Prescription Drug Abuse: Signs, Types, & Treatments

What Is Prescription Drug Abuse?

Abusing a prescription drug involves using it in a manner inconsistent with medical advice or without a valid prescription. This can include taking higher doses, using someone else’s prescription, altering its form (e.g., crushing or dissolving), or combining drugs for recreational purposes. When someone abuses prescription drugs, the brain and body chemistry are affected in various ways depending on the specific drug. Prolonged abuse can disrupt normal brain functioning, leading to addiction, impaired judgment, and a heightened risk of overdose.

Why Do People Abuse Prescription Drugs?

The reasons for prescription drug abuse vary widely. One common factor is the perception that prescription drugs, being obtained legally, are safer than illicit substances. Some individuals may turn to prescription drugs (with or without a prescription) as a means of self-medication or to cope with stress, anxiety, or other emotional issues.

Additionally, there is a misconception that prescription drugs provide a quick fix for various problems, leading to their misuse. In either case, prescribed or not, many people have no idea what they are getting into until the problem sneaks up on them, and when it does, it is a confusing and lonely experience.

Reasons for the prevalence of prescription drug abuse include:

• Overuse leads to dependence and addiction
• Using prescription drugs as a substitute for illicit substances
• Perceived benefits, such as increased concentration or relaxation
• Self-medication for physical or emotional pain
• Curiosity or experimentation with the effects of prescription drugs
• Pressure from peers or social influences to misuse prescription medications
• Lack of awareness about the potential dangers and risks associated with misuse
• Availability of prescription drugs through family or friends
• Desire to enhance performance or cope with stress in academic or professional settings
• Easy access to prescription medications through online pharmacies or illegal sources
• Inadequate monitoring or regulation of prescription drug distribution and prescriptions.²

Prescription Drug Abuse Statistics

Prescription drug abuse has become a significant public health concern. According to various studies, millions of people worldwide engage in the misuse of prescription drugs. Specific to the United States,

Some prescription drug abuse statistics in the United States are:¹

• 59.277 million or 21.4% of people 12 and over have used illegal drugs or misused prescription drugs within the last year
• 24.7% of those with drug disorders have an opioid disorder; this includes prescription pain relievers or “pain killers” and heroin)
• 22% of males and 17% of females used illegal drugs or misused prescription drugs within the last year
• From 2012 to 2015, the US saw a 264% increase in synthetic opioid (other than methadone) deaths
• In 2017, 67.8% of the 70,237 drug overdose deaths were opioid-related, including:
  • 28,466 deaths were fentanyl-related
  • 17,029 deaths were prescription-opioid-related
  • 15,482 deaths were heroin-related

In terms of accessibility, prescription drugs can be more readily available compared to illicit drugs. They are often obtained with legitimate prescriptions from healthcare professionals; however, the rise of online pharmacies, illegal sales, and diversion from legitimate sources have contributed to their increased availability outside the healthcare system. In some cases, people mail-order medications from outside their federal jurisdiction. Moreover, individuals may have access to prescription drugs through family or friends who have been legitimately prescribed these medications. In sum, the wide accessibility of prescription drugs, combined with the misconception of their safety, can contribute to their misuse and abuse.

What Prescription Drugs Are Commonly Abused?

Several types of prescription drugs are commonly abused due to their potential for producing euphoria, altering mood, or inducing relaxation—all of which are desirable sensations activated through the pleasure pathway. These drugs can be classified into different categories as follows:

Opioids

Prescription opioids are highly effective in relieving pain; however, their potent analgesic properties can also lead to misuse and addiction. Opioids interact with the brain’s reward system/pleasure pathway, producing feelings of pleasure and reducing pain perception, which can be highly addictive.

Commonly prescribed opioids include:

• Codeine
• Tramadol
• Dihydrocodeine
• Tapentadol
• Hydrocodone (Vicodin, Norco)
• Morphine
• Oxycodone
• Methadone
• Phenazocine
• Hydropmorphone
• Oxymorphone
• Levorphanol
• Buprenorphine
• Fentanyl

Central Nervous System (CNS) Depressants

Medications like benzodiazepinesare prescribed to treat anxiety, panic disorders, and sleep disorders. These drugs enhance the inhibitory effects of the neurotransmitter GABA, resulting in sedation, relaxation, and anxiolytic effects. Their calming properties make them desirable for misuse, leading to dependence and overdose risks.

Commonly prescribed CNS depressants include:

• Benzodiazepines (e.g., diazepam, alprazolam)
• Barbiturates (e.g., phenobarbital, pentobarbital)
• Nonbenzodiazepine sedatives (e.g., zolpidem, eszopiclone)
• Antidepressants with sedating properties (e.g., trazodone, amitriptyline)
• Antipsychotics with sedating effects (e.g., quetiapine, olanzapine)
• Muscle relaxants (e.g., carisoprodol, cyclobenzaprine)
• Anticonvulsants with sedative properties (e.g., clonazepam, gabapentin)
• Opioids and opioid analgesics (e.g., oxycodone, hydrocodone)
• Antihistamines with sedating effects (e.g., diphenhydramine, doxylamine)
• GHB (gamma-hydroxybutyrate) and GBL (gamma-butyrolactone)⁶

Stimulants

Stimulant medicationsare commonly prescribed to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Stimulants increase dopamine and norepinephrine levels in the brain, promoting alertness, focus, and increased energy. Their potential for improving cognitive performance and inducing a euphoric state can lead to misuse, especially among students or individuals seeking enhanced productivity.³

Commonly prescribed stimulants include:

• Dextroamphetamine (Dexedrine)
• Methylphenidate (Ritalin, Concerta)
• Adderall (amphetamine/dextroamphetamine)
• Vyvanse (lisdexamfetamine)
• Modafinil (Provigil)
• Atomoxetine (Strattera)
• Guanfacine (Intuniv)
• Lisdexamfetamine (Vyvanse)
• Dexmethylphenidate (Focalin)
• Bupropion (Wellbutrin)
• Methamphetamine (Desoxyn)

Risk Factors for Prescription Drug Abuse

While individual risk factors do vary, several common risk factors can increase the likelihood of someone abusing prescription drugs. These risk factors include a personal or family history of substance abuse, a history of mental health disorders, easy access to prescription drugs, social or peer pressure, and a lack of knowledge about the potential dangers and consequences of drug abuse.

Individuals with higher risk factors for drug abuse should exercise caution when it comes to certain drugs, particularly those with a high potential for abuse or addiction. By being aware of their risk factors and taking appropriate precautions, individuals can better protect themselves from the potential pitfalls of drug abuse.

Risk factors that can increase the likelihood of abusing prescription drugs include:

• Personal or family history of substance abuse: Having a genetic predisposition or being exposed to a family environment of substance abuse increases the risk of developing addiction due to a potential vulnerability to the effects of drugs.
• History of mental health disorders: Conditions such as anxiety, depression, or ADHD can increase the likelihood of prescription drug abuse as individuals may seek self-medication or relief from their symptoms.
• Easy access to prescription drugs: Being able to obtain prescription medications easily, whether through personal prescriptions or from others, increases the likelihood of misuse and addiction.
• Social or peer pressure: Being influenced by peers or social circles that engage in drug abuse can lead to experimentation and subsequent addiction. This may especially be true for younger individuals such as children, adolescents, and young adults.
• Lack of knowledge about the dangers of drug abuse: Insufficient awareness about the risks, potential side effects, and consequences of prescription drug abuse can make someone more likely to engage in risky behaviors without fully understanding the potential harm.
• History of trauma or adverse childhood experiences: Traumatic events or adverse childhood experiences can contribute to an increased vulnerability to substance abuse as individuals may turn to drugs as a coping mechanism or escape from emotional pain.⁹

Signs of Prescription Drug Abuse

Prescription drug abuse may be recognized through changes in behavior as well as physical and psychological symptoms. The individual may exhibit secretive or deceptive behavior, such as frequently visiting multiple doctors or pharmacies to obtain prescriptions, forging prescriptions, or hoarding medications. They may also show a noticeable change in their social activities, relationships, or hobbies as their focus becomes centered around obtaining and using the drugs.¹⁰ Physical signs can include changes in appetite, sleep patterns, and weight, as well as frequent headaches or unexplained aches and pains.¹⁰ Psychological symptoms may include mood swings, irritability, anxiety, or sudden changes in energy levels.¹⁰ One may also have trouble concentrating, memory problems, or appear drowsy or sedated.¹⁰

It’s important to differentiate between dependence and addiction. Dependence refers to the body’s physiological adaptation to the presence of a drug, leading to withdrawal symptoms when use is reduced or stopped abruptly. This is natural for everyone and most often occurs independently of addiction. Addiction, on the other hand, involves compulsive drug-seeking behavior, loss of control over drug use, and continued use despite negative consequences. Though most individuals struggling with addiction are also physically dependent, not all are, and vice versa. A substance use disorder (SUD) is a clinical diagnosis that encompasses both dependence and addiction. It is characterized by a pattern of problematic drug use that leads to significant impairment or distress in various areas of life. At this point, behavioral, physical, and psychological symptoms are present while one struggles with the vicious battle of cravings and withdrawal.¹⁰

Signs of prescription drug abuse vary by the drug involved …

Signs of Opioid Abuse

Signs someone may be abusing opioids include:

• Constricted or pinpoint pupils
• Drowsiness or excessive sleepiness
• Slurred speech
• Poor coordination or unsteady movements
• Nodding off or appearing sedated
• Shallow or slowed breathing
• Itching or flushed skin
• Euphoria or extreme mood swings
• Neglecting responsibilities or social withdrawal
• Doctor shopping or frequent visits to different healthcare providers
• Financial problems or borrowing money
• Changes in sleep patterns or insomnia
• Unexplained weight loss or changes in appetite¹¹

Signs of CNS Depressant Abuse

Signs someone may be abusing CNS depressants include:

• Slurred speech
• Impaired coordination or unsteady movements
• Drowsiness or excessive sleepiness
• Confusion or disorientation
• Memory problems or cognitive impairment
• Slow or shallow breathing
• Mood swings or emotional instability
• Poor judgment or decision-making
• Social withdrawal or isolation
• Neglecting responsibilities or declining performance at work or school
• Risky behaviors or engaging in dangerous activities
• Mixing depressants with alcohol or other substances⁶

Signs of Stimulant Abuse

Outward signs of stimulant abuse may include increased heart rate and blood pressure, dilated pupils, decreased appetite or weight loss, insomnia or irregular sleep patterns, restlessness or agitation, rapid or excessive speech, and increased sociability.⁷

Signs someone may be abusing stimulants include:

• Increased heart rate and blood pressure
• Rapid or excessive speech
• Dilated pupils
• Bloodshot eyes
• Insomnia or irregular sleep patterns
• Increased energy or hyperactivity
• Decreased appetite or weight loss
• Restlessness or agitation
• Excessive sweating
• Dry mouth or frequent thirst
• Tremors or involuntary movements
• Impaired coordination
• Paranoia or heightened anxiety
• Mood swings or irritability
• Hallucinations or delusions
• Risky behaviors or impulsivity
• Social withdrawal or isolation
• Neglecting responsibilities or declining performance at work or school
• Financial problems or borrowing money for drug use⁷

Dangers of Abusing Prescription Drugs

The dangers of prescription drug abuse are significant and can have severe consequences on both physical and mental health. One of the primary risks is the potential for overdose. Prescription drugs, when taken in higher doses or in combination with other substances, can overwhelm the body’s systems and lead to respiratory depression, unconsciousness, and even death. Additionally, prescription drug abuse can lead to addiction, which can disrupt daily functioning, strain relationships, and lead to financial problems (among other problems).

Taking prescription drugs in a manner other than prescribed, such as crushing and snorting them, can have serious side effects. This method of administration can cause damage to the nasal passages, respiratory system, and other organs. Dissolving and injecting is another dangerous form of misuse. Here, a “dirty hit” can lead to a host of health complications, including but not limited to bacteremia (bacteria in the blood), endocarditis, tetanus, necrotizing fasciitis (flesh-eating disease), wound botulism, hepatitis, and human immunodeficiency virus (HIV).⁷ Both can also result in a rapid onset of the drug’s effects, increasing the risk of an overdose. In sum, prescription drug abuse poses significant health risks, including the potential for overdose, addiction, and even death.

Each prescription drug has its own specific dangers of abuse:

Dangers of Abusing Opioids

Abusing opioids carries significant dangers that can have life-threatening consequences. One of the major risks is the development of drug tolerance, where the body becomes accustomed to the presence of opioids and requires higher doses to achieve the desired effects. As individuals increase their dosage to chase the initial high (“chasing the dragon”), the risk of overdose increases correspondingly. Opioid overdose can lead to respiratory depression, coma, and death.

Another danger is the high potential for developing addiction. Opioids can quickly create a physical and psychological dependence, making it challenging to stop using them without experiencing withdrawal symptoms and intense cravings. Withdrawal symptoms occur when opioid use is reduced or abruptly stopped, and they can include flu-like symptoms, intense cravings, anxiety, insomnia, muscle aches, nausea, and vomiting.¹³ The severity of withdrawal symptoms depends on factors such as the duration and dosage of opioid use. The risk of experiencing withdrawal symptoms is high due to the body’s adaptation to the presence of opioids, which leads to a disrupted balance of neurotransmitters and physiological dependence on the drug.

Opioid withdrawal symptoms vary depending on the severity of addiction and may include:

• Muscle and bone pain
• Restlessness or agitation
• Diarrhea or gastrointestinal distress
• Nausea and vomiting
• Insomnia or disturbed sleep patterns
• Cold flashes or chills
• Excessive sweating
• Anxiety or irritability
• Dilated pupils
• Abdominal cramping or abdominal pain
• Rapid heartbeat or increased blood pressure
• Runny nose or teary eyes¹³

For individuals struggling with opioid addiction, medically supervised detoxification or medication-assisted treatment (MAT) can be crucial components of their recovery journey. These medications help reduce cravings, minimize withdrawal symptoms, and stabilize brain chemistry, allowing individuals to focus on their recovery without the intense physical and psychological distress of withdrawal.¹⁴

Dangers of Abusing CNS Depressants

One of the primary risks of CNS depressant abuse is the development of drug tolerance, where the body adapts to the presence of the depressant and requires higher doses to achieve the desired effects. As individuals increase their dosage to chase the initial sedation or relaxation, the risk of overdose significantly rises. CNS depressants can cause respiratory depression, leading to slowed or shallow breathing, unconsciousness, and even death.⁶ Mixing CNS depressants with other drugs, particularly alcohol, can intensify their effects and amplify the risks. Combining depressants increases the sedative and respiratory-depressant properties, which can be extremely dangerous and potentially fatal.

After developing a dependence and/or addiction to CNS depressants, reducing or stopping their use abruptly can lead to withdrawal symptoms. These symptoms occur because the body has become reliant on the presence of the depressant to maintain normal functioning.

CNS depressant withdrawal symptoms vary depending on the severity of addiction and may include:⁶

• Anxiety or panic attacks
• Agitation or restlessness
• Insomnia or disturbed sleep patterns
• Irritability or mood swings
• Tremors or shaking
• Sweating or excessive perspiration
• Increased heart rate or palpitations
• Nausea or vomiting
• Muscle aches or pain
• Headaches or migraines
• Loss of appetite or changes in eating patterns
• Difficulty concentrating or foggy thinking
• Depression or feelings of sadness⁶

Individuals should never attempt to quit taking CNS depressants on their own, as it can be dangerous and potentially life-threatening. Abruptly stopping the use of depressants without medical supervision can lead to severe withdrawal symptoms and complications. It is recommended that individuals seek professional medical care and guidance to manage antidepressant withdrawal symptoms when discontinuing the use of CNS depressants to ensure a safe and supportive withdrawal process.

Dangers of Abusing Stimulants

Abusing stimulants can pose significant dangers and adverse effects on both physical and mental health. Continued use of stimulants can lead to tolerance, where the body becomes less responsive to the drug’s effects, requiring higher doses to achieve the desired results. Accordingly, this increases the likelihood of overdose. Long-term stimulant abuse can also result in various health complications, particularly cardiovascular problems such as increased heart rate, blood pressure, and strain on the cardiovascular system.⁷ This can lead to heart palpitations, irregular heartbeat, increased risk of heart attack or stroke, and other cardiovascular-related issues.

When an individual develops a dependence on stimulants and subsequently reduces or stops their use, they may experience withdrawal symptoms. These symptoms occur as the body adjusts to the absence of the stimulant.

Stimulant withdrawal symptoms vary depending on the severity of addiction and may include:¹⁰

• Insomnia or disturbed sleep patterns
• Irritability or mood swings
• Mental and physical exhaustion
• Increased appetite or weight gain
• Difficulty concentrating or focusing
• Depression or feelings of sadness
• Anxiety or panic attacks
• Suicidal thoughts or behaviors
• Cravings for the stimulant
• Lack of motivation or interest in activities
• Agitation or restlessness
• Slowed thinking or cognitive impairment¹⁰

During stimulant withdrawal, individuals are at an increased risk of experiencing depression and developing suicidal thoughts. Getting help for depression and suicidal thoughts during stimulant withdrawal is highly recommended. Treatment options may include therapy, counseling, medication, and support groups. Additionally, ensuring a strong support system of loved ones, friends, or support groups can also be beneficial in navigating the challenges of withdrawal and promoting mental well-being.

Preventing Prescription Drug Abuse

Preventing prescription drug abuse starts with taking medications safely and responsibly and having an awareness of potential dangers. Prior to receiving any prescription, it’s crucial to have open and honest communication with one’s healthcare provider. Discuss any personal or family history of substance abuse or addiction, as well as any risk factors that may make one more susceptible to potential abuse or addiction. A medical professional can help assess the appropriateness of prescribing certain medications and suggest alternative treatments if necessary. If prescribed, one should take prescription medications exactly as directed. This includes following the recommended dosage, frequency, and duration of use. One should avoid altering the prescribed dose or sharing medication with others.

Treating Prescription Drug Abuse & Addiction

The treatment process begins with a thorough assessment by healthcare professionals to determine individual needs and develop a personalized treatment plan. It may include detoxification followed by various forms of therapy such as cognitive-behavioral therapy (CBT), individual counseling, group therapy, and support groups like Narcotics Anonymous (NA). The success of recovery varies depending on individual factors such as the severity of the addiction, level of commitment, and adherence to the treatment plan. Healthcare providers, addiction specialists, or addiction treatment centers can provide guidance on available treatment options and connect individuals with the appropriate resources. Various online therapy options have gained popularity and have been found to be effective for addiction treatment. Such sessions can provide convenience, accessibility, and privacy for individuals seeking help so long as one’s provider is reputable, licensed, and specializes in addiction.

Treatment options for prescription drug abuse and addiction include:

Therapy Options

Therapy options for prescription drug abuse and addiction often include individual counseling and group therapy. Individual therapy, such as cognitive behavioral therapy (CBT), helps individuals identify and modify negative thought patterns and behaviors associated with drug use through a one-on-one therapeutic relationship designed to address personal challenges while developing coping strategies. Group therapy offers a supportive environment where individuals can share experiences, gain insights, and receive peer support. Aftercare support groups, such as Narcotics Anonymous (NA), provide ongoing support and encouragement for long-term recovery.

The costs and timelines for treatment can vary depending on various factors, including the severity of the addiction, the chosen treatment provider, insurance coverage, and individual needs. Treatment durations can range from a few weeks for detoxification to several months or more for comprehensive outpatient or residential programs. Costs can include fees for therapy sessions, medications, medical assessments, and any additional services required. Fortunately, many support groups, such as 12-Step groups, are free of charge or request a nominal donation. To find the right therapist, it can be helpful to start by researching addiction specialists with experience in treating prescription drug abuse and addiction. Referrals from primary care physicians, addiction treatment centers, or recommendations from trusted individuals can also be valuable. It’s important to consider factors such as the therapist’s credentials, expertise, treatment approach, and compatibility with personal preferences. Initial consultations or phone interviews can provide an opportunity to ask questions and assess whether the therapist is the right fit.

Therapy options for addressing prescription drug abuse and addiction include:

• Cognitive behavioral therapy (CBT): CBT helps individuals identify and change negative thoughts, emotions, and behavioral patterns related to prescription drug abuse. It focuses on developing coping strategies, improving problem-solving skills, and preventing relapse.
• Dialectical behavior therapy (DBT): DBT combines elements of CBT with mindfulness techniques to address emotional regulation, distress tolerance, and interpersonal effectiveness. By stressing the importance of remaining aware of and grounded in the present, it can assist individuals in managing cravings, reducing impulsive behaviors, and improving relationships.
• Group therapy: Group therapy provides a cathartic, supportive environment where individuals can share their experiences, gain insights, and receive peer support. It offers a sense of community and helps individuals build social skills and a network of understanding peers.
• Motivational interviewing (MI): MI aims to explore and resolve ambivalence towards change. It helps individuals enhance their motivation to overcome prescription drug addiction by identifying personal values, setting goals, and addressing any barriers or concerns.
• Family therapy: Family therapy involves the participation of family members to address the impact of prescription drug addiction on family dynamics. It helps improve communication, rebuild trust, and develop a supportive and understanding environment that can contribute to long-term recovery.
• 12-step programs and other support groups: Programs such as Narcotics Anonymous (NA), SMART Recovery, Celebrate Recovery, Dual Recovery Anonymous (DRA), and others provide a structured approach to recovery through a series of steps and principles. They offer peer support, accountability, and a sense of belonging to individuals struggling with prescription drug addiction.

Intensive Outpatient Treatment

Intensive outpatient treatment (IOP) is a form of outpatient rehab that provides a higher level of care and structure compared to traditional outpatient programs. It offers a comprehensive approach to recovery, combining individual and group therapy, educational sessions, relapse prevention planning, and support from a multidisciplinary team while being intentionally designed for those who may benefit from more support but do not require 24/7 supervision in a residential setting. IOP generally involves more frequent and longer therapy sessions than other types of outpatient rehab. Therapy sessions typically occur several times a week for a few hours each session, allowing for more intensive treatment and support while still providing flexibility for individuals to continue with their daily responsibilities.

Different types of IOP options may be available depending on location. These can include a combination of evidence-based therapies, such as CBT, DBT, motivational interviewing, and family therapy. Additionally, IOP programs often incorporate holistic approaches, such as mindfulness practices, art therapy, or fitness activities, to support overall well-being. The costs and timelines for IOP treatment can vary depending on factors such as the location, facility, and duration of the program. The duration of IOP treatment can range from a few weeks to several months, depending on the individual’s progress and needs. Costs may include therapy fees, medication management, assessments, and any additional services provided. As of 2022, the average cost for a 3-month outpatient rehab program is $5,000.¹⁵

Rehab

Rehab options for prescription drug abuse and addiction can include inpatient and outpatient programs. Understanding some of the key differences between inpatient vs outpatient rehab is crucial to making an informed decision. Inpatient rehab, also known as residential treatment, provides a highly structured and immersive environment where individuals reside at the facility for a designated period of time, typically ranging from 30 to 90 days or longer. This type of rehab offers intensive therapy, medical supervision, and 24/7 support to address the physical, psychological, and emotional aspects of addiction. As of 2022, the average cost associated is around $6,000, though this may prove significantly higher due to the comprehensive services provided, including room and board, medical care, therapy sessions, and other amenities.

Outpatient rehab, on the other hand, allows individuals to live at home and attend treatment sessions during scheduled times, providing more flexibility for personal and professional commitments. Outpatient programs can range from a few hours a day several times a week to less frequent sessions as the individual progresses in their recovery. Outpatient rehab is generally more affordable compared to inpatient, and the timeline can vary from a few weeks to several months or even longer, depending on the specific program and individual progress. It’s important to note that costs and timelines can vary greatly, and it is recommended to contact individual treatment facilities or consult with healthcare providers to obtain specific information.

In My Experience

In my experience, prescription drug abuse and addiction is about as scary a thing as it gets. Having worked at a methadone clinic as well as in general practice with a focus on addiction, prescription abuse is one that I see get out of hand quickly. Most everyone I have worked with began their addiction with a prescription for a legitimate health concern. After taking it correctly for a period, tolerance set in, and the client began adjusting dosages and frequency to continue receiving the desired effect. This “innocent” misuse in the beginning quickly led to more serious abuse. From here, individuals may begin abusing more powerful versions of the prescription medication. In respect to “gateway drugs,” my experience is that prescription drugs meet this description.

One important fact that cannot be understated is that prescription drugs are powerful. Most clients who ultimately became addicted to prescription drugs noticed the issue getting out of hand sooner than the point of seeking help but thought they could handle the issue themselves. That said, I strongly urge anyone at the first sign of awareness to seek help. The sooner one seeks and receives help, the less likely one is to suffer the harsh consequences of addiction.