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Prescription Drug Addiction and Pain Medication Abuse
Most people who take prescription medications use them responsibly.
However, the non-medical use or abuse of prescription drugs is a
serious public health concern. Nonmedical 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 occurs most frequently among people who use pain relievers,
CNS depressants, or stimulants as prescribed. Patients, healthcare
professionals, and pharmacists all have a responsibility to prevent
misuse and addiction. For example, if a doctor prescribes a pain
medication, CNS depressant, or stimulant, 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. 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.
Trends in Prescription Drug Abuse
In 1999, an estimated 4 million people, about
2 percent of the population age 12 and older, were currently (use
in past month) using prescription
drugs non-medically. Of these, 2.6 million misused pain relievers,
1.3 million misused sedatives and tranquilizers, and 0.9 million
misused stimulants. While
prescription drug abuse affects many Americans, some trends of particular
concern can be seen among older adults, adolescents, and women.
The misuse of prescribed medications may be the most common form
of drug abuse among the elderly. Older people are prescribed medications
about three times more frequently than the general population, and
have poorer compliance with directions for use.
The National Household Survey on Drug Abuse numbers indicate that
the sharpest increases in new users of prescription drugs for non-medical
purposes occur in 12 to 17 and 18 to 25 year-olds. Among 12 to 14
year-olds, psychotherapeutics (e.g., pain killers, tranquilizers,
sedatives, and stimulants) were reported to be one of two primary
drugs used.
The 1999 Monitoring the Future Survey of 8th,
10th, and 12th graders nationwide, showed that for barbiturates,
tranquilizers, and narcotics other than heroin,
general long-term declines in use in the 1980s leveled-off in the
early 1990s, with modest increases again in the mid-1990s.
Overall, men and women have roughly similar rates of
nonmedical use of prescription drugs, 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 nonmedically. Also, among women and men
who use either a sedative, anti-anxiety drug, or hypnotic, women
are almost twice as likely to become addicted.
The Drug Abuse Warning Network, which collects
data on drug-related hospital emergency room episodes, 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:
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Opioids - often prescribed to treat pain.
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Central Nervous System (CNS) Depressants - used to treat anxiety
and sleep disorders.
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Stimulants - prescribed to treat narcolepsy
and often "attention
deficit/hyperactivity disorder".
Opioids
Opioids are commonly prescribed because of their analgesic or pain
relieving properties. Taken exactly as prescribed, opioids can be
used to manage pain, hovever, any deviation from instructions can
lead to addiction, which is defined as compulsive, often uncontrollable
use.
Among the drugs that fall within this class - sometimes referred
to as narcotics - are morphine, codeine, and related drugs. Morphine
is often used before or after surgery to alleviate severe pain. Codeine
is used for milder pain. Other examples of opioids that can be prescribed
to alleviate pain include 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 its side effects. In addition to their pain
relieving properties, some of these drugs are used to relieve severe
diarrhea (Lomotil, for example, which is diphenoxylate) or severe
coughs (codeine).
Opioids act by attaching to specific proteins 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 block the transmission of pain messages
to the brain.
In addition to relieving pain, opioid drugs can affect regions of
the brain that mediate what we perceive as pleasure, resulting in
the initial euphoria that many opioids produce. They can also produce
drowsiness, cause constipation, and, depending upon the amount of
drug taken, depress breathing. Taking a large single dose could cause
severe respiratory depression or be fatal.
Opioids may interact with other drugs and are only safe to use with
other drugs under a physician's supervision. Typically, they should
not be used with substances such as alcohol, antihistamines, barbiturates,
or benzodiazepines. These drugs slow down breathing, and their combined
effects could risk life-threatening respiratory depression.
Chronic use of opioids can result in tolerance to the drugs so that
higher doses must be taken to obtain 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 occur if use is reduced
abruptly.
Symptoms of withdrawal can include restlessness,
muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes
with
goose bumps
("cold turkey"), and involuntary leg movements.
CNS Depressants
CNS depressants slow down normal brain function. In higher doses,
some CNS depressants can become general anesthetics.
CNS depressants can be divided into two groups, based on their chemistry
and pharmacology:
-
Barbiturates, such as mephobarbital (Mebaral) and pentobarbital
sodium (Nembutal), which are used to treat anxiety, tension, and
sleep disorders.
-
Benzodiazepines, such as diazepam (Valium), chlordiazepoxide
HCl (Librium), and alprazolam (Xanax), which can be prescribed
to treat anxiety, acute 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.
There are many CNS depressants, and most act on the brain similarly
- they affect the neurotransmitter gamma-aminobutyric acid (GABA).
Neurotransmitters are brain chemicals that facilitate communication
between brain cells. GABA works by decreasing brain activity. Although
different classes of CNS depressants work in unique ways, ultimately
it is their ability to increase GABA activity that produces a drowsy
or calming effect. Both barbiturates and benzodiazepines can be addictive
and should be used only as prescribed.
CNS depressants should not be combined 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.
Discontinuing prolonged use of high doses of CNS depressants can
lead to withdrawal. Because they work by slowing the brain's activity,
a potential consequence of abuse is that when one stops taking a
CNS depressant the brain's activity can rebound to the point that
seizures can occur. Someone 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.
Often the abuse of CNS depressants occurs in conjunction with the
abuse of another substance or drug, such as alcohol or cocaine. In
these cases of polydrug abuse, the treatment approach needs to address
the multiple addictions.
Stimulants
Stimulants are a class of drugs that enhance brain activity - they
cause an increase in alertness, attention, and energy that is accompanied
by increases in blood pressure, heart rate, and respiration.
Historically, 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 wane. Now, stimulants are prescribed
for treating only a few health conditions, including narcolepsy, "attention-deficit
hyperactivity disorder" (ADHD). Stimulants may also be used for short-term
treatment of obesity, and for patients with asthma.
Stimulants such as 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, 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.
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 cardiovascular
failure 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 individuals.
Stimulants should not be mixed with antidepressants or over-the-counter
cold medicines containing decongestants. Anti-depressants may enhance
the effects of a stimulant, and stimulants in combination with decongestants
may cause blood pressure to become dangerously high or lead to irregular
heart rhythms.
The only effective treatment of addiction to prescription
stimulants, such as methylphenidate and amphetamines, is intensive
out-patient
or in-paitent treatment.
For more information on prescription drug abuse check: www.prescription-drug-rehab.com
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