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 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), 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 and legal 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 2014 Monitoring the Future Survey, their most recent report, 1.8% of 12th graders had used Ritalin non-medically in the last 12 months, and 6.8% had used Adderall in the last 12 months. Adderall was the most commonly abused prescription drug by high school seniors; marijuana/hashish was #1 overall at 35%.
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 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. When taken in large quantities, DXM produces a distorted awareness, altered time perception and hallucinations. As reported in 2015 in the National Institute on Drug Abuse’s (NIDA) Monitoring the Future Survey 4.1 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?
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. In fact, half of heroin users reported using prescription opioids before starting heroin. And this problem is growing - a 2016 report noted that heroin use and related deaths have been climbing due to a cheaper cost of heroin and an easier access. The United Nations Office on Drugs and Crime reported that between 26.4 million and 36 million individuals abuse opioids worldwide, with 467,000 of them being addicted to heroin.
Studies report heroin users are 3 times more likely to be addicted than users of prescription painkillers (54% vs. 14%). Heroin is cheap relative to the high cost of prescription painkillers on the street, 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
- National Institute on Drug Abuse (NIDA). The Science of Drug Abuse and Addiction. Infographics. Accessed Feb 9, 2017 at http://www.drugabuse.gov/related-topics/trends-statistics/infographics
- Drugs.com. Prescription Painkillers Trail Only Marijuana in Abuse Rates, Report Shows. Accessed Feb 7, 2017 at https://www.drugs.com/news/painkillers-trail-only-marijuana-abuse-rates-report-shows-42486.html
- National Institute on Drug Abuse (NIDA). Drug Facts. Prescription and Over-the-Counter Medications. Accessed Feb 4, 2017 at https://www.drugabuse.gov/sites/default/files/rxandotcdrugfacts_final_12152015.pdf
- Pharmacy Times. The Connection Between Prescription Opioids and Heroin. September 12, 2016. Accessed Feb. 9, 2017 at http://www.pharmacytimes.com/contributor/shelby-leheny-pharmd-candidate-2017/2016/09/the-connection-between-prescription-opioids-and-heroin
- National Institute on Drug Abuse. The Science of Drug Abuse and Addiction. Frequently Asked Questions. Accessed Feb 8, 2017 at http://www.drugabuse.gov/frequently-asked-questions#quickly
- Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH) Services. Accessed Feb 6, 2017 at https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm.
- National Institute on Drug Abuse. Infographics. Accessed Feb 9, 2017 at https://www.drugabuse.gov/related-topics/trends-statistics/infographics
- National Institute on Drug Abuse. Monitoring the Future 2016 Survey Results. Accessed Feb. 9, 2017 at https://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2016-survey-results
- SAMHSA. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. Accessed Feb 4, 2017 at https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm.
- Safety News Alert. 7 startling facts about prescription painkillers. Accessed Feb 9, 2017 at http://www.safetynewsalert.com/7-startling-facts-about-prescription-painkillers/
- Drugs.com. Groups Push FDA to Revoke Approval of Highly Potent Painkiller. Accessed Feb 6, 2017 at https://www.drugs.com/news/groups-push-fda-revoke-approval-highly-potent-painkiller-50563.html
- The United States Department of Justice. Office of Public Affairs. Attorney General Holder, Calling Rise in Heroin Overdoses ‘Urgent Public Health Crisis,’ Vows Mix of Enforcement, Treatment. Accessed Feb 8, 2017 at http://www.justice.gov/opa/pr/2014/March/14-ag-246.html