Medications and Other Prescription Drugs
Prescription drugs help make complex surgery possible, relieve pain, and enable people with chronic medical conditions to control their symptoms and live productive lives. Most people who take prescription medications use them responsibly. However, the non-medical use of prescription drugs is a serious public health issue. Non-medical use of prescription drugs like opioids, central nervous system (CNS) depressants, and stimulants can lead to abuse and addiction, characterized by compulsive drug seeking and use.
Addiction is less common among people who use a pain reliever, stimulant or CNS depressant the way it is prescribed; however, prescription drugs that are used inappropriately can lead to addiction in some instances. Preventing misuse and addiction is the responsibility of patients, healthcare professionals, and pharmacists. Physicians and other health care providers should screen for any type of substance abuse during routine history-taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why. Furthermore, if a pain medication, CNS depressant, or stimulant, is prescribed by a doctor, the patient should follow the directions for use carefully, and also learn what effects the drug could have and potential interactions with other drugs by reading all information provided by the pharmacist.
Trends in Prescription Drug Abuse
In 1999, it was estimated that around 4 million people were currently, or within the previous month, using prescription drugs illegitimately. The breakdown between drug classes is as follows; 2.6 million people misused pain relievers, 1.3 million people misused sedatives and tranquilizers, and 0.9 people million misused stimulants. While prescription drug abuse is a national problem, some alarming trends can be seen among categories of older adults, adolescents, and women.
Misused prescription medications may be the most common form of drug abuse among the elderly population. Some major factors for this is that older people are prescribed medications about three times more frequently than the general population, and don't always have the wherewithal to follow directions for use.
The National Household Survey on Drug Abuse numbers showed that the biggest growth in new users of prescription drugs for non-medical purposes occur in the 12 to 17 age bracket as well as 18 to 25 year-olds. Among 12 to 14 year-olds, psychotherapeutics like pain killers, tranquilizers, sedatives, and stimulants, were reported to be one of two primary drugs being abused.
Another study done in 1999, the Monitoring the Future Survey of 8th, 10th, and 12th graders across the nation, proved that for barbiturates, tranquilizers, and narcotics other than heroin, general long-term declines in use in the 80's leveled-off in the early 90's, with slight increases again in the mid-90's.
Men and women, overall, have nearly similar rates of prescription drug abuse, with the exception of 12 to 17 year olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs non-medically. Also, among women and men who use either a hypnotic, sedative or anti-anxiety drug, women are practically twice as likely to become addicted.
Data collection on drug-related hospital emergency room episodes, done by The Drug Abuse Warning Network, reported that mentions of hydrocodone as a cause for visiting an emergency room increased 37 percent among all age groups from 1997 to 1999. Also, mentions of clonazepam increased 102 percent since 1992.
Commonly Abused Prescription Drugs
While many prescription drugs can be abused or
misused, these three classes are most commonly abused:
- Opioids - often prescribed to treat pain.
- CNS Depressants - used to treat anxiety and
- Stimulants - prescribed to treat narcolepsy
and attention deficit/hyperactivity disorder.
Opioids are commonly prescribed because of their effective pain relieving properties. Many studies have shown that properly managed medical use of opioid analgesic drugs is safe and rarely causes clinical addiction, which is defined as compulsive, often uncontrollable use. If they're taken exactly as prescribed, opioids can be an effective pain manager.
Amongst the drugs that fall within this class - sometimes referred to as narcotics - are codeine, morphine and related drugs. Morphine is frequently used before or after surgery to relieve severe pain. Codeine is used for more mild pain. There are other examples of opioids which can be prescribed to alleviate pain including oxycodone (OxyContin-an oral, controlled release form of the drug); propoxyphene (Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of the side effects that are associated with this drug. In addition to their effective analgesic properties, some of these drugs can be used to relieve severe diarrhea (Lomotil, for example, which is diphenoxylate) or severe coughs (codeine).
Opioids function by attaching to specific proteins that are called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord, they can effectively block the transmission of pain messages to the brain.
In addition to pain relief, opioids can affect regions of the brain and produce a perceived feeling of pleasure, resulting in the initial euphoria that many opioids produce. They can also cause drowsiness, constipation, and, depending on the dosage of the drug taken, reduce breathing. Taking a large single dose could cause acute respiratory depression or even be fatal.
Other drugs may interact with opioids and are only safe to use with other drugs under the supervision of a physician. Normally, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. These drugs tend to slow breathing, and when combined, their effects could result in life-threatening respiratory depression.
Tolerance to opioids can result from chronic use of the drugs. This makes it so that higher doses must be taken to achieve the same initial effects. Long-term use also can lead to physical dependence - the body adapts to the presence of the drug and withdrawal symptoms can occur quite abruptly if use is reduced.
Withdrawal symptoms can include muscle and bone pain, restlessness, insomnia, vomiting diarrhea, cold flashes and unintentional leg movements.
Some of the options for effectively treating addiction to prescription opioids are drawn from experience and research on treating heroin addiction. Here are some examples:
Methadone, which is a synthetic opioid that blocks the effects of heroin and other opioids, eradicates withdrawal symptoms, and relieves cravings. This has been use for over thirty years to effectively treat people who are addicted to opioids.
An alternative to methadone, called LAAM (levo-alpha-acetyl-methadol), blocks the effects of opioids for up to 72 hours. Naltrexone is a long acting opioid blocker often used with highly motivated people in treatment programs encouraging complete abstinence, and also to prevent relapse.
Another synthetic opioid, Buprenorphine, will soon be available. Also, naloxone thwarts the effects of opioids and is used to treat overdoses.
Normal brain function is slowed by CNS depressants. Some CNS depressants, taken in higher doses, can develop into general anesthetics.
Based on their chemistry and pharmacology, CNS depressants can be divided into two groups:
- Benzodiazepines, such as alprazolam (Xanax), diazepam (Valium) and chlordiazepoxide HCl (Librium), which can be prescribed to treat anxiety, severe stress reactions, and panic attacks. Benzodiazepines that have a more sedating effect, such as triazolam (Halcion) and estazolam (ProSom) can be prescribed for short-term treatment of sleep disorders.
- Barbiturates, such as mephobarbital (Mebaral) and pentobarbital sodium (Nembutal), generally used to treat anxiety, tension, and sleep disorders.
The human brain reacts similarly to the many CNS depressants that are available. They affect the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are chemicals in the brain that aid in communication between brain cells. GABA works by decreasing activity in the brain. Each class of CNS depressants works uniquely, but ultimately, the drowsy or calming effect that is produced by them is caused by their ability to increase GABA activity. Even though these effects are beneficial for people suffering from anxiety or sleeping disorders, benzodiazepines and barbiturates can be addictive and should only be used as prescribed.
CNS depressants should not be taken in combination with any medication or substance that causes sleepiness, including prescription pain medicines, certain over-the-counter cold and allergy medications, or alcohol. The effects of the drugs can combine to slow breathing, or slow both the heart and respiration, which can be fatal.
Putting an end to prolonged use of high doses of CNS depressants can lead to withdrawal. Since they work by slowing the brain's activity, a potential effect of abuse is that when one stops taking a CNS depressant, the brain's activity can rebound to the point that seizures may occur. Anyone who is thinking about ending their use of a CNS depressant, or who has stopped and is suffering withdrawal, should speak with a physician and seek medical treatment.
In addition to medical supervision, counseling in an in-patient or out-patient setting can help people who are overcoming addiction to CNS depressants. One example is cognitive-behavioral therapy, which has been a successful way to help individuals in drug treatment for abuse of benzodiazepines. This type of therapy focuses on changing a patient's thinking, expectations, and behaviors while at the same time increasing their skills for coping with various stresses in life.
Frequently the abuse of CNS depressants will happen in conjunction with the abuse of another drug or substance, such as cocaine or alcohol. When there are cases of multiple drugs being abused at once, the treatment approach needs to address the multiple addictions.
Stimulants are basically the opposite of a depressant. They are a class of drugs that boost brain activity. They cause an increase in alertness, attention, and energy that can also be accompanied by increases in blood pressure, heart rate, and respiration.
In the past, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the use of stimulants began to decrease. Now, stimulants are prescribed for treating only a few health conditions, including narcolepsy, attention-deficit hyperactivity disorder (ADHD), and depression that has not responded to other treatments. Stimulants may also be used for short-term treatment of obesity, and for patients with asthma.
Stimulants like dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) have chemical structures that are similar to key brain neurotransmitters called monoamines, which include norepinephrine and dopamine. Stimulants increase the levels of these chemicals in the brain and body. This, in turn, increases blood pressure and heart rate, constricts blood vessels, increases blood glucose (sugar), and opens up the pathways of the respiratory system. In addition, the increase in dopamine is associated with a sense of euphoria that can accompany the use of these drugs.
Research has shown that people with ADHD don't become addicted to stimulant medications, such as Ritalin, when they take it in the form prescribed and at treatment dosages. However, when people misuse them, stimulants can be addictive and in most cases the person needs a drug treatment program to recover from the abuse.
The consequences of stimulant abuse can be extremely dangerous. Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and/or the potential for heart attack or lethal seizures. Taking high doses of some stimulants repeatedly over a short period of time can lead to hostility or feelings of paranoia in some people.
Stimulants should not be mixed with over-the-counter cold medicines containing decongestants or with antidepressants. Stimulants taken with decongestants may cause blood pressure to become dangerously high or lead to irregular heart rhythms. Since anti-depressants may enhance the effects of a stimulant, they should not be combined.
Since each patient's situation is different, treatment options can vary. The first step in treating prescription stimulant addiction may be to slowly decrease the drug's dose and attempting to treat withdrawal symptoms. This process of detoxification could then be followed with one of many drug rehab programs to aid in the psychological aspect of the addiction.