- Prescription Drug Use in America
- Statistical Overview of Prescription Drug Use
- Most Abused Prescription Drugs
- Signs & Symptoms of Prescription Drug Abuse
- Prescription Drug Abuse Risk Factors
- Preventing Prescription Drug Abuse
- Seeking Help for Prescription Drug Addiction
- Therapeutic Modalities
- Medications & Supplements
- Alternative or Holistic Therapies
- Key Sources
- Medical Disclaimer
These days, it is possible to take a pill for almost any condition. Whether it’s a physical, mental, or emotional ailment, there is no shortage of prescription medications on the market that can ease our symptoms. While, overall, these advances in medicine have done wonders for public health, it could be argued that prescription drug abuse is also spiraling out of control.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), over 18 million people (roughly 6% of the population) aged 12 and above have overused prescription drugs in the past year. These numbers are larger than the U.S.’s consumption of cocaine, hallucinogens, and heroin combined. These rates are so high that the Centers for Disease Control (CDC) have classified prescription drug abuse as a national epidemic.
The good news is that, while prescription drug abuse can lead to dangerous complications, it is not a life sentence. Treatment is available for those who find themselves addicted to prescription medications.
This article provides information about prescription drug abuse in the U.S., along with which medications are most widely abused, and how to seek help.
Prescription Drug Use in America
Prescription drug abuse kills more people each year than car accidents. To put it in perspective, the number of written prescriptions increased from 3.95 billion in 2009 to 4.22 billion in 2019. If that isn’t alarming enough, the U.S. surpasses all other countries in the world in terms of consumption. According to the New York Times, the U.S. accounts for 99% of the world’s Vicodin and 80% of the world’s Oxycontin and Percocet consumption.
These staggering statistics point to the fact that prescription drug use is not only on the rise, but that the number of people abusing these drugs is also increasing.
Reasons for Increased Prevalence
While numerous factors are involved, one of the main reasons for this spike in prescription drug use is that many new medications have been introduced in the 21st century. This includes depressant drugs such as Valium and Xanax, anti-depressants such as Prozac, and stimulants like Adderall and Ritalin that treat attention-hyperactivity disorder (ADHD). The production of these drugs has also risen alongside increased clinical diagnoses for conditions like anxiety, depression, and ADHD.
An increase in pain medications also followed in the wake of new policies around compassionate pain management in 1997. This was compounded by the 2001 Pain Relief Promotion Act, which encouraged research, education, and training into pain care. Following these changes in legislation, pain medication purchases for oxycodone, hydrocodone, and methadone increased 4 times, 9 times, and 13 times, respectively.
According to the National Institute on Drug Abuse (NIDA), the rise in prescription medication abuse also varies according to gender and age, but it is also likely due to ease of access and misinformation about the addictive properties of these drugs. The increase in prescriptions is also due to increased medical marketing and a growing number of diagnosed mental health conditions.
Are Prescription Drugs Addictive?
The short answer is, yes. While each type of prescription drug affects the body differently, there are general ways that they lead to addiction.
The first is that the body develops a tolerance, which means that the person needs to take higher and higher doses of the drug to achieve the desired effect. The second is that this increased tolerance also results in intense drug cravings if the medication is discontinued. This cycle of tolerance and cravings can create an addiction loop that is difficult to break without intervention.
Prescription drugs can also be addictive for emotional and psychological reasons. Many people take them to ease pain, anxiety, and depression, or because these medications make them feel confident, energized, and focused. The idea of re-experiencing the discomfort of their original conditions can cause individuals to form a psychological addiction to the drug.
Statistical Overview of Prescription Drug Use
- In 2017, 18 million people were estimated to have abused or misused prescription drugs at least once in the past year.
- The 2015 SAMHSA National Drug Survey reports that around 119 million people (44.5% of the population) aged 12 and above used prescription drugs in the past year.
- In that same year, 18.9 million people 12 and older misused prescription drugs in the past 12 months.
- Of that cohort, roughly 97.5 million people used pain relievers (36.4%), 39.3 million used tranquilizers (14.7%), 17.2 million used stimulants (6.4%), and 18.6 million used sedatives (6.9%).
- Misuse of prescription drugs is highest among people aged 18 to 25: 14.4% report non-medical use in the past year.
- More than 80% of older patients aged 57 to 85 use at least 1 prescription medication per day. 50% report taking more than 5 medications or supplements per day.
- Overdose deaths from prescription drugs have quadrupled since 1999.
Most Abused Prescription Drugs
The most dispensed prescription drugs include opioid painkillers, anti-anxiety medications, and stimulants. Below, we discuss the most abused drugs from those categories, as well as their effects.
Opioids work by targeting the opioid receptors in the body’s nervous system to reduce acute and chronic pain. Since the 1990s, doctors have been prescribing increasingly more opioid medications. This is partially due to an aging population and because more people are living with long-term pain issues. Tolerance and dependence can easily occur with opioids, however. Ideally, they should only be used for short-term periods.
When these drugs are taken in excess, they can lead to feelings of euphoria that are similar to heroin. However, too much of the drug can result in negative physical effects, such as vomiting, breathing problems, coma, or even death. According to the Centers for Disease Control (CDC), over 247,000 people have died from prescription opioids between 2009 and 2019.
Below are the most abused prescription opioids. Other common versions include Lortab, Lorcet, Vicodin, Dilaudid, Darvon, Dolphine (methadone), and Demerol.
Oxycodone is a highly addictive opioid that causes euphoria and sedation. When taken correctly, it is used to treat moderate or severe pain following cancer treatment, accidents, or operations. It is sold under the popular brand name, OxyContin, or in combination with acetaminophen, under the brand name Percocet.
This drug is so popular that, according to the Drug Enforcement Agency (DEA), 58.8 million prescriptions for oxycodone were dispensed in 2013.
Common street names for oxycodone include:
- Hillbilly heroin
Fentanyl is a synthetic opioid that is typically used to treat cancer pain. Creating feelings of euphoria and relaxation, fentanyl is 50 to 100 times more potent than morphine. Fentanyl is also illegally manufactured and sold as a recreational drug, often as a substitute (or supplement) for heroin. Due to its high potency, the CDC reports that over half of opioid-related deaths are due to fentanyl.
Common street names for fentanyl include:
- China Girl
- China White
- Dance Fever
- Great Bear
- Tango & Cash
Codeine is a common pain reliever that is found in prescription-strength cough syrup and is used to relieve the symptoms of cold and flu. It is also the most prescribed and misused of all opioids. When codeine is consumed in high quantities, it can cause sedation and an altered state of consciousness. Codeine is often combined with sugary soda to produce illicit concoctions known as “purple drank,” “sizzurp,” or “lean.”
Common street names for codeine include:
- Captain Cody
- Doors and fours
- Pancakes and syrup
Morphine is a natural opioid derivative found in plants that acts directly on the opioid system in the body to provide pain relief. Over 500,000 kg of morphine is produced each year; however, more than 70% of that is used to make other opioids, like heroin and oxycodone.
Common street names for morphine include:
- Miss Emma
- White stuff
Opioid Withdrawal Effects
Withdrawing from opioids can produce severe and uncomfortable symptoms. Medically assisted detox is normally recommended, as the withdrawal symptoms can be difficult to deal with and lead to relapse. These include:
- Strong drug cravings
- Difficulty sleeping
- Agitation or irritability
- Runny nose
- Excessive sweating
- Digestive problems
Central Nervous System (CNS) Depressants
CNS depressants are drugs that are typically prescribed to help with anxiety and sleep issues. These medications, which include barbiturates and benzodiazepines (“benzos”), work by attaching to the gamma-aminobutyric acid (GABA) receptors in the brain, effectively controlling the neurotransmitters that contribute to anxiety and stress. This generates feelings of calmness, reduced anxiety, and muscle relaxation.
CNS depressants are more commonly known as “downers,” which are in contrast to stimulants, which are referred to as “uppers.” At high doses, CNS depressants can slow your heartbeat or breathing to dangerous levels. They can also lead to seizures.
Below are the most abused prescription CNS depressants. Other common versions include Librium, Halcion, ProSom, Lunesta, Sonata, and Ambien.
Xanax and Ativan
Xanax and Ativan are potent benzodiazepines that are used to treat anxiety, panic attacks, and insomnia. While Xanax and Ativan perform similar functions, Xanax is faster acting and more widely prescribed. When used in excess, these drugs can produce a high that is like being drunk.
Xanax and Ativan are also frequently abused with other drugs, like opioids and alcohol, which is a dangerous combination. The CDC estimates that deaths involving benzos and opioids more than quadrupled from 2002 to 2015.
Common street names for Xanax and Ativan include:
- Bicycle Parts
- Blue Footballs
- French Fries
- School Bus
- Yellow Boys
Klonopin and Valium
Klonopin and Valium are brand names for clonazepam and diazepam, two other drugs in the benzodiazepine category. Like Xanax and Ativan, these drugs are prescribed for their sedative effects. In high doses, these drugs can produce euphoric highs, relaxation, feelings of drunkenness, and talkativeness.
Common street names for Klonopin and Valium include:
- Super Valium
CNS Withdrawal Effects
Like opioids, withdrawal from CNS depressants can be difficult and uncomfortable, so medically supervised detox is recommended. Some of the withdrawal effects include:
- Strong drug cravings
- Anxiety and panic
- Excessive sweating
- Difficulty sleeping
- Muscle pain
Stimulants produce energy, increased brain activity, alertness, and euphoria. This is due to the way these drugs stimulate the production of dopamine, a pleasure chemical in the brain. However, in high doses, stimulants can lead to high body temperature, irregular heartbeat, aggression, paranoia, heart failure, or seizures.
Below are the most abused prescription stimulants. Other common versions include Dexedrine, Focalin, ProCentra, and Zenzedi.
Adderall is the most prescribed amphetamine stimulant in the U.S.I It is typically used to treat attention-deficit hyperactivity disorder (ADHD) and sleep disorders like narcolepsy. Known as “brain boosters,” Adderall is also used as a performance and study enhancer by college students, athletes, and professionals. This use as an enhancer makes Adderall an easily abused drug.
Common street names for Adderall include:
- Black Beauties
- Pep Pills
- Study Buddies
- Smart Pills
Ritalin is similar to Adderall, as it is also used to treat ADHD. The difference between these two medications is that Ritalin is made of methylphenidate hydrochloride, whereas Adderall is composed of amphetamine salts. Ritalin is also widely available, making it an easy drug to misuse and abuse among adolescents and young adults.
Common street names for Ritalin include:
- Diet Coke
- Kiddie Cocaine
- Kiddie Coke
- Poor Man’s Cocaine
- Vitamin R
Stimulant Withdrawal Effects
Stimulants alter the functioning of neurotransmitters in the brain. Therefore, sudden discontinuation can create several uncomfortable symptoms, such as:
- Increased appetite
- Difficulty concentrating
- Suicidal thoughts
Signs & Symptoms of Prescription Drug Abuse
The signs and symptoms of prescription drug abuse can vary between people, depending on the type of drug, how much they’ve taken, and long they’ve used it. However, below are some common signs of abuse to look out for:
- Depression or anxiety
- Poor coordination
- Slow or shallow breathing
- Upset stomach, vomiting, or constipation
- Slurred speech
- Mood swings
- Memory problems
- Slow breathing
- Mood changes
- Difficulty walking
- Trouble concentrating
- Poor judgment
- Slow reflexes
- Slurred speech
- Weight loss and lack of appetite
- High blood pressure
- Uneven heart rate
Addiction and abuse are also accompanied by behavioral signs and symptoms which can be applied across most prescription drug types. These include:
- Running out of prescriptions early
- Faking symptoms to get prescriptions
- “Doctor shopping”: seeking out several doctors to acquire multiple prescriptions
- Hiding or lying about your prescription drug use
- Difficulties controlling prescription drug use
- Continuing to use prescription medications, despite their negative side-effects
- Impulsive behaviors
- Spending a great deal of time using, obtaining, or recovering from prescription drug use
- Isolation from work, family, and social life
- Financial problems
- Loss of interest in activities or hobbies
- Abusing other substances (“poly-substance use”)
- Relationship problems
- A decline in personal hygiene
Prescription Drug Abuse Risk Factors
Like most substances, there are risk factors that can make you more susceptible to prescription drug abuse. These include:
- Peer pressure or influence from friends or colleagues
- Age: adolescents and the elderly are most at risk
- Genetics and biology
- Mental health and/or co-occurring mental health conditions (e.g., anxiety or depression)
- Knowledge about prescription drugs (e.g., how addictive they are and what the risks are)
Negative Health Consequences
Long-term prescription drug use can leave lasting and damaging effects on a person’s physical and mental health. Some of the issues include:
- Accidental death due to an overdose
- Decreased sensory feelings, like taste, touch, sound, sight
- Frequent nervous breakdowns
- Paranoia and anxiety
- Breathing and heart problems
- Sleep disorders
- Low sperm production and lack of sex drive
- Joint pain and bone decay
- Drying up of spinal fluid and synovial fluid, which are non-replaceable
- Loss of vital neural connections, which can even lead to paralysis
- Irritability and violent behavior
- Low concentration
- Low response and decreased agility
- Low immunity
- Constipation and digestive problems
- Intestinal infection that can spread to the liver and pancreas
- Decreased mental sharpness
- Depression and anxiety
- Memory loss
- Poor performance at school or work
- Dry and corrosive eyes
- Kidney and liver failure
- Hardening and decay of arteries
- Uncontrollable anger
- Dry mouth, low levels of saliva, and tooth decay
- Poor social skills
- Inability to concentrate or fulfill commitments
- Disorganized lifestyle with lack of self-care
- Cardiac arrest
- Seizures or convulsions
- Irritability and suicidal thoughts
- Involuntary muscle movements, like teeth clenching
- Intolerance to loud noise or bright lights
- Impaired judgment
- General body fatigue due to low oxygen intake
- Lethargy due to abnormal metabolism
- Lack of motivation for real work
- Chronic pessimism and denial
- Kidney and liver failure
Another important thing to look out for is a potential overdose. Key signs and symptoms of an overdose include:
- Confusion, delirium, and hallucinations
- Breathing problems, including slowed or irregular breathing
- Cold body temperature with dry skin
- Violent mood swings
- Bluish skin around the lips or under the fingernails
- Nausea or vomiting
- Extreme constipation
- Pinpoint pupils
- Coma or inability to come to sense
Preventing Prescription Drug Abuse
While prescription drug abuse can be driven by a psychological or emotional need, there are ways to take these medications safely. The Food and Drug Administration, for example, offers the following guidelines for safe prescription medication use:
- Always follow the directions carefully.
- Don’t increase or lower your dosage without talking to your doctor first.
- Never stop taking medication on your own.
- Never crush or break pills, especially if they’re time released.
- Be aware of how a drug will affect your driving and other daily tasks.
- Learn about what can happen if you combine your medication with alcohol or other prescription and over-the-counter drugs.
- Talk honestly with your doctor about any personal or family history of substance abuse.
- Never allow other people to use your prescription medications, and don’t take theirs.
Seeking Help for Prescription Drug Addiction
If you think your prescription drug use is out of control and causing problems in your life, help is available. Alcohol and drug treatment centers are well-equipped to provide tailored, individualized recovery plans. Below is a list of the most common forms of substance abuse treatment programs and what they entail.
Detox programs are available at certain clinics and medical facilities, where they supervise a person’s drug withdrawal and provide supportive medications, where necessary. These clinics are usually staffed with a team of doctors and nurses who have experience with addiction and drug withdrawal. The advantage of going to a detox center is that medical assistance is readily available. A detox center will place you in comfortable surroundings, where you can be assured of help in case of emergencies. These clinics also provide medications to ease some of the symptoms.
Short-Term Inpatient (Residential)
Short-term inpatient centers typically start with medical detox and are followed by a program of addiction treatment, such as therapy or counseling, for 30 to 90 days. These programs range from basic inpatient to luxury options, all varying in terms of their amenities and types of therapy. These facilities usually provide 24-hour medical support and are often led by a team of counselors, clinicians, and doctors. Short-term inpatient rehab is ideal for individuals who need detoxing and therapy, but who don’t require long-term treatment.
Long-term inpatient treatment varies in length, but typically ranges between 3 to 18 months. This type of rehab is best suited to individuals with long-term chronic addictions, especially those who have co-occurring mental health issues. Long-term treatment also provides an opportunity for the individual to physically withdraw from drugs while they focus on their mental and emotional rehabilitation. These centers also vary in terms of their provision of amenities, which range from basic to luxury options.
Partial Hospitalization Programs (PHP)
For individuals who are seeking intensive treatment but still prefer to live at home, partial hospitalization (PHP) or day treatment programs are also available. PHP typically consists of hospital treatment 5 to 7 days a week for 4 to 8 hours per day. Like inpatient treatment, clinical staff are on hand to assist with detox, medication management, and withdrawal symptoms. PHP also involves counseling and group therapy, as well as specialized services that focus on skill-building, relapse prevention, and employment assistance.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs are less involved than partial hospitalization programs and typically take place at a treatment center or outpatient clinic. Clients receiving intensive outpatient treatment will usually visit the center 2 to 5 days per week for 2 to 4 hours per day. IOP is well suited to clients who have just completed inpatient rehab and who wish to receive intense treatment while living off site. IOP programs vary, but they often involve a mixture of individual and group therapy, case management, 12-Step programs, experiential therapies, cognitive-behavioral therapies (CBT), and services that cover topics like skill-building, goal setting, and relapse prevention.
Standard Outpatient Programs
Standard outpatient programs are suited to individuals who have just completed an inpatient program and want to continue some form of therapy. Standard outpatient is also ideal for people who may be juggling other responsibilities, such as work or school. Individuals typically report to a treatment center or clinic 1 or 2 days per week. These programs can include counseling, group therapy, 12-Step groups, skills development, goal setting, and relapse prevention training.
Stopping prescription drug use can be done on your own, but it is not recommended — especially when it comes to opioids. Not only it is dangerous because of the way these drugs affect the central nervous system, but complications and uncomfortable side effects can also occur during withdrawal. Detoxing is best done safely under medical supervision, where clinicians can keep you safe and comfortable.
During rehab, centers and clinics will provide a range of treatments, such as medications, counseling, and behavioral therapies. Below are some of the more effective therapy options for prescription drug addiction.
Rehab facilities that offer dual diagnosis are often staffed with psychiatrists or clinical therapists that can diagnose and/or treat co-occurring mental health conditions. This kind of treatment is especially useful for people who have underlying issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). This allows clinicians to address these conditions alongside withdrawal from the drug itself.
Cognitive-Behavioral Therapy (CBT)
Another effective therapy for addiction and substance abuse is cognitive-behavioral therapy (CBT). CBT helps individuals change negative cycles of thought and behavior into more positive ones, and this has shown to be especially effective for addiction and mental health conditions. Clients receiving CBT for addiction learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence. CBT also helps clients find solutions to triggers that might encourage drug use.
Dialectical-Behavior Therapy (DBT)
Dialectical-behavior therapy is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients identify negative influences in their lives and learn how to develop healthy coping skills. This kind of therapy is useful for people who have been addicted to prescription drugs, especially those who have anxiety or mood disorders. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
The Matrix Model
The Matrix Model is another form of therapy that has shown to be effective in treating substance abuse. This 16-week approach is comprehensive and consists of a mixture of behavioral therapy, individual counseling, 12-Step support, family education, drug testing, and encouraging non-drug-related activities. Through guided therapy, patients learn about issues connected to addiction and relapse. These sessions are designed to promote self-esteem and self-worth while the patient and therapist work together to reinforce positive behavioral changes.
Medications & Supplements
Medication-assisted treatment (MAT) can sometimes be used to safely wean someone off a prescription drug, especially opioids. Some of the most common ones are:
Naltrexone is an opiate antagonist that can block the pleasurable effects of opioids, leading to a decreased desire to take them. Naltrexone is also used for alcohol addiction.
Suboxone or Buprenorphine
Buprenorphine is a partial opioid agonist that works by attaching to the brain’s opioid receptors to block cravings and lessen the risk of abuse. Suboxone is the brand name of the prescription medication that contains a combination of buprenorphine and naltrexone.
Anti-depressants can be useful during the detox process, as many clients often experience depression and anxiety when they wean off prescription medications.
Melatonin is a natural hormone that is produced in the brain and is responsible for setting the body’s sleep-wake cycle. This is especially helpful for stimulant withdrawal, which causes sleep disruption.
Alternative or Holistic Therapies
Many rehab centers also provide holistic therapies. The purpose of these therapies is to treat the whole person and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable coping skills. Popular holistic therapies include nutritional therapy, animal-assisted therapy (e.g., emotional support dogs), massage therapy, adventure therapy (e.g., hiking or rock climbing), mindfulness and meditation, art therapy, music therapy, yoga, and equine-assisted (horse) therapy.
If you or a loved one are struggling with prescription drug addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
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Miech R., Schulenberg, J., Johnston, L., Bachman, J., O’Malley, P., Patrick, M. (2017). Monitoring the Future National Adolescent Drug Trends in 2017: Findings Released. Institute for Social Research, The University of Michigan. http://www.monitoringthefuture.org//pressreleases/17drugpr.pdf.
National Institute on Drug Abuse. (2020). Misuse of Prescription Drugs Research Report. Drugabuse.gov. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/overview.
Substance Abuse and Mental Health Services Administration. (2006). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm.
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
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