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Prescription Drug Addiction: Top Facts for You and Your Family

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 24, 2021.

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 67,000 drug overdose deaths occurred in the United States in 2018, the latest stats from the CDC Opioids were involved in roughly 46,000 of these overdose deaths in 2018, or about 70% of all drug overdose deaths.

Causes of addiction are multifaceted:

  • Research has 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, many people who experience an overdose are given another prescription for an opioid with 6 months.
  • Some people who become addicted started their addiction with a legal prescription given to them by their doctor.
  • Leftover pain medications stored 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 many times over since 1999, as noted by the CDC. Heroin also continues to play a role, especially in 2010-2013.

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 2020 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 2020, daily marijuana use for each grade was:

  • 8th grade: 1.1% - down from 1.3%% in 2019 (but still a concerning trend in this very young age group)
  • 10th grade: 4.4% - down from 4.8% in 2019
  • 12th grade: 6.9% - up from 6.4% in 2019

E-vaporizer ("vaping") use is on the rise, and still a significant concern in 2020. Both marijuana and tobacco can be vaped. Nearly one-third of students in 12th grade report past-year tobacco vaping, raising concerns about the impact on health and potential for addiction. The FDA and the American Academy of Pediatrics are working on significant regulations to help curtail this rapid rise in teen vaping.

Vaping of marijuana In 2020, past-year vaping of marijuana for each grade was:

  • 8th grade: 8.1%
  • 10th grade: 19.1%
  • 12th grade: 22.1%

Alcohol, Amphetamine 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 16.8% of 12th graders and 9.6% of 10th graders in 2020. 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 other substance abuse for teens? The percentage of eighth graders who misused amphetamines, inhalants, and cough medicine over the past 12 months continues to gradually increase. In 2019, 4.1% of eighth-graders reported misuse of amphetamines such as Ritalin and Adderall, and in 2020 that number rose to 5.3%

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 no longer 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 or less if possible, and substitute ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) when you can. Talk to your doctor about this, and how to control short-term, acute pain.

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. Some names of opiate prescription medications at the center of the U.S. addiction epidemic include:

  • morphine
  • oxymorphone
  • oxycodone (Oxycontin)
  • hydrocodone (Zohydro ER)
  • codeine
  • methadone
  • fentanyl

Also concerning is that many of these medications (such as Lorcet, Tylenol with Codeine #3, or Vicodin) may also contain acetaminophen, which in itself can be toxic to the liver at high 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) 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: Uses and Warnings

In January 2015 the FDA approved a new abuse-deterrent formulation of Zohydro ER, an extended-release hydrocodone product.

  • 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 it. However, it can still abused via the oral route.
  • Taking cut, broken, chewed, crushed, or dissolved Zohydro ER enhances drug release and increases the risk of overdose and death.
  • With intravenous (IV) abuse, the inactive ingredients in Zohydro ER can result in death, local tissue necrosis, infection, pulmonary granulomas, increased risk of endocarditis and valvular heart injury, embolism, and death.
  • Healthcare providers should consider prescribing naloxone for the emergency treatment of opioid overdose with Zohydro ER.

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. It can be fatal.

Learn more: Zohydro ER (in more detail)

Hysingla ER: Another Abuse Deterrent Formulation

Many more abuse-deterrent formulations are entering the market to help curb the abuse of immediate-release products. But this does not mean these products are safer.

The FDA approved Hysingla ER (hydrocodone bitartrate) in 2014. It is an acetaminophen-free, extended-release (ER) opioid for severe pain requiring daily, long-term treatment and for which no alternatives exist for the patient.

The lack of acetaminophen (Tylenol) in the product can help to lower the risk of toxicity due to excessive doses of acetaminophen. As with other abuse-deterrent forms, Hysingla ER abuse-deterrent properties may reduce, but not totally prevent, abuse of the drug. People can still abuse it by swallowing the intact tablet.

Do not drink alcohol or take benzodiazepines or other nervous system depressant-type medicines with Hysingla ER. Dangerous side effects or death could occur.

Swallow Hysingla ER whole if you are prescribed this medicine. Do not cut, break, chew, crush, dissolve, snort, or inject Hysingla ER because this may cause you to overdose and die. Crushing, chewing, or dissolving the tablets can cause rapid release and absorption of a potentially fatal dose of hydrocodone. The tablet forms a thick gel and cannot be easily prepared for injection, and resists passage through a hypodermic needle.

Serious, life-threatening, or fatal respiratory depression may occur with use of Hysingla ER, and even once dose in a child can be fatal. Keep out of reach and out of sight of children in a secure location not accessible by others, including visitors to the home.

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 medicines 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. Your doctor might prescribe these drugs to help lower anxiety, for short-term help with sleep, and to lessen panic attack 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 or stopped breathing (respiratory depression) is a risk with benzodiazepines, especially when combined with alcohol and other CNS depressants and opiates. This effect may lead to death.

Addiction to benzodiazepines can lead to a severe withdrawal symptoms, and these drugs must often be slowly discontinued (often over 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. But steroids can be abused by the general public as well.

Anabolic steroids such as testosterone can have legitimate and legal prescription 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 boost 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. Parents, in conjunction with teachers and their healthcare provider should assess the risk of abuse in their family members and consider secure storage areas, if needed.

In the NIH's 2020 Monitoring the Future Survey, their most recent report, 5.3% of 8th graders had abused ampehtamine-type drugs in the previous year, up from 4.1% in 2019.

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 dextromethorphan cocktails.

When taken in large quantities, dextromethorphan produces:

  • a distorted awareness
  • altered time perception
  • possible hallucinations

As reported in the National Institute on Drug Abuse’s (NIDA) 2020 Monitoring the Future Survey 4.6% of 8th graders reported abusing cough and cold medicines in the past 12 months; a rise of about 1.4% from the previous year.

Common brand names of over-the-counter dextromethorphan 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 can be a cheaper 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. Dangerous combinations of heroin + fentanyl are often found on the streets and can be deadly.

Fentanyl Deaths Are On the Rise

Fentanyl (brand name examples: 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 2018 it was reported by the CDC that fentanyl was the top opioid leading to overdose deaths in the U.S. The latest drug overdose death counts through May 2020 suggest even higher rates of overdose deaths during the COVID-19 pandemic.

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 for a boost to the euphoric effects. Users may not be aware of these additions, which can lead to a deadly overdose.
  • Carfentanyl is a much more potent cousin to fentanyl. It is used in veterinary medicine as a large animal tranquilzer, but has also been found to be cut into illicit drugs, leading to fatal overdose.

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, strongly consider taking 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. You could help save a life.

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 mental health issues can also be identified and addressed. The need for social services, such as housing or food needs, can be addressed.

  • The first goal of addiction 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. This is safely performed under medical supervision.
  • Maintenance treatment can then help to prevent further abuse of potent and possibly fatal narcotics. Maintenance medications may include: Sublocade, Vivitrol, Suboxone, or Zubsolv.
  • 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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.