Prescription drugs are increasingly taken as primary drugs of abuse.
Patients and users underestimate the dangers of abuse and addiction, as drugs like OxyContin® are not illegal and don’t carry the same stigma as heroin and cocaine.
Over $78 billion in prescription and over-the-counter drugs are produced each year in the United States. A significant number of people take them without a doctor's prescription or uses more than prescribed.
There are three classes of commonly Abused Prescription Drugs:
1. Opioids – primarily used for treating pain, include: Morphine, Codeine, OxyContin® (Oxycodone), Darvon® (Propoxyphene), Vicodin® (Hydrocodone), Dilaudid® (Hydromorphone), Demerol® (Meperidine), Lomotil® (Diphenoxylate).
When opioid drugs are abused, they can also cause feelings of euphoria by affecting the brain regions that control pleasure. Opioids are powerfully addictive. Tolerance, physical dependence, and addiction can result from long-term use of opioids. Abusers experience withdrawal when they reduce or stop using the opioid, making it impossible to quit by themselves. Withdrawal symptoms include: Restlessness, Muscle and bone pain, Insomnia, Diarrhea, Vomiting, Cold flashes with goose bumps, Involuntary leg movements.
Despite the potent addictive qualities and dangers of abuse of opioids, when medical use of opioids is properly managed, they are safe, rarely leading to addiction and providing effective pain management. Opioids should not be combined with other drugs except when supervised by a doctor.
2. Central Nervous System (CNS) depressants – barbiturates and benzodiazepines are prescribed for anxiety and sleep disorders.
The following drugs are benzodiazepines: Xanax® (Alprazolam), Valium® (Diazepam)
Chlorazepate® (Tranxene), Ativan®, Alzapam® (Lorazepam), Serax® (Oxazepam), Centrax® (Prazepam), Librium® (Chlordiazepoxide), Paxipam® (Halazepam), Halcion® (Triazolam), Klonopin® (Clonazepam), Dalmane®, Durapam® (Flurazepam), Restoril®, Razepam® (Temazepam), ProSom® (Estazolam)
Possible side effects of benzodiazepines include drowsiness, poor coordination and light-headedness. Overuse of benzodiazepines can lead to respiratory difficulties, sleeplessness, coma and even death. Withdrawal from benzodiazepines, such as Xanax and Valium, can take months - some patients have reported withdrawal symptoms lasting years. Withdrawal from benzodiazepines can produce terrible mental and physical effects.
Barbiturates such as mephobarbital (Mebaral®) and pentobarbital sodium (Nembutal®) are prescribed to treat anxiety, tension, and sleep disorders. If improperly used, barbiturates can cause an individual to feel depressed or experience respiratory difficulties, in addition to physical and psychological dependence.
Some Barbiturate are Amobarbital (Amyta®), Pentobarbital (Nembutal®), Secobarbital (Seconal®), Tuinal (amobarbital/secobarbital combination), Butalbital (Fiorina®), Butabarbital (Butisol®), Talbutal (Lotusate®), Aprobarbital (Alurate®)
Most CNS depressants decrease brain activity and produces drowsiness or a calm feeling.
When beginning a prescribed treatment using barbiturates or benzodiazepines, the patient may feel drowsy and clumsy. However, after a few days, the body adapts to the presence of the CNS depressants and these side effects fade away. The body can continue to adapt to the drug over time, creating tolerance, so more and more of the drug is required to produce the desired effects. Withdrawal from CNS depressants can be very dangerous – stopping use of the drug may cause the brain’s activity to skyrocket as it goes from depressed to overactive, potentially resulting in seizures. No one should try to quit without medical supervision. The dose must be reduced gradually through detoxification.
3. Stimulants – used to treat sleep disorder narcolepsy, attention-deficit hyperactivity disorder (ADHD), and obesity. Students studying long hours, athletes who think their performance can improve from drugs, and workers who want to stay awake on the job often use stimulants.
Some stimulants that may be prescribed include: Dexedrine® (dextroamphetamine), Ritalin® (methylphenidate), Adderall® (d-amphetamine and amphetamine mixture). Currently, physicians prescribe stimulants in treatment of only a few health conditions such as narcolepsy, attention-deficit hyperactivity disorder (ADHD), and depression that has not responded to other treatments. Stimulants also provide suppression of appetite for short-term treatment of obesity. Stimulants are also sometimes used in treatment of asthma.
Although stimulant use is not characterized by physical dependence and risky withdrawal, stimulant abuse can be dangerous. Sometimes users turn to stimulants compulsively, similar to an addiction. Taking high doses of some stimulants over a short time can lead to hostility and paranoia, in addition to high body temperatures and an irregular heartbeat. Stimulants may present a risk of cardiovascular failure or lethal seizures. Behavioral therapies used for effectively treating cocaine or methamphetamine addiction are useful in treating prescription stimulant addiction.
Physicians are in a position to not only prescribe drugs when needed but they are often able to identify when prescription drug abuse exists. They can then help patients get help for prescription drug addictions. Physicians also must keep in mind that there is a potential for their patient to be visiting other doctors to obtain more of the prescription, as well. Pharmacists can also help prevent prescription drug abuse by giving clear information about how to take a medication appropriately, the effects of the medication, and any possible drug interactions. Pharmacists can help prevent prescription fraud or diversion by looking for false or altered prescription forms.
Patients themselves can also take steps to prevent addiction and abuse of prescription drugs. Directions should be followed carefully for prescription drugs. It is also important to learn about effects of the medication and potential interactions with other drugs by reading all information provided by the pharmacist. If it seems that a prescription is no longer working as you feel it should, talk to your doctor.
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