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Prescription Drugs of Abuse

You may have experienced an illness or health condition that required the use of a prescription drug. Most people can take these medication and have no problems stopping use once they run out or their doctor instructs them to do so.

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But why do some people abuse prescription medication? Healthline explains that there are several types of medications that are considered some of the most addictive in health care today. Below, we examine some of these and their relationship to addiction.

To clarify, the National Institute on Drug Abuse (NIDA) defines misuse of a prescription medication as taking it in a way other as prescribed, taking someone else’s medication even if its use may seem warranted (such as to treat illness or pain), or using medication recreationally for its desired effects.

Opioids

Opioids have a very high potential for abuse. They are currently fueling the prescription drug overdose epidemic in the U.S.

NIDA reports that opioid overdoses cause approximately 130 deaths in the United States per day. Heroin is the most widely used illicit opioid today, but many opioids are available for legitimate medical use.

Commonly prescribed opioids are:
  • Morphine, known by the brands Arymo ER, Kadian, MS Contin, and Morphabond. This is most commonly prescribed to patients who have pain that is constant and cannot be relieved with other medication.
  • Fentanyl, sold under the names Abstral, Actiq, and Fentora. Its transdermal patch is known as Duragesic. This is most often used for pain in people who have a high tolerance to weaker opioid medication. It also treats pain that appears in spurts even when other medication is prescribed to treat it.
  • Codeine, sold as Tuzistra XR. Many cough medications contain codeine as an active ingredient, such as Robitussin AC. Codeine is also sold along with acetaminophen in products such as Tylenol with Codeine. It is available with other medications and under many names. Codeine can be used for mild to moderate pain, but it treats cough when used in combination with other medications.
  • Hydrocodone, which is sold alone under the brand names Hysingla and Zohydro ER. Combination forms of the medication are known by the commercial names Lortab, Norco, and Ceta Plus, though it is available under various name brands. Medication containing hydrocodone is used for pain, but it can also treat cough.

Prescription opioids are meant to relieve pain in moderate to severe cases. They work by communicating with chemical messengers in the brain that signal pain and provide comfort by causing an increase in the release of dopamine.

Dopamine is a hormone that is associated with pleasure. This boost in pleasure could fuel misuse in people who feel that prescription opioids have given them a new lease on life.

In November 2018, U.S. News & World Report compiled a list of alternatives to opioids. These include:
  • Topical analgesics. These are creams or lotions applied to parts of the body that are in pain. They usually contain capsaicin, menthol, or NSAIDs (nonsteroidal anti-inflammatory drugs) that relieve pain once applied to the skin.
  • Oral analgesics. These medications are taken by mouth and consist of NSAIDs. Common examples are ibuprofen (Advil), naproxen sodium (Aleve), and acetylsalicylic acid (aspirin). However, they are not recommended for people who have kidney issues.
  • Physical therapy and exercise. These are also known to improve outcomes in those who experience long-term pain.

Stimulants

These medications can be helpful for people who are diagnosed with attention deficit hyperactivity disorder (ADHD).

Prescription stimulants are sometimes known as study drugs. They are commonly abused by high school and college students who are looking to stay up all night cramming for tests or writing papers. Studies have found that students who abuse prescription stimulants actually have lower GPAs than those who don’t, suggesting that they don’t actually improve academic performance.

Well-known stimulants include:
  • Adderall. Per Healthline, Adderall’s main ingredients are amphetamine sulfate, amphetamine aspartate, dextroamphetamine sulfate, and dextroamphetamine saccharate. Adderall improves concentration by releasing norepinephrine into the brain.
  • Concerta. This drug consists of methyphenidate, like Ritalin. It is formulated as an extended-release version of the medication so children can take it only once daily.
  • Ritalin. This consists of methylphenidate, but it must be taken two to three times per day.
  • Vyvanse. Used to treat ADHD and binge eating disorder, the main ingredient in Vyvanse is lisdexamfetamine. The body converts this into dextroamphetamine once you take the medication. This drug is normally taken once per day.
Alternatives to stimulants for ADHD are:
  • This antidepressant is known to be effective in those with ADHD.
  • Tricyclic antidepressants. This medication is used for patients who do not respond well to stimulants. These antidepressants are known increase levels of norepinephrine in the brain. Well-known brands are Pamelor, Tofranil, and Elavil.
  • Its primary ingredient is atomoxetine. This allows the brain to maintain norepinephrine levels to improve focus.

Barbiturates

These are sedatives that relax the central nervous system. They are formulated from barbituric acid. Their use in the United States is far less common today, but you may have heard of them in a historical context.

Benzodiazepines largely replaced barbiturates, primarily due to barbiturates’ high potential for abuse.

Examples of barbiturates are:
  • Butalbital which is used for headaches and migraines.
  • Phenobarbital, a medication that was once used for seizures in children.
  • Amobarbital, known in popular culture as “truth serum.” This makes it hard for a person to focus, making it more difficult to conjure a lie.
  • Secobarbital. Once used to help people with sleep issues, it is now most commonly used in physician-assisted suicides where the practice is legal.
  • Pentobarbital, which is a sedative approved for use in animals. States where lethal injection is legal often use this as part of their cocktail.

Barbiturates are known to have a high misuse potential because it is easy to become tolerant to their effects. Once you require higher doses of the medication, it becomes more difficult to gauge a safe dosage.

People can become psychologically dependent on barbiturates very quickly. There are no known treatments that can help if you overdose on barbiturates.

Benzodiazepines

These drugs are often seen as a modern alternative to barbiturates, but they pose their own set of problems.

Benzodiazepines are controlled substances that must be prescribed by a physician. They are known in popular culture as downers or benzos because they depress the central nervous system.

They are commonly prescribed to people who suffer from insomnia, seizures, or panic disorders, and they can assist with symptoms of alcohol withdrawal. Common benzodiazepines are:
  • Clonazepam (Klonopin), which is usually prescribed for seizures and panic attacks.
  • Diazepam (Valium). This medication is customarily prescribed for panic attacks, anxiety, irritable bowel syndrome, seizures, muscle spasms, and to assist with alcohol withdrawal.
  • Alprazolam (Xanax), which is used for depression, agoraphobia, panic disorder, and anxiety.
  • Lorazepam (Ativan). This drug treats anxiety but is also used for those experiencing symptoms of withdrawal form alcohol and cancer patients who need assistance coping with nausea and vomiting.

Experts explain that benzodiazepines are dangerous because they quickly cause dependency. This does not cause a person to misuse these medications, but it can cause uncomfortable feelings of withdrawal. You cannot stop using benzodiazepines suddenly because of this. Doing so is dangerous.

Alternatives to benzodiazepines might include:
  • Antidepressants. Zoloft is an antidepressant that can work in those who have panic or anxiety disorders. It is especially beneficial to those who deal with concurrent depression and anxiety, per Harvard Medical School.
  • Holistic treatments. These can include hypnosis, yoga, and cognitive behavioral therapy.

Benzodiazepines were implicated in 64,000 deaths in the United States in 2016. Finding alternatives may save the lives of those who are prone to dependency or addiction.

Muscle Relaxants

Muscle relaxants are usually prescribed for those who deal with spasms. These drugs can assist during recovery so you can get through the day and use your muscles correctly during rehabilitation exercises. They also prevent muscles from seizing up during certain moments.

Examples of these medications are:
  • Cyclobenzaprine (Flexeril), which is used to treat injuries or physical conditions that involve the muscle and skeletons. It must be used along with physical therapy and exercise to be successful.
  • Carisoprodol (Vanadom, Soma, or Rela), which is prescribed to control muscle spasms or relieve pain relating to musculoskeletal injuries or conditions. This medication is used along with physical therapy.
  • Metaxalone (Skelaxin), which is a muscle relaxant that should be used along with physical therapy. It works by blocking certain nerve impulses to control muscles that become tense.

These medications are known to make you feel sleepy, and this relaxation is appealing to many who abuse the drugs.

A 2014 paper published by Pharmacy and Therapeutics said that approximately 53,000 patients visited the emergency room in 2011 because they misused muscle relaxants. An estimated 18 percent of these cases involved the use of alcohol while on these medications. About 4.8 percent of suicide attempts were found to have involved muscle relaxants.

Most alternatives to muscle relaxants are natural. You can ask your doctor if these might be enough for you.
  • Rest is crucial to helping your muscles recover. It is important to avoid overworking your injured muscle.
  • Sunlight and vitamin D could prevent muscle spasms. A vitamin D deficiency is known to cause pain or spasms in the muscles.
  • Cayenne pepper contains capsaicin. You can add this to a recipe, or use it as a topical remedy on muscles that require extra attention.

Antidepressants

Antidepressants are traditionally used for those who are diagnosed with clinical depression. They are best used along with therapy. They are not common drugs of abuse.

Antidepressants are also commonly prescribed to manage the following conditions:
  • Obsessive-compulsive disorder (OCD)
  • Anxiety
  • Panic disorder
  • Bulimia
  • Social phobia or agoraphobia
There are different kinds of antidepressants.
  • Tricyclic antidepressants: These are usually prescribed to those who do not respond to other types of antidepressants, most often due to side effects.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): This includes medication such as Cymbalta. SNRIs ensure that serotonin and norepinephrine stay in the brain at elevated levels to improve mood.
  • Selective serotonin reuptake inhibitors (SSRIs): This category of antidepressants limits the reuptake of serotonin, but they are known to cause rapid changes in mood.
  • Monoamine oxidase inhibitors (MAOIs): These tend to be a last-resort solution to problems in people with depression. MAOIs are known for their many side effects, and they require that users stay on a stringent diet. They are mostly prescribed when other medications don’t work.

A 2014 report from Substance Abuse and Rehabilitation found that people with substance use disorders are more likely to abuse antidepressants. The report found that people misuse antidepressants by snorting or injecting them. That being said, this practice is not common.

An April 2018 article from The New York Times reported that scientists and health experts have not yet imposed guidelines that allow physicians to gauge who might be most at risk of misusing antidepressants. Since antidepressants do not lead to the euphoria or sedation associated with most forms of drug abuse, they are not generally primary drugs of abuse.

A mild level of physical dependence does form with prolonged antidepressant use, and people may experience antidepressant discontinuation syndrome when they stop use. Oftentimes, doctors advise patients to gradually reduce their dosage when they want to stop taking the medication.

Mayo Clinic says that some people opt for natural alternatives to antidepressants.

Consult your doctor before you try any of these.:
  • 5-HTTP: 5-hydroxytryptophan is said to improve the mood of people who take it. More data is needed, but you shouldn’t take this supplement if you are already taking a prescription antidepressant.
  • St. John’s wort: This herbal remedy has not been approved to treat depression, but it is easy to find. Do not take it while on antidepressants, birth control medications, and medications that treat HIV, as St. John’s wort may interact with these.
  • DHEA: Your body already makes the hormone dehydroepiandrosterone. More studies need to be conducted to show how effective it is when taken as a supplement. It has shown to improve mood in people with depression.

Avoid Prescription Medication Abuse

Abuse of prescription medications carries significant risks to virtually every area of life.

Avoid all prescription misuse and abuse by only taking medications as prescribed. Never take someone else’s prescription medication, and never mix your medication with other substances, including alcohol.

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