In 2017, 18 million Americans reported abusing prescription drugs at least one time (2). Many of these drugs are highly dangerous, addictive, and even fatal. Despite the dangers associated with many prescribed medications, prescription drug abuse is often overlooked by health care professionals, addiction specialists, and even patients themselves. There are several reasons for this, including (2, 3):
- People associate addiction with the use of illicit drugs, not prescribed drugs
- People believe that prescription drugs are safe and non-addictive
- People don’t ask questions about medications and their potential risks and side effects
- Prescribing professionals may not educate patients about the risks associated with prescribed medications, including the risk of dependence
- There is less stigma associated with prescription drugs compared to illicit drugs
- Using a controlled substance is not illegal if a person has a prescription, and will not result in consequences if a drug screen yields positive for a prescribed drug
- Health or mental health professionals may not ask about dependence in people with valid prescriptions for medications
- People assume the medication is not being misused when it is prescribed to treat a valid medical issue
For all of the above reasons, prescription misuse can go undetected for long periods of time, making a person more vulnerable to developing an addiction. In fact, the Substance Abuse and Mental Health Services Administration cites prescription drug abuse as the fastest growing drug problem in the United States, and is disproportionately affecting teens and young adults (3).
Commonly Abused Prescription Drugs
The most commonly abused prescription drugs are opioids, stimulants, and benzodiazepines, which are controlled medications regulated by the DEA because of their high potential for abuse and addiction. Opioids are some of the most commonly abused prescription drugs, and also the most deadly. Opioids including heroin, synthetics opioids like fentanyl and prescription painkillers account for two thirds of all overdose deaths in the US. Unfortunately, over-prescribing opioids continues to be a major problem and in many states, there are enough opioid prescriptions to account for each resident (1).
Benzodiazepines are another commonly abused prescription medication, and include medications like Xanax, Valium, and Ativan, which are most commonly prescribed to people with anxiety disorders. When used long term, the use of these medications can lead to the development of tolerance, causing people to increase their dose which also increases their risk of addiction.
Once addicted, people using benzodiazepines often cannot stop using the medication without medical monitoring because there is a high risk for medical problems including seizures. Unmonitored, withdrawal from benzodiazepines can even be fatal. Even those who are able to avoid the medical hazards during the withdrawal period may experience the psychological symptoms of withdrawal, which include intense “rebound” anxiety that can strengthen cravings.
The third most common type of prescription drug that gets abused are stimulant medications like Adderall and Ritalin, which are prescribed to people struggling with ADD or ADHD, and sometimes to people with sleep disorders like narcolepsy. These medications are often used as “study drugs” by college students and even young professionals working to gain a competitive edge. The long term use of stimulants can lead to several health issues including heart problem, loss of executive functioning, and weight loss.
Signs of Prescription Drug Abuse
Many people are not made aware of the signs that indicate prescription drug abuse. Prescription drug abuse describes taking any unprescribed medication or using a prescribed medication more often or in higher doses than prescribed, or using the medication for off-label uses (3). Signs of prescription drug abuse include:
- Running out of a prescription early
- Taking higher doses than prescribed
- Taking more frequent doses than prescribed
- Taking for recreational reasons
- Using the medication to cope with stress or difficult emotions
- Intensifying effects with alcohol or other drugs
- Having frequent thoughts, urges or cravings for the medicine
- Becoming anxious when running low on the medicine
- Feeling like you need the medicine to feel normal or ok
- Giving up other activities because of the medicine’s effects
- Not being able to function or work because of the medicine’s effects
- Driving or doing other unsafe tasks while under the influence of the medicine
- Conflict with loved ones who are concerned or upset by your use of the medicine
- Doctor shopping to get more medicine, a sooner refill or a higher dose
- Resorting to buying the medicine illegally when you run out
- Continuing to use the medication when it negatively affects you, your life, or functioning
- Feeling physically ill when you miss a dose
- Feeling intense distress, anxiety, or depression when you stop the medicine
- Trying to cut back or stop but not being able to
- Trying to hide or minimize how much you are taking
Prevention of Prescription Drug Abuse
When people are aware of the risks and dangers of prescription drugs, they can take preventative measures to avoid becoming dependent. This is especially important for people who are at higher risk of developing an addiction because of one or more of the following factors:
- Having a family history of addiction
- Having a mental health condition like depression, PTSD or anxiety
- Having a history of substance use issues
- Being naturally more impulsive or having trouble making good decisions
- Being under a lot of stress or experiencing emotional distress
Even people who do not have any of the risk factors listed above should be vigilant for signs of addiction, especially if they are prescribed a controlled substance. Controlled substances are those which have been identified as carrying a risk for abuse and dependence, and typically require people to show a picture ID and sign a form at the pharmacy. People who are prescribed a controlled substance should take the following precautions to avoid dependence:
- Only take the medication in the dose prescribed, at the time recommended, and for the condition or symptoms it is prescribed to treat
- Learn more about the medication and possible risks and side effects online, or from the doctor or pharmacist prescribing the medication
- Ask the prescribing professional about any non-controlled alternatives that could be effective in treating your condition
- Ask your doctor if it would be recommended to take “drug holidays” where you take a day or two off to avoid developing a tolerance or becoming dependent (more common in stimulants prescribed for ADD/ADHD and as-needed medication for anxiety)
- Avoid possible drug interactions by not drinking alcohol or taking other medications without consulting with your prescriber or pharmacist about potential interactions
- Keep track of side effects when starting a new medication and discuss these with your prescriber at any follow-up appointment
- Be aware of developing a tolerance to the medication, or finding the original dose isn’t working, and be explore options with your prescriber other than asking for an increased dose
- Maintain open conversations with your prescriber and other professionals involved in your treatment about any signs of dependence you are noticing
Prescription medications help many with debilitating physical and mental health conditions, and are sometimes necessary to help manage symptoms. It is important to weigh the potential benefits of any medication against the potential risks, and these include the risk for dependence. Many people do not realize that it is possible to become addicted to a prescribed medication, and that it can even happen to some people when they are taking their medication as prescribed, especially when the medication is a controlled substance. Knowing the early warning signs, maintaining open dialogue with your prescriber, and seeking early treatment when needed can help to prevent addiction.
- CDC. Therapeutic Drug Use.
- What is the scope of prescription drug misuse?
- Rise in Prescription Drug Misuse and Abuse Impacting Teens.