Prescription Drug Abuse

Medically reviewed by:
John Nguyen, B.S.

What is Prescription Drug Abuse?

Living with chronic pain is devastating. Prescription painkillers are safe and effective when used correctly under a physician’s supervision. However, incorrect use can put an individual at risk of developing a prescription drug abuse disorder.

Prescription pain relievers are narcotics (also known as opioids) that are used in the treatment of moderate-to-severe pain, and are prescribed following injury, surgery, and or chronic disease such as cancer. Opioids work by activating opioid receptors throughout the central nervous system and other organs throughout the body. As opioids bind to these receptors, they prevent pain signals from being activated in the brain through the release of dopamine.

Recently, there’s been a significant increase in the prescription of opioid pain relievers for the treatment of chronic, non-cancer pain (i.e. back pain, osteoarthritis) despite the serious risks of abuse.

If people take their medication in a way other than directed, consume medication that doesn’t belong to them, and/or take the medication to achieve a high, that is considered prescription drug abuse. When individuals misuse these medications, they typically do so by swallowing the medicine normally, or crushing the pills, dissolving the powder in water, and injecting the liquid. The powder can also be snorted.

Prescription drug abuse consists of a group of problematic behavioral and physiological characteristics that develop after repeated prescription painkiller use. “Drug-seeking” and “doctor shopping” is very common in people with opioids in particular. Many patients report repeated “loss” of their previously prescribed medication or will tamper with the prescription.

Tolerance and dependence are components of prescription drug abuse that can develop with prolonged treatment. Tolerance occurs when an increased dose of painkillers is required to maintain the desired effect of analgesia (pain relief). Dependence is when a reduction of dosage or discontinuation of the drug results in withdrawal syndrome, which is characterized by a runny nose, sweating, muscle and joint pain, vomiting and diarrhea, and high blood pressure and heart rate. Addiction is the last, most severe stage of Opioid Use Disorder, where there are biological changes within the brain that cause compulsive use resulting in drastic negative social effects on patients’ lives.

Types of Prescription Drugs Abused

Opioid abuse is a common phenomenon in recent years but continues to change with different laws, availability, and preferences. The most misused prescription drugs in the United States are:

Hydrocodone

Hydrocodone is an opioid agonist used in the treatment of moderate to severe pain. It is also used as a cough suppressant. Serious side effects include abuse, heart and blood pressure issues, breathing problems, seizures, and serotonin syndrome, while the adverse effects of overdose are somnolence that may progress to coma, muscle flaccidity, sweating, and low heart rate and blood pressure. Treatment of a hydrocodone overdose includes naloxone (Narcan) and supportive measures such as oxygen, intravenous fluids, and vasopressors.

Oxycodone

Oxycodone, commonly known by the trade name OxyContin, is an opioid agonist indicated for the management of severe pain in which alternative treatments are inadequate. The most serious adverse effects of its use include addiction, decreased breathing, adrenal insufficiency, low blood pressure, seizures, and withdrawal syndrome. Oxycodone overdose symptoms consist of shallow and slowed breathing, decreased heart rate and blood pressure, cold/clammy skin, constricted pupils, and even death. Overdose treatment is typically naloxone (Narcan) with support comprising of oxygen, intravenous fluids, and vasopressors.

Percocet

Percocet is a medication that includes both oxycodone and acetaminophen and is indicated for moderate to severe pain. Its adverse effects are similar to those of oxycodone. However, excess acetaminophen can also cause liver and kidney damage. N-acetylcysteine (NAC) is administered if acetaminophen overdose is suspected.

Vicodin

Vicodin, also sold as Norco, is the way hydrocodone is typically prescribed, and is a combination of hydrocodone and acetaminophen. While the adverse effects are comparable to those of hydrocodone, acetaminophen overdose can in addition cause liver (and kidney) damage which can be treated through N-acetylcysteine (NAC) administration.

Other relatively less widely prescribed, potent, and/or misused prescription painkillers at the focus of abuse are: codeine, fentanyl, hydromorphone, meperidine, methadone, morphine, oxymorphone.

What are the Side Effects of Abusing Prescription Drugs?

In addition to the potential of addiction, opioid pain relievers are also associated with a number of side effects:

• Tolerance: requiring more of the medication for the same degree of pain relief
• Dependence: having symptoms of withdrawal when the medication is reduced or stopped
• Increased sensitivity to pain
• Constipation
• Nausea and vomiting
• Confusion and somnolence
• Itchiness and perspiration
• Depression

Taking more than the prescribed dose of opioid painkillers can also cause respiratory arrest, especially when mixed with alcohol or co-ingested with benzodiazepines, leading to death.

What are the Signs of a Prescription Pill Overdose?

The signs and symptoms of opioid painkiller overdose are somnolence, unconsciousness, respiratory depression that may progress to coma or death, constricted pupils, low heart rate and blood pressure, and cold/clammy skin.

Opioid antagonists (naloxone and nalmefene) are used to prevent respiratory depression in such an emergency setting. However, the mainstay treatment of opioid painkiller overdose is supportive measures (oxygen, IV fluids, and vasopressors). If arrhythmia (irregular heartbeat) or cardiac arrest ensues, advanced life-support is required.

Treatment Options for Prescription Drug Abuse

It is firstly important for users to talk to their physician about alternative ways to manage their pain, as some other options may work better and have fewer side effects. These treatment modalities may include:

• NSAIDs
• Injections
• Massage and acupuncture
• Cognitive behavioral therapy (CBT)
• Exercise therapy, including physical therapy
• Weight loss

However, if prescription pain relievers are required:

• Never take more than is prescribed
• Never sell prescribed narcotics
• Store them in a secured location out of the reach of others
• Never take painkillers with alcohol and other medications such as benzodiazepines (Valium and Xanax), muscle relaxants (Flexeril and Soma), and hypnotics (Ambien and Lunesta)

Further, it is essential to provide treatment for those struggling with Opioid Use Disorder to prevent overdose and death. Treatment involves providing medication-assisted treatment (MAT), which address a user’s individual needs by combining medication such as methadone, buprenorphine, or naltrexone, with behavior therapies such as drug counseling.

Behavioral therapies are used for prescription painkiller addiction to help people change their attitudes and perceptions related to drug use thus increasing healthier lifestyles.

An example of behavioral therapy is cognitive-behavioral therapy (CBT), which helps alter patients’ drug use and behaviors. CBT also modifies how these patients manage their triggers and stressors that lead to opioid painkiller use.

Family therapy is primarily used for adolescents with substance abuse issues. It applies personal and family influences on drug use patterns, and works to improve their overall functioning.