Prescription Drug Addiction

Some of the drugs prescribed by a physician may have a potential for abuse and could eventually lead to addiction. Most people take prescription drugs according to the instructions of the doctor, but some still become addicted.

The National Institute on Drug Abuse indicates that many people over the age of 12 have taken prescription drugs for nonmedical purposes during their lifetime. In the last few years, there has been a large increase in the cases of misuse and abuse of prescription drugs in UK. This has led to large number of people visiting emergency rooms due to overdoses and a substantial number being admitted because of a prescription addiction.

Drug addiction can be defined as a chronic brain disease that results in overwhelming drug-seeking behaviour and usage, despite the dangerous effects on the user and their loved ones. Drug abuse alters the appearance and functions of the brain.

The initial decision to take prescription drugs, for many individuals, is usually voluntary. After a short period of time, however, the drug alters the brain, causing repeated drug abuse. This affects an individual’s self-restraint and ability to make intelligent decisions. This persistent behaviour creates intense impulses in the user whereby they end up taking more drugs. (1)

What Are Prescription Drugs?

A prescription drug is a drug that legally requires a medical prescription to be issued, as opposed to over-the-counter drugs that can be purchased without a prescription. The definition of prescription drugs varies depending on the jurisdiction. The difference lies in the likelihood for their misuse by persons abusing drugs or practicing medicine without a license or without the necessary qualifications to issue the drugs. (1)

Prescription medicines can be helpful in the treatment of many illnesses when used as prescribed by a physician. Those with the potential for abuse are categorised into three groups: stimulants used to manage attention-deficit hyperactivity disorder (ADHD) and narcolepsy; central nervous system (CNS) depressants that are prescribed in the treatment of disorders like panic, anxiety and sleep disorders; and opioids used in patients suffering from chronic to mild pain, coughs and diarrhoea.

Misuse of these drugs has been known to have serious consequences on the user. (1)

• Opioids:Prescription drugs in this classification include morphine, OxyContin, Percodan, codeine, Percocet and Vicodin. These drugs are used to treat mild to chronic pain because they block the brain’s perception of pain. Opioids are commonly abused because of their pain-relieving capabilities and release of dopamine, making it easier for users to become addicted to them compared to other types of painkillers.
• Central Nervous System Depressants: Commonly referred to as sedatives or tranquilizers, CNS depressants decelerate brain functions and produce a calm or drowsy feeling. They are prescribed in the treatment of anxiety and panic attacks. These drugs include barbiturates and benzodiazepines like Xanax, Valium and Librium.
• Stimulants: These drugs make people more alert and energetic. They are mostly prescribed in the treatment of fatigue, ADHD, depression and tiredness. Common stimulants include Adderall, Concerta, Dexedrine and Ritalin. These drugs produce feelings of euphoria and have a high potential of being abused.

Medical Actions of Prescription Drugs

Opioid and other painkillers manage pain well when taken as prescribed and have improved the quality of life for people with chronic pain. They rarely cause addiction or dependence when used for a short term under a doctor’s strict supervision. However, long-term use of opioids in many cases results in physical dependence and addiction, since the drug causes a joyful feeling in the user. (1)

CNS depressants have an impact on the brain’s neurotransmitter, gamma-aminobutyric acid (GABA), which lowers brain activity, making the user drowsy or calm. These depressants may help a person feel calm and sleepy for a few days to a few weeks. After some time, however, the user may need larger doses to experience the same calm and sleepy feeling. (1)

Quitting CNS depressants after long-term use may have life-threatening effects such as withdrawal seizures.

Stimulants are known to give the body a swift jump-start, high levels of alertness, attention and energy. Initially, stimulants were prescribed in the treatment of asthma and obesity. Currently, they are prescribed to treat problems such as ADHD, depression and narcolepsy.

Stimulants are safe when taken as prescribed under a physician’s supervision. Abuse of these drugs in higher doses results to dependence. (1)

It is illegal for people to be in possession of these drugs without a doctor’s instructions. It is not an offence to be in possession of these drugs if a doctor has prescribed them to you. (2)

Opioid pain medications

Opioids are addictive because they contain chemicals that attach to the brain’s opioid receptors, the same receptors that deal with heroin. Opioid receptors are located on the nerve cells in numerous brain and body locations, particularly in the part of the brain that’s responsible for perception of pain and pleasure. Some opioid drugs include Vicodin, OxyContin and Duragesic. (3)

Stimulants

These are addictive because they produce effects like those produced by cocaine. Stimulants cause a build-up of the brain chemicals dopamine and norepinephrine. They include Ritalin and Concerta.

Depressants

Depressants act like club drugs and make a person feel calm and relaxed. This is what makes them addictive. Some of these drugs include Valium and Xanax. All abused prescription drugs result in a pleasurable overflow of dopamine into the brain’s reward pathways. The longing to experience that feeling again is what makes them addictive.

How Prescription Drug Addiction develops

Prescription drug addiction develops because of the effects of the drug on the brain. It alters normal functions when taken over a long period of time or in larger doses. Such drugs change the brain’s reward system, making the person will feel good only when they use the drug. Eventually this causes powerful cravings for more of the drug and results in substance dependence, commonly referred to as physical dependence. It is the major element in the addiction cycle. (3)

The user becomes dependent on the drug because their brain and body have adjusted to functioning under the influence of the drug in their system for a long period. The user must take higher doses of the drug to experience the initial effects of the drug. This is referred to as tolerance.

When the user tries to stop using the drug, they experience uncomfortable withdrawal symptoms. Taking the drug consistently despite its many negative consequences is a sign of addiction.

To prevent addiction, a patient is advised to follow the doctor’s instructions when using the prescribed drug. However, there is still a possibility of dependence and addiction even when taken on the prescribed dosage. Patients are advised to be cautious and communicate any issues or concerns with their physician.

• Stimulants: Used for attention deficit disorder and narcolepsy treatment
• Opiates: Used for pain treatment
• Tranquilizers/Sedatives: Used to relieve anxiety and treat sleep disorders

Commonly Abused Prescription Drugs

• Pregabalin
• Opioid Painkillers
• Gabapentin
• Diazepam
• Fentanyl (Duragesic)
• Hydrocodone (Vicodin)
• Oxycodone (OxyContin)
• Oxymorphone (Darvon)
• Hydromorphone (Dilaudid)
• Meperidine (Demerol)
• Morphine Sulfate
• Zolpidem Tartrate (Ambien)
• Pentobarbital Sodium (Nembutal)
• lprazolam (Xanax)
• Dextroamphetamine (Dexedrine)
• Methylphenidate (Ritalin and Concerta)
• Amphetamines (Adderall)

Genetics

A person whose genetic inclination is towards impulsivity and novelty may end up struggling with prescription drug abuse. Research conducted on twins and adopted children revealed that having a biological parent who had a substance use disorder may make an individual prone to substance abuse during a later stage in life.

There are some individuals who inherit certain disorders that must be treated with prescription drugs. Such persons are at an increased risk for abusing and becoming dependent on these drugs.

Environmental

Environmental factors are the second major cause of prescription addiction. A person raised in a disorderly household where prescription addiction is unrestrained is likely to develop drug addiction later in life.

Additionally, factors such as social media may also encourage an individual to misuse prescription drugs.

Risk Factors

The following risk factors have been known to make a person vulnerable to prescription drug abuse:

• Impulsivity
• Being prescribed medications for legitimate purposes
• Personal or family history of substance misuse
• Trauma and/or pain
• Personal or family history of mental illness
• Novelty-seeking

Co-Occurring Disorders

There are many mental disorders that may co-occur with prescription drug abuse. Some common co-occurring disorders include:

• Schizophrenia
• Post-traumatic stress disorder
• Alcoholism
• Anxiety
• Other substance abuse
• Bipolar disorder

Signs, Symptoms and Effects of Prescription Drugs Addiction

Psychological/mood factors

• Notable changes in mood or mood swings
• Poor judgment and decision-making abilities
• Altered mental status, appearing ‘high’, disoriented or confused regarding person, place and time
• Becoming preoccupied or obsessed with obtaining, taking or recovering from the drug
• Interpersonal problems
• Lack of social support network

Behavioural symptoms

• Stealing prescriptions from friends and family
• Dependence on others to help the individual complete responsibilities they can no longer fulfil
• Obtaining different prescriptions that can be sold to obtain money to buy the prescription of choice
• Repeated reports that prescriptions were lost or stolen to obtain additional medication
• Obtaining prescriptions from several different doctors
• Crushing pills and snorting the powder or mixing it with water to inject in order to achieve a quicker and more potent effect
• Borrowing/stealing prescription medications from others
• Inconsistent or contradictory responses to questions asked about prescription usage

The Dangers of Prescription Drug Addiction

Prescription drug abuse poses a danger to the individual and also puts those around the user at risk. Some of these dangers include;

• Labile moods
• Worsening well-being
• Worsening of physical and mental illnesses
• Consequences of risk-taking behaviours
• Psychological and physical tolerance
• Crumbling interpersonal relationships
• Inability to fulfil responsibilities at work or home
• Joblessness
• Homelessness
• Legal problems
• Withdrawing from previously enjoyable activities
• Addiction
• Increasing financial troubles
• Social isolation

Impact of long-term prescription drugs abuse on the brain

When the user starts abusing prescription drugs, they do so to get the pleasurable high feeling. This feeling is caused by the electrical stimulation of the brain’s reward centre by dopamine.

Dopamine is a neurotransmitter that is responsible for the feelings of pleasure and reward. It helps in promoting vital actions like eating when a person is hungry, leading to the production of pleasurable sensations when the requisite behaviour happens. (4)

Prescription painkillers, alcohol and other mood-altering drugs create this effect artificially when consumed in excess quantities. Commonly abused substances such as opiates, amphetamines and cocaine generate neurochemical reactions that escalate dopamine amounts unleashed in the brain’s reward centre neurons, thus causing dopamine overflow and resulting in a high sensation.

Prescription painkillers are highly addictive when used for nonmedical purposes and can even result in physical dependence. They can also cause severe withdrawal symptoms when the person stops using them. Long-term use of prescription drugs reduces the ability of dopamine receptors in the brain to adjust to the increase of dopamine levels in the system.

Dopamine reduction is associated with impulsive behaviour that leads to escalating and compulsive self-administration of drugs. Also, low dopamine results in a loss of pleasure in activities that were previously enjoyed, and this drives the user to administer drugs in a reactive attempt to relive past moments of pleasure.

The toxic levels of the drug erode the grey matter in the prefrontal cortex, hence reducing self-control and the user’s ability to rationally consider consequences as a result of reduced executive function.

Substance-induced disorders are different from independent co-occurring mental disorders because most or all of the psychiatric symptoms experienced by the user are the direct result of the substance use. In some cases, however, a user may have both independent and substance-induced mental disorders. (8)

Prescription Drugs Overdose Explained

Most prescription medications affect the part of the brain that regulates breathing. High doses of these drugs may lead to reduced breathing and could even lead to death in some cases.

Opioid overdose happens when a person takes the drugs to get high or takes an extra dose either accidentally or on purpose. It may occur when individuals mix the prescriptions with alcohol, medicines or illegal drugs. Opioid overdoses have been known to be devastating when mixed with certain anxiety treatment medicines like Xanax or Valium.

Overdose may also occur to a person who is getting a medication-assisted treatment (MAT), which is commonly used in opioid abuse and addiction treatment.

Anyone using prescription drugs legally or under a doctor’s prescription is still at risk of an overdose. However, the following are at a greater risk of overdose.

• People who take prescription drugs illegally
• People who take the drugs in larger amounts than prescribed
• Users who mix opioids with other medicines and/or alcohol
• Individuals with medical conditions like reduced kidney or liver function
• Persons over 65 years old

Some of the signs of overdose include pale face, shallow breathing, limp body, slow heartbeat, seizures and discoloured fingernails.

Teen prescription drugs abuse

Prescription drugs have devastating consequences and may even lead to death in cases of overdose, especially when it has been combined with drugs or alcohol.

Prescription drug abuse results in risky behaviours in teens. A recent study conducted in the US revealed that adolescents who used prescription drugs for nonmedical purposes to get high were at a greater risk of smoking cigarettes or marijuana, drinking excessive alcohol and abusing several other drugs.

How to Quickly Recognise that Someone Is Misusing Prescription Drugs

Physical and behavioural signs and symptoms will always manifest in a person abusing prescription medication. For instance, prescription drugs alter the structure of the brain after some time, making it difficult for the addict to make sound decisions. Abuse of prescription drugs will have different symptoms depending on the kind of drug abused. Signs of abusing prescription drugs include:

• Opioids: Physical signs include slowed breathing, nausea, constipation, a sense of confusion, lack of coordination and drowsiness in some cases. Withdrawal symptoms of opioids when a person tries to quit the drug include vomiting, involuntary movements, flashes, nausea, cold and vomiting, pains, restlessness and seizures.
• Depressants: Symptoms include sleepiness, poor judgment, slurred speech, involuntary movements, problems with concentration and memory, slower breathing, walking difficulties and dizziness.
• Stimulants: Signs to note in a person misusing stimulants include agitation, sense of anxiety, loss of appetite, high body temperatures, weight loss and in some cases, seizures.

Signs and Symptoms of Withdrawal

The user starts experiencing drug withdrawal symptoms from prescription medications when their body has developed a physical tolerance towards the drugs.

Withdrawal symptoms may differ in each person depending on the types of drug abused, level of dependence, frequency of use and additional substances abused. They include;

CNS Depressant Withdrawal Symptoms

• Life-threatening seizures
• Insomnia
• Anxiety
• Confusion
• Tachycardia
• Sweating </li
• Tremors and shaking

Painkillers Withdrawal Symptoms

• Agitation
• Anxiety
• Abdominal cramping, nausea, vomiting, diarrhoea
• Muscle and bone pain
• Insomnia
• Sweating, chills, goose bumps
• Dilated pupils

Stimulant Withdrawal Symptoms

• Depression
• Irritability
• Difficulty sleeping
• Intense dreams

Overcoming Prescription Drugs Addiction

Addiction is a chronic disease that affects the brain, causing a compulsion to seek drugs. However, it is a curable disease, though the risk of relapsing may make it seem difficult to overcome.

Overcoming prescription drug addiction may be challenging and stressful. A client without the support of friends or family may end up relapsing back to the addiction cycle.

To beat the addiction, it is recommendable to seek help from:

• Trusted family members or friends
• Your doctor, who may be able to recommend resources
• Self-help groups, such as a 12-step programme
• Your church or faith group
• School counsellor or nurse
• Support groups, either in person or from a trustworthy website
• Your employee assistance program, which may offer counselling services for substance abuse problems

Inpatient and Outpatient Treatment

Inpatient rehab
In this type of program, the client undergoes treatment within a drug rehabilitation centre on a full-time basis. This type of program is recommended for individuals who cannot recover without close supervision due to their heavy dependence on prescription drugs.

Inpatient drug rehabilitation is preferable for the following reasons;

• It keeps the client from normal activities that may trigger drug abuse cravings, enabling the individual to focus on full recovery.
• It is carried out under a safe and conducive environment where the client can seek assistance from professionals any time.
• The client is under constant monitoring, enabling the doctor to change treatment based on what may work best for them.
• Minimal chances of relapse.
• Client confidentiality is ensured because only a few people know what is going on with a client.

Outpatient Rehab

Evaluation
Before the client embarks on a detoxification process, an evaluation is necessary to determine the specific treatment plan for the client. This is an extremely important part of the recovery process because it enables the medical team to understand the treatment that is appropriate to the client.

The team assesses the individual’s medical history, symptoms and severity of the addiction. This enables the drug rehabilitation team to create a special and personalized treatment plan that makes the detox process efficient.

Detoxification
This process begins when the client quits taking the prescription drugs. It involves removing the drugs the recovering user had consumed from their system. Clients are advised to undergo a detoxification process in a drug rehabilitation centre under a doctor’s supervision.

Prescription Drugs Addiction Statistics

The health survey of England conducted by the Health and Social Care Information Centre (HSCIC) found that 50% of women and men regularly take more than one prescription medication. It also reported that over 2.9 million prescription items were distributed daily in 2014, a yearly increase of more than 55.2% over the number of prescription items distributed 10 years earlier.

The biggest increase was between 2013 and 2014. During this period, more than 3.8 million prescription drugs were distributed, mainly antidepressants. A study conducted by the British Journal of Clinical Pharmacology reported an 80% escalation in annual deaths between 2001 and 2011 related to the misuse of prescription opioid analgesics. (10)

The cost of prescription drug abuse to society

The illegal use of prescription drugs has proved costly to society in some of the following ways:

• Impact on Workplace Productivity: Prescription drug abuse costs the UK more than $20 million per year in lost productivity. The loss of productivity is a direct result of incarceration, reduced labour participation, premature mortality, participation in treatment programs away from work and hospitalisation.
• Impact on Health and Healthcare Systems: The government, in most cases, is forced to spend on the patients visiting emergency departments and those who are hospitalised.
• Other Costs to Society: Apart from economic and financial costs, other costs include the impact on crime and the criminal justice system, the spread of blood-borne infections, deaths from overdose and effects on unborn children.

Ready to Get Help for Your Addiction?

Getting help for a drug addiction problem involves;

• Knowing that the user can’t fix the problem directly: The user must know that they cannot fix the problem unless they are a licensed healthcare professional. The user’s friends and relatives are also advised not to try to fix the problem because addictions are complicated, severe diseases that require special medical intervention to overcome.
• Identifying the Issue: The user must figure out whether their substance use problem is mild, moderate or severe whilst seeking help. Therefore, seeking the assistance of a qualified physician should be a person’s first course of action. Once the issue has been identified, the doctor will guide the user and their loved ones through the rest of the process.
• Talking About the Problem: Most recovering users are usually worried about the impact of the treatment on their social life; thus, merely identifying the issue and getting the advice of a qualified medical professional in most cases is not enough. It is equally important for the client to open up and share their thoughts and concerns with someone they can really trust, like a friend or family member.
• Intervention: The National Council on Alcoholism and Drug Dependence defines intervention as a professionally directed education process resulting in a face-to-face meeting of family members and friends with the affected individual. It is recommended that user’s loved ones consult with a professional to get help on who may act as an interventionist to guide the user and their family through the initial recovery process.
• Learning More About Treatment Options: It’s important to know the different types of treatment plans and options available. For instance, some people may prefer individual therapy to group therapy, while others may opt for inpatient rehabilitation as opposed to outpatient rehab.

Sources

• https://www.webmd.com/
• https://www.drugwise.org.uk/
• https://www.drugabuse.gov/
• https://www.hazeldenbettyford.org/
• https://www.ncbi.nlm.nih.gov/
• https://www.nida.nih.gov/
• https://www.samhsa.gov/data/
• https://www.independent.co.uk/