Julia Miller

11/16/17

Research Paper

Prescription Drug Abuse: A Legal Addiction?

Prescription drug abuse affects twenty percent of the U.S. adult population- thats over

fifty million people. (American Addiction Centers) Close to fifteen million of those people are

considered to be dependent on some form of prescription drug. (Talbot) The statistics are

staggering. One in four teens has reported prescription drug abuse, making it the third most

commonly abused drug by teenagers, following marijuana and alcohol. (NIDA)

Prescription drugs make up the highest percentage of overdose deaths in the United

States, approximately forty percent of total drug-related deaths. (AAC) Since 1999,

prescription drug-related deaths have quadrupled. It is reported that eighty percent of long-

term opioid addicts began with using and eventually misusing prescription drugs. (NIDA)

Emergency room visits and treatment center admissions are steadily increasing. (SAMHSA)

There are many different types of prescription drugs that have potential for abuse.

These drugs fall into four different categories: opioids, hypnotics, anti-anxiety medications,

and stimulants. The ten most commonly abused medications are Vicodin, Oxycontin, Fentanyl,

Morphine, Adderal, Ritalin, Valium, Xanax, Ativan, Klonopin, and Ambien. Vicodin, Oxycontin,

Fentanyl, and Morphine are all considered opiates and used to treat pain, with Fentanyl and

Morphine being the strongest.

 Adderal and Ritalin are stimulant medications commonly used to treat ADHD and

other attention deficit disorders. These two drugs are most often abused by younger adults

and students. Adderal is a form of amphetamine and Ritalin has as an extremely high

potential for abuse.

Valium, Xanax, Ativan, and Klonopin are all quick-acting anti-anxiety medications that

have addictive qualities. They are all in the benzodiazepine category. Benzodiazepines have

sedative properties. Ambien is a long-lasting and fast-acting benzodiazepine-like drug that

soothes electrical activity in the brain and can be used to treat insomnia. Ativan can also be

used to treat insomnia. (AAC)

Prescription drug abuse comes in many forms. It can be taking a medication that was

prescribed for someone else, taking a larger does than prescribes, taking a medication in a

different way than was prescribed, or using a medication for another purpose other than what

is intended by ones doctor. (Mayo Clinic) A person may voluntarily take prescription drugs as

a result of an injury or other medical condition. Continued use or initiating misuse of

prescription drugs can produce physical dependence and ultimately lead to addiction.

Some users may not see their use as a problem because they have obtained their

prescription legally. Use of prescription drugs in a way that is not intended by a medical

professional can be dangerous and life-threatening. Some users continue to obtain

prescription drugs illegally and continue to use in an addictive manner. Others may
discontinue use of one prescription drug and resume use of another. These are some

examples of the many ways in which prescription drug abuse can manifest and continue.

Risk factors for developing abuse or addiction to prescription drugs include a past

addiction or an addiction to a different substance, a family history of substance abuse or

addiction, being of a young age, a previous or co-occurring psychiatric condition, a social

environment that facilitates drug abuse, and easy access to prescription drug.

Seniors with health problems are also at risk for developing an addiction to

prescription drugs. They are often not adequately educated as to how to appropriately take

their prescriptions and are often prescribed more than one medication at a time. This can

present problems such as negative interactions and overdosing. (Mayo Clinic)

A stimulant high produces different effects than an opioid high. A stimulant user may

experience symptoms such as alertness and increased energy, euphoria, and excitement.

They may also have an increased heart rate and respiration. An opioid high produces

symptoms such as relaxation and intense happiness. An opioid user may experience

drowsiness and decreased heart rate and respiration. (Medline) A benzodiazepine high is

also different from an opioid high. Some similar symptoms are present, such as relaxation

and feelings of sedation. Other symptoms may include lowered anxiety and an increased

sense of self-confidence. (WebMD)

There are multiple different routes of administration in regards to prescription drug

abuse. These drugs can be swallowed, injected, smoked, or crushed and snorted. Different
routes of administration reach the brain at different speeds and therefore produce effects at

different intervals. (Wiki Lectures) Injecting drugs into the bloodstream is the fastest route of

administration. Smoking a drug also produces rapid effects in the brain. Taking prescription

drugs by mouth may be the most common method. (WebMD)

Signs of abuse of prescription drugs are abundant. These include: constipation,

drowsiness, reduced appetite, nausea, confusion and poor concentration, agitation,

unexplained euphoria, high body temperature, slowed breathing, slurred speech, insomnia,

high blood pressure, dizziness, irregular heart rate and/or palpitations, poor coordination,

memory problems, as well as anxiety and paranoia.

The feelings a drug produces differ from signs of abuse: a user may feel the symptoms

of a high while intoxicated by the drug. Signs of abuse may persist after the user is no longer

under the influence. These detrimental side effects may not present in a drug user that has

not progressed to abuse and/or addiction.

Signs of addiction can include all the clinical symptoms mentioned above in addition to

increased tolerance, loss of control of use, drug cravings, and the presence of withdrawal

symptoms when use is decreased or stopped. Tolerance develops as use continues and the

body becomes accustomed to the presence of a drug. Eventually, the user needs more and

more of the same drug to produce the same effects. If a drug is not introduced into the brain

when it is expected, the brain produces a craving, an intense, physical need for a drug.
 Aside from the physical signs of abuse or addiction, behavioral symptoms may also

appear- stealing, forging, or selling prescriptions, intentionally misplacing ones

prescriptions, and seeking out the same prescription from more than one doctor. (Mayo

Clinic) Signs and symptoms of an opioid overdose differ from those of a stimulant overdose.

These symptoms include slowed respiration, unconsciousness, blue lips and extremities, and

coma. An opioid overdose can often lead to death. The symptoms of a stimulant overdose

include chest pain, headache, confusion, agitation, hallucinations, and unconsciousness.

(NCADD)

The mechanism of action in a prescription drug overdose is the inhibition of the

medulla, the part of the brain that regulates breathing. Once the drugs have reached the

medulla in the innermost part of the brain, breathing is slowed and eventually suppressed

completely. This can lead to death. Death from a stimulant overdose is rare, but can still

occur. (Addiction Resource)

Withdrawal from prescription drugs is very dangerous and can be fatal. The body has

become physically accustomed to the presence of a drug and the sudden discontinuation of

use throws off the newly developed levels of homeostasis. Regulating homeostasis without

the presence of drugs can bring about dangerous physical symptoms. Medical detoxification is

often necessary in treating the initial symptoms of withdrawal.

Withdrawal symptoms typically consist of severe flu-like symptoms and occasionally

seizures. Other symptoms include tremors, headaches, memory problems, sweating, and
nausea. Symptoms may appear 24-48 after use is discontinued and may persist for up to two

weeks. (AAC) Stimulant withdrawal produces different symptoms: most commonly fatigue,

depression, and agitation, muscle aches, and mood swings. Withdrawal from stimulant drugs

is not often fatal.

Medical management of prescription drug withdrawal can be accomplished using different

types of medication. These medications are Naloxone, Buprenorphine, Methadone, and other

anti-anxiety medications such as Clonidine and Neurontin. Naloxone, also known as Narcan,

produces immediate withdrawal by binding to opioid receptors and reversing overdose

effects. Naloxone is often used in emergency situations to save a users life and allow them to

get immediate medical attention. (NIDA) It can also be used to manage withdrawal

symptoms when in combination with Buprenorphine. Buprenorphine partially activates

opioid receptors in the brain. Naloxone and Buprenorphine combine to form Suboxone, a

drug used to prevent drug cravings and manage withdrawal symptoms.

Naltrexone is not an opioid and prevents other opioids from binding to and activating

receptors in the brain. This prevents the user from feeling the effects of any other opiate

drug. Detoxification must be completed before beginning Naltrexone. Methadone acts on the

same receptors in the brain, mimicking the effects of a drug, and preventing any withdrawal

symptoms from presenting. Methadone, Naltrexone, and Suboxone can be used in the long-

term treatment of prescription drug addiction in addition to the immediate treatment and

management of withdrawal symptoms. (AAC)

 At this time, there is no FDA-approved medication for the use in managing stimulant

withdrawal. Some medications to treat individual symptoms, including benzodiazepines, may

be used. Tapering the drug by slowly decreasing the dose and monitoring the patient are the

most commonly used methods to treat withdrawal from stimulants. (AAC)

Medications such as Methadone and Suboxone can only be accessed with a valid

prescription from a medical professional or through a clinic. Public and privately-funded

clinics offer Methadone as a way to decrease the use of other opioids. Naltrexone injections

can be provided in a doctors office. It can also be prescribed in tablet form. Narcan is often

carried by first responders and other emergency personnel. In all states but one, it can be

purchased directly from a pharmacist. Otherwise, in Nebraska, it requires a physicians

prescription to obtain. (First-hand experience)

Treatment of prescription drug withdrawal and addiction is most effective when it

consists of three vital aspects: medical detoxification, medication management, and

behavioral or talk therapy. Including these three components in treatment and recovery

allow for the most effective and long-lasting treatment. Some may scorn the use of

medication in the treatment of recovery, especially if the drug of choice is (or was) legally

obtained medication at first. This method of treating prescription drug addiction can be

tricky, both for the used and for those around him or her.

Drugs like Buprenorphine and Methadone bind to opioid receptors and activate them,

producing a similar, yet muted, effect to the drug of choice. Although medications like these

can be habit-forming at high doses, using medication in treatment can be beneficial to

someone who has abused similarly acting drugs in the past- withdrawal symptoms are

prevented and the brain is reset to a normal homeostatic state so that the former user can

more effectively receive psychosocial treatment and continue to improve mentally,

emotionally, and physically.

Considering the disease model of addiction, someone with a different disease may take

medication to restore his or her body to normal functioning following the presentation of

symptoms and progression of the disease. The use of medications in the treatment of the

disease of addiction is no different, except in the presentation of symptoms. One of the main

symptoms of prescription drug abuse is the misuse of medication, whether obtained illegally

or through a medical professional. The presentation of symptoms does not have any bearing

on the method and mechanism of action of medical treatment.

Behavioral therapy is an important component of treating prescription drug treatment.

A common form that is utilized is cognitive behavioral therapy. Cognitive behavioral therapy

connects ones thoughts, feelings, and behaviors. The premise is that ones thoughts and

feelings affect behavior and that ones behavior also affects ones thoughts and feelings. Faulty

thought patterns and distressing emotions lead to destructive behaviors. The cycle continues

as destructive behaviors lead to negative emotions and damaging thought patterns. If one can

become aware of and modify their thoughts and feelings, he or she can hopefully change his or

her behavior. In turn, changing ones behavior can positively modify thoughts and feelings.

(AAC)
 Many question the legitimacy of prescription drug abuse and addiction, as well as the

methods of treatment employed. The source of prescription drugs is often legal and

justifiable in the eyes of medical professionals. It can be difficult to distinguish when a user

crosses the line into drug abuse and even more difficult to recognize when a user becomes

addicted to prescription drugs.

Prescription drugs account for many different types of drugs that all have abuse

potential and the manifestation of misuse and addiction can begin and present in a variety of

ways. The signs, symptoms, and long-term side effects can be severe and fatal if not treated

appropriately. Medication management, despite being controversial, is a very effective tool in

treating withdrawal symptoms and managing long-term recovery from all types of

prescription drugs. In combination with medically managed detoxification and behavioral

therapy, medication assisted treatment can be quite effective in treating prescription drug

abuse and addiction.

 Bibliography
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