precription drugs abuse and addiction

8/14/2019 Precription Drugs Abuse and Addiction

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PRESCRIPTIONDRUGS

What is prescriptiondrug abuse?

Although most peopletake prescription med-ications responsibly,

there has been an increase inthe nonmedical use of or, asNIDA refers to it in this report,abuse1 of prescription drugs in

the United States.

What are someof the commonlyabused prescriptiondrugs?

Although many pre-scription drugs can beabused, there are several

classifications of medicationsthat are commonly abused.

The three classes ofprescription drugs that aremost commonly abused are:

Opioids, which aremost often prescribedto treat pain;

Central nervous system(CNS) depressants, whichare used to treat anxietyand sleep disorders; and

Stimulants, which areprescribed to treat thesleep disorder narcolepsyand attention-deficithyperactivity disorder(ADHD).

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e

rec

tor

The nonmedical use or abuse ofprescription drugs is a serious andgrowing public health problem in thiscountry. The elderly are among thosemost vulnerable to prescription drugabuse or misuse because they areprescribed more medications than theiryounger counterparts. Most people takeprescription medications responsibly;however, an estimated 48 million people(ages 12 and older) have used prescrip-tion drugs for nonmedical reasons intheir lifetimes. This represents approxi-mately 20 percent of the U.S. population.

Also alarming is the fact that the2004 National Institute on Drug Abuses(NIDAs) Monitoring the Future surveyof 8th-, 10th-, and 12th-graders foundthat 9.3 percent of 12th-graders reportedusing Vicodin without a prescription inthe past year, and 5.0 percent reportedusing OxyContinmaking thesemedications among the most commonlyabused prescription drugs by adolescents.

The abuse of certain prescriptiondrugsopioids, central nervous system(CNS) depressants, and stimulantscan alter the brains activity and leadto addiction. While we do not yet

understand all of the reasons for theincreasing abuse of prescription drugs,we do know that accessibility is likelya contributing factor. In addition tothe increasing number of medicinesbeing prescribed for a variety of healthproblems, some medications can beobtained easily from online pharmacies.Most of these are legitimate businessesthat provide an important service; how-ever, some online pharmacies dispensemedications without a prescriptionand without appropriate identity verifi-cation, allowing minors to order themedications easily over the Internet.

NIDA hopes to decrease the prevalenceof this problem by increasing awarenessand promoting additional research onprescription drug abuse. Prescriptiondrug abuse is not a new problem, butone that deserves renewed attention. Itis imperative that as a Nation we makeourselves aware of the consequencesassociated with the misuse and abuseof these medications.

Nora D.Volkow, M.D.DirectorNational Institute on Drug Abuse

U . S . D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s N a t i o n a l I n s t i t u t e s o f H e a l t h

ResearchReportN A T I O N A L I N S T I T U T E O N D R U G A B U S E

S E R I E S

AbuseandAddiction

1A common vocabulary has not been established in the field of prescription drug abuse.Because much of the data collected in this area focuses on nonmedical use of prescriptiondrugs, the definition of abuse used in this report does not correspond to the definition ofabuse/dependence listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).


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OpioidsWhat are opioids?

Opioids are commonlyprescribed because oftheir effective analgesic,

or pain-relieving, properties.Medications that fall withinthis classreferred to asprescription narcoticsincludemorphine (e.g., Kadian,Avinza), codeine, oxycodone(e.g., OxyContin, Percodan,Percocet), and related drugs.

Morphine, for example, isoften used before and aftersurgical procedures to alleviatesevere pain. Codeine, on theother hand, is often prescribedfor mild pain. In addition totheir pain-relieving properties,some of these drugscodeineand diphenoxylate (Lomotil)for examplecan be used to

relieve coughs and diarrhea.

How do opioids affectthe brain and body?Opioids act on the brainand body by attaching tospecific proteins called opioidreceptors, which are foundin the brain, spinal cord, andgastrointestinal tract. When

these drugs attach to certainopioid receptors, they canblock the perception of pain.Opioids can produce drowsi-ness, nausea, constipation,and, depending upon theamount of drug taken, depressrespiration. Opioid drugs

also can induce euphoriaby affecting the brain regionsthat mediate what we perceiveas pleasure. This feeling isoften intensified for thosewho abuse opioids whenadministered by routes otherthan those recommended. Forexample, OxyContin often issnorted or injected to enhanceits euphoric effects, while at

the same time increasing therisk for serious medicalconsequences, such as opioidoverdose.2

What are the possibleconsequences of opioiduse and abuse?Taken as directed, opioidscan be used to manage pain

effectively. Many studieshave shown that the properlymanaged, short-term medicaluse of opioid analgesic drugsis safe and rarely causesaddictiondefined as thecompulsive and uncontrollableuse of drugs despite adverse

consequencesor depend-

ence,which occurs when thebody adapts to the presenceof a drug, and often resultsin withdrawal symptomswhen that drug is reducedor stopped. Withdrawal symptoms include restlessness,muscle and bone pain, insomnia, diarrhea, vomiting, coldflashes with goose bumps

(cold turkey), and involuntaleg movements. Long-term uof opioids can lead to physicdependence and addiction.Taking a large single dose ofan opioid could cause severerespiratory depression that calead to death.

Is it safe to useopioid drugs with othermedications?Only under a physicianssupervision can opioids beused safely with other drugsTypically, they should not beused with other substancesthat depress the CNS, such a

2NIDARESEARCH REPORT SERIES

Over-the-counter (OTC) medicines, such as certain coughsuppressants (including dextromethorphan); sleep aids (such

as doxylamine, an ingredient in Unisom); antihistamines (such asdiphenhydramine, found in Benadryl); and dimenhydrinates (inGravol or Dramamine) can be abused for their psychoactiveeffects. OTC medicines also can be abused when not taken asdirected. It is also important to note that OTC medications canproduce dangerous health effects when taken with alcohol.

Over-the-Counter (OTC) Medicines Can Be Abused

2 This does not apply only to opioids. Changes in routes of administration also contribute to the abuse of other prescription medications, andthis practice can lead to serious medical consequences.


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alcohol, antihistamines,barbiturates, benzodiazepines,or general anesthetics, becausethese combinations increase

the risk of life-threateningrespiratory depression.

CNS depressantsWhat are CNS depressants?

CNS depressants, sometimesreferred to as sedativesand tranquilizers, are sub-

stances that can slow normal

brain function. Because ofthis property, some CNSdepressants are useful inthe treatment of anxiety andsleep disorders. Among themedications that are commonlyprescribed for these purposesare the following:

Barbiturates, such asmephobarbital (Mebaral)and pentobarbital sodium(Nembutal), are used totreat anxiety, tension, andsleep disorders.

Benzodiazepines, suchas diazepam (Valium),chlordiazepoxide HCl(Librium), and alprazolam(Xanax), are prescribedto treat anxiety, acute

stress reactions, and panicattacks. The more sedatingbenzodiazepines, such astriazolam (Halcion) andestazolam (ProSom) areprescribed for short-termtreatment of sleep dis-orders. Usually, benzodi-azepines are not prescribedfor long-term use.

How do CNS depressantsaffect the brain and body?There are numerous CNS

depressants; most act onthe brain by affecting theneurotransmitter gamma-aminobutyric acid (GABA).Neurotransmitters are brainchemicals that facilitatecommunication betweenbrain cells. GABA worksby decreasing brain activity.Although the different classes

of CNS depressants work inunique ways, it is throughtheir ability to increase GABAactivity that they produce adrowsy or calming effect thatis beneficial to those sufferingfrom anxiety or sleep disorders.

What are the possibleconsequences of CNS

depressant use and abuse?Despite their many beneficialeffects, barbiturates andbenzodiazepines have thepotential for abuse and shouldbe used only as prescribed.During the first few days oftaking a prescribed CNSdepressant, a person usuallyfeels sleepy and uncoordinated,

but as the body becomesaccustomed to the effects ofthe drug, these feelings beginto disappear. If one uses thesedrugs long term, the bodywill develop tolerance for thedrugs, and larger doses willbe needed to achieve thesame initial effects. Continueduse can lead to physical

dependence andwhenuse is reduced or stoppedwithdrawal. Because all CNSdepressants work by slowing

the brains activity, when anindividual stops taking them,the brains activity can reboundand race out of control, poten-tially leading to seizures andother harmful consequences.Although withdrawal frombenzodiazepines can beproblematic, it is rarely lifethreatening, whereas with-

drawal from prolonged useof other CNS depressants canhave life-threatening compli-cations. Therefore, someonewho is thinking about discon-tinuing CNS depressant therapyor who is suffering withdrawalfrom a CNS depressant shouldspeak with a physician or seekmedical treatment.

Is it safe to use CNSdepressants with othermedications?CNS depressants should beused in combination withother medications only undera physicians close supervision.Typically, they should notbe combined with any other

medication or substance thatcauses CNS depression,including prescription painmedicines, some OTC coldand allergy medications, andalcohol. Using CNS depressantswith these other substancesparticularly alcoholcan slowboth the heart and respirationand may lead to death.

NIDARESEARCH REPORT SERIES3


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StimulantsWhat are stimulants?

As the name suggests,stimulants increasealertness, attention,

and energy, as well as elevateblood pressure and increaseheart rate and respiration.Stimulants historically wereused to treat asthma and otherrespiratory problems, obesity,neurological disorders, and avariety of other ailments. But

as their potential for abuse andaddiction became apparent, themedical use of stimulants beganto wane. Now, stimulants areprescribed for the treatment ofonly a few health conditions,including narcolepsy, ADHD,and depression that has notresponded to other treatments.

How do stimulants affectthe brain and body?Stimulants, such as dextroam-phetamine (Dexedrine andAdderall) and methylphenidate(Ritalin and Concerta), havechemical structures similar to afamily of key brain neurotrans-mitters called monoamines,which include norepinephrine

and dopamine. Stimulantsenhance the effects of thesechemicals in the brain.Stimulants also increaseblood pressure and heartrate, constrict blood vessels,increase blood glucose, andopen up the pathways ofthe respiratory system. Theincrease in dopamine is

associated with a sense ofeuphoria that can accompanythe use of these drugs.

What are the possibleconsequences of stimu-lant use and abuse?As with other drugs of abuse,it is possible for individuals tobecome dependent upon oraddicted to many stimulants.Withdrawal symptoms asso-ciated with discontinuing

stimulant use include fatigue,depression, and disturbanceof sleep patterns. Repeated useof some stimulants over a shortperiod can lead to feelings ofhostility or paranoia. Further,taking high doses of a stimu-lant may result in dangerously

high body temperature andan irregular heartbeat.There is also the potentialfor cardiovascular failure or

lethal seizures.

Is it safe to use stimulanwith other medications?Stimulants should be usedin combination with othermedications only under aphysicians supervision.Patients also should be awarof the dangers associated witmixing stimulants and OTCcold medicines that containdecongestants; combiningthese substances may causeblood pressure to becomedangerously high or lead toirregular heart rhythms.


More than 6.3 Million AmericansReported Current Use of Prescription Drugs

for Nonmedical Purposes in 2003

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration.National Survey on Drug Use and Health, 2004.

5.0

4.0

3.0

2.0

1.0

0Stimulants Sedatives and

TranquilizersOpioid PainRelievers

MillionsofAmericans


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Trends inprescription

drug abuse

Although prescriptiondrug abuse affectsmany Americans, some

concerning trends can beseen among older adults,adolescents, and women.Several indicators suggest thatprescription drug abuse is onthe rise in the United States.

According to the 2003 NationalSurvey on Drug Use andHealth (NSDUH), an estimated4.7 million Americans used pre-scription drugs nonmedicallyfor the first time in 2002

2.5 million used painrelievers

1.2 million usedtranquilizers

761,000 used stimulants 225,000 used sedatives

Pain reliever incidence

increasedfrom 573,000initiates in 1990 to 2.5 millioninitiates in 2000and hasremained stable through 2003.In 2002, more than half (55percent) of the new userswere females, and more thanhalf (56 percent) were ages18 or older.

The Drug Abuse Warning

Network (DAWN), which mon-itors medications and illicitdrugs reported in emergencydepartments (EDs) across theNation, recently found that twoof the most frequently reportedprescription medications indrug abuse-related casesare benzodiazepines(e.g., diazepam, alprazolam,clonazepam, and lorazepam)

and opioid pain relievers(e.g., oxycodone, hydrocodone,morphine, methadone, andcombinations that include

these drugs). In 2002, ben-zodiazepines accounted for100,784 mentions that wereclassified as drug abuse cases,and opioid pain relieversaccounted for more than119,000 ED mentions. From1994 to 2002, ED mentions ofhydrocodone and oxycodoneincreased by 170 percent and

450 percent, respectively.While ED visits attributed todrug addiction and drug-takingfor psychoactive effects havebeen increasing, intentionaloverdose visits have remainedstable since 1995.

Older adultsPersons 65 years of age andabove comprise only 13 per-cent of the population, yetaccount for approximatelyone-third of all medicationsprescribed in the United States.Older patients are more likelyto be prescribed long-term andmultiple prescriptions, whichcould lead to unintentionalmisuse.

The elderly also are at riskfor prescription drug abuse, inwhich they intentionally takemedications that are not med-ically necessary. In additionto prescription medications,a large percentage of olderadults also use OTC medicinesand dietary supplements.Because of their high ratesof comorbid illnesses, changes

Past Month Use of Selected Illicit DrugsAmong Youths, by Age: 2003

18%

15

12

9

6

3

0Age 12 or 13

PercentUsinginPastMonth

Age 14 or 15 Age 16 or 17

Marijuana

Psychotherapeutics

Inhalants

Hallucinogens

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration.National Survey on Drug Use and Health, 2004.


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in drug metabolism with age,and the potential for druginteractions, prescription andOTC drug abuse and misusecan have more adverse healthconsequences among theelderly than are likely to beseen in a younger population.Elderly persons who takebenzodiazepines are atincreased risk for cognitiveimpairment associated withbenzodiazepine use, leading

to possible falls (causing hipand thigh fractures), as wellas vehicle accidents. However,cognitive impairment may bereversible once the drug isdiscontinued.

Adolescents andyoung adultsData from the 2003 NSDUHindicate that 4.0 percent of

youth ages 12 to 17 reportednonmedical use of prescriptionmedications in the past month.Rates of abuse were highestamong the 1825 age group(6.0 percent). Among the

youngest group surveyed, ages1213, a higher percentagereported using psychothera-peutics (1.8 percent) thanmarijuana (1.0 percent).

The NIDA Monitoring theFuture survey of 8th-, 10th-,

and 12th-graders found thatthe nonmedical use of opioids,tranquilizers, sedatives/barbi-turates, and amphetamineswas unchanged between 2003and 2004. Specifically, thesurvey found that 5.0 percentof 12th-graders reported usingOxyContin without a prescrip-tion in the past year, and9.3 percent reported using

Vicodin, making Vicodin oneof the most commonly abuselicit drugs in this population.Past year, nonmedical use of

tranquilizers (e.g., Valium,Xanax) in 2004 was 2.5 percefor 8th-graders, 5.1 percent f10th-graders, and 7.3 percenfor 12th-graders. Also withinthe past year, 6.5 percent of12th-graders used sedatives/barbiturates (e.g., Amytal,Nembutal) nonmedically,and 10.0 percent usedamphetamines (e.g., Ritalin,Benzedrine).Youth who use other drug

are more likely to abuseprescription medications.

According to the 2001 NationHousehold Survey on DrugAbuse (now the NSDUH),63 percent of youth who hadused prescription drugs non-medically in the past year

had also used marijuana inthe past year, compared with17 percent of youth who hadnot used prescription drugsnonmedically in the past yea

Gender differencesStudies suggest that womenare more likely than men tobe prescribed an abusableprescription drug, particularly

narcotics and antianxietydrugsin some cases,55 percent more likely.

Overall, men and womenhave roughly similar rates ofnonmedical use of prescriptiodrugs. An exception is foundamong 12- to 17-year-olds. Inthis age group, young womeare more likely than youngmen to use psychotherapeuti


Past-Year Use of Other Drugs Reportedby Prescription Drug Abusers:

Persons Aged 12 to 25, 200170

60

50

40

30

20

100

Marijuana

P

ercentUsinginPastMonth

Hallucinogens Inhalants HeroinCocaine(including

crack)

Past Year Use ofPrescription Drugs

No Past Year Use ofPrescription Drugs

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration.The NHSDA Report, January 16, 2003.


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drugs nonmedically. In addi-tion, research has shown thatwomen are at increased riskfor nonmedical use of narcotic

analgesics and tranquilizers(e.g., benzodiazepines).

Preventing andrecognizing prescriptiondrug abuseThe risks for addiction toprescription drugs increasewhen the drugs are used inways other than for those

prescribed. Healthcareproviders, primary care phy-sicians, and pharmacists, aswell as patients themselves, allcan play a role in identifyingand preventing prescriptiondrug abuse.Physicians. Because about

70 percent of Americans(approximately 191 million

people) visit their primary carephysician at least once every2 years, these doctors are in aunique positionnot only toprescribe medications, but alsoto identify prescription drugabuse when it exists, help thepatient recognize the problem,set recovery goals, and seekappropriate treatment.Screening for prescription drug

abuse can be incorporatedinto routine medical visits byasking about substance abusehistory, current prescriptionand OTC use, and reasonsfor use. Doctors should takenote of rapid increases in theamount of medication needed,or frequent, unscheduled refillrequests. Doctors also shouldbe alert to the fact that those

addicted to prescription drugsmay engage in doctor shop-pingmoving from providerto providerin an effort toobtain multiple prescriptionsfor the drug(s) they abuse.

Preventing or stoppingprescription drug abuse is animportant part of patient care.However, healthcare providers

should not avoid prescribingor administering stimulants,CNS depressants, or opioidpain relievers if needed. (Seetext box on Pain Treatmentand Addiction.)Pharmacists. By providing

clear information on how totake a medication appropriatelyand describing possible side

It is estimated that more than 50 million Americans suffer fromchronic pain. When treating pain, healthcare providers have

long wrestled with a dilemma: How to adequately relieve apatients suffering, while avoiding the potential for that patientto become addicted to the pain medication.

Many healthcare providers underprescribe opioid pain relievers,such as morphine and codeine, because they overestimate thepotential for patients to become addicted. This fear of prescribingopioid pain medications is known as opiophobia. Althoughthese drugs carry a risk for addiction and physicians shouldwatch for signs of abuse and addiction in their patients, thelikelihood of patients with chronic pain becoming addicted toopioids is low (with the exception of those with a personalor family history of drug abuse or mental illness). The risk ofbecoming addicted to prescription pain medications is alsominimal in those who are treated on a short-term basis. Moreresearch is needed to better understand what other factorspredispose people to addiction to prescription pain relievers,and what can be done to prevent addiction among those at risk.

Pain management for patients who have substance abusedisorders is particularly challenging, but these patients can still

be treated successfully with opioid pain medications. Developingnew and effective addiction and pain medications that are lesslikely to be abused is a priority for NIDA. For example, themedication buprenorphine/naloxone (Suboxone), developed byNIDA in collaboration with the pharmaceutical industry for treat-ing opioid addiction, may provide an alternative medication forpain that has less abuse potential than other pain medications,while also having a much greater safety margin. However, furtherresearch is needed before this practice can be recommended.

Pain Treatment and Addiction


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effects or drug interactions,pharmacists also can playa key role in preventingprescription drug abuse.

Moreover, by monitoringprescriptions for falsificationor alterations and being awareof potential doctor shopping,pharmacists can be the firstline of defense in recognizingprescription drug abuse. Somepharmacies have developedhotlines to alert other phar-macies in the region when afraudulent prescription isdetected.Patients. There are also

steps a patient can take to en-sure that they use prescriptionmedications appropriately.Patients should always followthe prescribed directions, beaware of potential interactionswith other drugs, never stopor change a dosing regimen

without first discussing it withtheir healthcare provider, andnever use another personsprescription. Patients shouldinform their healthcare profes-sionals about all the prescrip-tion and OTC medicines anddietary and herbal supplementsthey are taking, in addition toa full description of their pre-senting complaint, before they

obtain any other medications.

Treating prescriptiondrug addictionYears of research have shownus that addiction to any drug(illicit or prescribed) is a braindisease that, like other chronicdiseases, can be treatedeffectively. No single type of

treatment is appropriate forall individuals addicted toprescription drugs. Treatmentmust take into account thetype of drug used and theneeds of the individual.

Successful treatment mayneed to incorporate severalcomponents, including detox-ification, counseling, and insome cases, the use of phar-macological therapies. Multiplecourses of treatment may beneeded for the patient tomake a full recovery.

The two main categoriesof drug addiction treatmentare behavioral and pharmaco-logical. Behavioral treatmentsencourage patients to stopdrug use and teach them howto function without drugs,handle cravings, avoid drugsand situations that could leadto drug use, and handle arelapse should it occur. Whendelivered effectively, behavioral

treatmentssuch as individucounseling, group or familycounseling, contingencymanagement, and cognitivebehavioral therapiesalsocan help patients improve

their personal relationshipsand their ability to function awork and in the community.

Some addictions, suchas opioid addiction, can betreatedwith medications.These pharmacological treat-ments counter the effects ofthe drug on the brain andbehavior, and can be used torelieve withdrawal symptoms

treat an overdose, or helpovercome drug cravings.Although a behavioral orpharmacological approachalone may be effective fortreating drug addiction,research shows that, at leastin the case of opioid addic-tion, a combination of bothis most effective.



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Treating addiction toprescription opioidsSeveral options are available

for effectively treating pre-scription opioid addiction.These options are drawn fromresearch regarding the treat-ment of heroin addiction,and include medications suchas naltrexone, methadone,and buprenorphine, as wellas behavioral counselingapproaches.

Naltrexone is a medicationthat blocks the effects ofopioids and is used to treatopioid overdose and addic-tion. Methadone is a syntheticopioid that blocks the effectsof heroin and other opioids,eliminates withdrawalsymptoms, and relieves drugcraving. It has been used

successfully for more than30 years to treat heroinaddiction. The Food and Drug

Administration (FDA) approved

buprenorphine in October2002, after more than a decadeof research supported byNIDA. Buprenorphine, whichcan be prescribed by certifiedphysicians in an office setting,is long lasting, less likely tocause respiratory depressionthan other drugs, and is welltolerated. However, moreresearch is needed to deter-mine the effectiveness of thesemedications for the treatmentof prescription drug abuse.A useful precursor to long-

term treatment of opioidaddiction is detoxification.Detoxification in itself is not atreatment. Rather, its primaryobjective is to relieve with-

drawal symptoms while thepatient adjusts to being drugfree. To be effective, detoxifi-cation must precede long-term

treatment that either requirescomplete abstinence or incor-porates a medication, such asmethadone or buprenorphine,into the treatment program.

Treating addiction toCNS depressantsPatients addicted to barbitu-rates and benzodiazepines

should not attempt to stoptaking them on their own.Withdrawal symptomsfrom these drugs can beproblematic, andin the caseof certain CNS depressantspotentially life-threatening.

Although no research regardingthe treatment of barbiturateand benzodiazepine addictionexists, addicted patients

should undergo medicallysupervised detoxificationbecause the treatment dosemust be gradually tapered.Inpatient or outpatient coun-seling can help the individualduring this process. Cognitive-behavioral therapy, whichfocuses on modifying thepatients thinking, expecta-tions, and behaviors, while atthe same time increasing skillsfor coping with various lifestressors, also has been usedsuccessfully to help individualsadapt to the discontinuationof benzodiazepines.

Often barbiturate and ben-zodiazepine abuse occurs inconjunction with the abuse ofanother substance or drug,


Many Physicians Have Difficulty DiscussingSubstance Abuse With Patients

Over 40% of physicians report having difficulty discussing substance abuse, including abuse ofprescription drugs, with their patients. In contrast, less than 20% have difficulty discussing depression.

National Center on Addiction and Substance Abuse at Columbia University (CASA). Missed Opportunity: National Survey ofPrimary Care Physicians and Patients on Substance Abuse, New York:CASA, 2000.

50

40

30

20

10

0Depression

Percent

ofPhysicians

Alcohol Abuse Prescription Drug Abuse


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OPIOIDS Oxycodone (OxyContin, Percodan, Percocet) Propoxyphene (Darvon) Hydrocodone (Vicodin, Lortab, Lorcet) Hydromorphone (Dilaudid) Meperidine (Demerol) Diphenoxylate (Lomotil) Morphine (Kadian, Avinza, MS Contin) Codeine Fentanyl (Duragesic) Methadone

Generally prescribed for Postsurgical pain relief Management of acute or chronic pain Relief of cough and diarrhea

In the bodyOpioids attach to opioid receptors in the brainand spinal cord, blocking the perception of pain.

Effects of short-term use Alleviates pain Drowsiness Constipation Depressed respiration (depending on dose)

Effects of long-term use Potential for physical dependence and addiction

Possible negative effects Severe respiratory depression or death

following a large single dose

Should not be used withOther substances that cause CNS depression, including: Alcohol Antihistamines Barbiturates Benzodiazepines General anesthetics

CNS DEPRESSANTSBarbiturates Mephobarbital (Mebaral) Pentobarbital sodium (Nembutal)

Benzodiazepines Diazepam (Valium) Chlordiazepoxide hydrochloride (Librium) Alprazolam (Xanax) Triazolam (Halcion) Estazolam (ProSom) Clonazepam (Klonopin) Lorazepam (Ativan)

Generally prescribed for Anxiety Tension Panic attacks Acute stress reactions Sleep disorders Anesthesia (at high doses)

In the bodyCNS depressants slow brain activity through actionson the GABA system, producing a calming effect.

Effects of short-term use A sleepy and uncoordinated feeling

during the first few days; as the bodybecomes accustomed (tolerant) to theeffects, these feelings diminish.


Possible negative effects Seizures following a rebound in brain

activity after reducing or discontinuing use

Should not be used withOther substances that cause CNS depression, including: Alcohol Prescription opioid pain medicines Some OTC cold and allergy medications

STIMULANTS Dextroamphetamine (Dexedrine and Adderall) Methylphenidate (Ritalin and Concerta)

Generally prescribed for Narcolepsy Attention-deficit hyperactivity disorder (ADHD) Depression that does not respond to other treatme

In the bodyStimulants enhance brain activity, causing an increasein alertness, attention, and energy.

Effects of short-term use Elevated blood pressure Increased heart rate Increased respiration Suppressed appetite Sleep deprivation


Possible negative effects Dangerously high body temperature or an

irregular heartbeat after taking high doses

Cardiovascular failure or lethal seizures For some stimulants, hostility or feelingsof paranoia after taking high dosesrepeatedly over a short period of time

Should not be used with OTC decongestant medications Antidepressants, unless supervised by a physician Some asthma medications

Use and Consequences of Commonly Prescribed Medications


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such as alcohol or cocaine.In these cases of polydrugabuse, the treatment approachmust address the multiple

addictions.

Treating addiction toprescription stimulantsTreatment of addiction toprescription stimulants, suchas Ritalin, is often based onbehavioral therapies that haveproven effective in treatingcocaine and methamphetamine

addiction. At this time, thereare no proven medicationsfor the treatment of stimulantaddiction. However, NIDA issupporting a number of studieson potential medications fortreating stimulant addiction.

Depending on the patientssituation, the first steps intreating prescription stimulant

addiction may be tapering thedrug dosage and attemptingto ease withdrawal symptoms.The detoxification processcould then be followed by oneof many behavioral therapies.Contingency management,for example, uses a systemthat enables patients to earnvouchers for drug-free urinetests. (These vouchers canbe exchanged for items thatpromote healthy living.)Cognitive-behavioral therapyalso may be an effectivetreatment for addressingstimulant addiction. Finally,recovery support groupsmay be helpful in conjunctionwith behavioral therapy.


Glossary

Addiction: A chronic, relapsing disease charac-terized by compulsive drug seeking and use,

despite harmful consequences, and by neuro-chemical and molecular changes in the brain.

Barbiturate:A type of CNS depressant oftenprescribed to promote sleep.

Benzodiazepine:A type of CNS depressantoften prescribed to relieve anxiety. Valium andLibrium are among the most widely prescribedmedications.

Buprenorphine:Medication approved by theFDA in October 2002 for treatment of opioidaddiction.

Central nervous system (CNS):The brainand spinal cord.

CNS depressants: A class of drugs thatslow CNS function (also called sedatives andtranquilizers), some of which are used to treatanxiety and sleep disorders; includes barbituratesand benzodiazepines.

Detoxification: A process that enables thebody to rid itself of a drug, while at the sametime managing the individuals symptomsof withdrawal; often the first step in a drugtreatment program.

Dopamine: A neurotransmitter present inregions of the brain that regulate movement,emotion, motivation, and feelings of pleasure.

Methadone: A long-acting synthetic medicationthat is effective in treating opioid addiction.

Narcolepsy: A disorder characterized byuncontrollable episodes of deep sleep.

Norepinephrine:A neurotransmitter presentin some areas of the brain and the adrenalglands; decreases smooth muscle contraction andincreases heart rate; often released in response

to low blood pressure or stress.Opioids: Controlled drugs or narcotics mostoften prescribed for the management of pain;natural or synthetic chemicals based on opiumsactive componentmorphinethat work bymimicking the actions of pain-relieving chemicalsproduced in the body.

Opiophobia:A healthcare providers fear thatpatients will become addicted to opioids evenwhen using them appropriately; can lead to theunderprescribing of opioids for pain management.

Physical dependence: An adaptivephysiological state that can occur with regular

drug use and results in withdrawal when druguse is discontinued. (Physical dependence aloneis not the same as addiction, which involvescompulsive drug seeking and use, despite itsharmful consequences.)

Polydrug abuse:The abuse of two or moredrugs at the same time, such as CNS depressantsand alcohol.

Prescription drug abuse:The intentionalmisuse of a medication outside of the normallyaccepted standards of its use.

Prescription drug misuse:Taking amedication in a manner other than thatprescribed or for a different condition than thatfor which the medication is prescribed.

Psychotherapeutics: Drugs that have an effecton the function of the brain and that often areused to treat psychiatric disorders; can includeopioids, CNS depressants, and stimulants.

Respiratory depression: Depression ofrespiration (breathing) that results in the reducedavailability of oxygen to vital organs.

Sedatives: Drugs that suppress anxietyand relax muscles; the National Survey onDrug Use and Health classification includesbenzodiazepines, barbiturates, and other typesof CNS depressants.

Stimulants: Drugs that increase or enhancethe activity of monamines (such as dopamineand norepinephrine) in the brain, which leadsto increased heart rate, blood pressure, andrespiration; used to treat only a few disorders,such as narcolepsy and ADHD.

Tolerance:A condition in which higher doses of

a drug are required to produce the same effectsas experienced initially.

Tranquilizers: Drugs prescribed to promotesleep or reduce anxiety; this National Surveyon Drug Use and Health classification includesbenzodiazepines, barbiturates, and other typesof CNS depressants.

Withdrawal: A variety of symptoms that occurafter chronic use of some drugs is reduced orstopped.


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Cowan, D.R.; Wilson-Barnett, J.; Griffiths, P.;and Allan, L.G. A survey of chronic noncancerpain patients prescribed opioid analgesics.Pain Medicine4(4):340351, 2003.

CSAT. Substance Abuse Among Older Adults(TIP #26). DHHS Pub. No. BKD250.SAMHSA, 1997.

Fishbain, D.A.; Rosomoff, H.L.; and Rosomoff,R.S. Drug abuse, dependence and addictionin chronic pain patients. Clin J Pain8:7785, 1992.

Helling, D.K.; Lemke, J.H.; Semla, T.P.; Wallace,R.B.; Lipson, D.P.; and Cornoni-Huntley, J.Medication use characteristics in the elderly:the Iowa 65+ Rural Health Study J AmGeriatr Soc35(1):412, 1987.

Johnston, L.D.; OMalley, P.M.; and Bachman,

J.G. Monitoring the Future: National SurveyResults on Drug Use, Overview of KeyFindings 2004. Bethesda, MD, NIDA,NIH, DHHS (2005). Available at:www.monitoringthefuture.org.

Joransson, D.E.; Ryan, K.M.; Gilson, A.M.;and Dahl, J.L. Trends in medical use andabuse of opioid analgesics. JAMA283(13):17101714, 2000.

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Access informationon the NIDA Web site

Information onprescription drugs andother drugs of abuse

Selected PrescriptionDrugs with Potentialfor Abuse chart(www.drugabuse.gov/DrugPages/PrescripDrugsChart.html)

Publications andcommunications(including NIDA NOTES)

Calendar of events Links to NIDA

organizational units Funding information

(including programannouncementsand deadlines)

International activities Links to related

Web sites (access toWeb sites of manyother organizations inthe field)

NIDA Web Siteswww.drugabuse.gov

www.steroidabuse.orgwww.clubdrugs.org

National Clearinghousefor Alcohol and DrugInformation (NCADI)

Web Site: www.health.orgPhone No.: 800-729-6686

References

NIH Publication Number 05-4881

Printed July 2001, Revised August 2005

Feel free to reprint this publication.

precription drugs abuse and addiction

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