Medication prescribed by a physician can be very effective in relieving pain, anxiety or sleeplessness and in treating conditions like depression or attention deficit disorder. But some drugs used to help with these problems can also become addictive and even deadly when they're misused. A prescription drug is misused when it’s taken for non-medical reasons, when more of the drug is used than prescribed, and when it's mixed with other drugs including alcohol.
The increase in annual deaths from drug overdose, which have more than tripled since 1999, is the main reason why the Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic. According to the CDC, 45 Americans die each day on average from prescription drug overdose. That’s more than from heroin and cocaine combined. About one half of these deaths involve combining a prescription drug with at least one other drug.
Surveys and research studies by the National Institute on Drug Abuse show that the dramatic rise in prescription drug abuse corresponds to a similar increase in the number of prescriptions written. More prescriptions provide more opportunities for abuse. And many people mistakenly believe that a drug prescribed by a doctor is safer than other substances when misused.
Who is abusing prescription drugs?
Certain groups seem to be at greater risk for abusing prescription drugs:
- Service members were prescribed pain medication at a rate four times higher in 2009 than in 2001. Combat-related injuries may help to explain the increase in prescriptions and the corresponding increase in self-reported misuse of prescription drugs during the same period.
- Adolescents and young adults have the highest rates of non-medical use of prescription drugs. They're the group most likely to get them from a friend, buy them on the street or steal them from a family member. Youths abusing prescription drugs are also more likely than other groups to report abusing other drugs like marijuana and alcohol.
- Middle-aged women have in recent years had the greatest increase in deaths due to prescription drug overdose. This may be because women tend to be more susceptible than men to chronic pain, and they're often prescribed painkillers in higher doses. They’re also more likely to "doctor shop" to get pain pills from multiple physicians.
- Older adults are more likely to be prescribed multiple medications for longer periods. This can lead to improper use of medication, especially when age-related changes in drug metabolism and cognitive decline are present.
Commonly abused prescription drugs
Although many types of medications can be misused, the greatest number of problems with addiction and overdose occur with three classes of prescription drugs:
- Opioids (hydrocodone, oxycodone, morphine, codeine and related drugs) are narcotic pain relievers. They work by reducing the intensity of pain signals reaching the brain. When an opioid is taken in larger quantities than prescribed, it often provides a feeling of euphoria that can be addictive. Taken in large enough doses or mixed with other drugs, opioids can cause breathing to slow down so much that it stops, resulting in a fatal overdose. These drugs are responsible for the majority of drug overdose deaths in the United States.
- Central nervous system depressants are tranquilizers and sedatives that slow brain activity. Benzodiazepines are typically prescribed for anxiety, acute stress reactions and panic attacks. Non-benzodiazepine medications are prescribed for sleep problems. And barbiturates are prescribed less frequently for anxiety and sleep but also for seizure disorder. Misuse of central nervous system depressants can lead to physical dependence and withdrawal symptoms if they're stopped. In combination with other drugs, especially alcohol, these drugs can affect heart rhythm, slow respiration and potentially lead to death.
- Stimulants are prescribed for a few health conditions, primarily attention deficit hyperactivity disorder. They’re misused in order to enhance alertness, attention and energy, but they also elevate blood pressure, heart rate and respiration. Repeated abuse can result in hostility, paranoia and psychosis.
See NIDA's Commonly Abused Prescription Drug Chart for a comprehensive listing of the commercial and street names of drugs in each of these classes and their effects.
Military response to prescription drug abuse
In 2012, the Department of Defense expanded drug testing requirements for service members to include some of the most abused prescription drugs containing hydrocodone and benzodiazepine. It also limited the length of time for a valid prescription for commonly abused drugs to six months. Service members with prescriptions for these drugs are not subject to disciplinary action when they're taken within the prescribed dosage and time limits.
Military health care providers and pharmacies have also become more alert to the signs of abuse by service members and military family members. These signs include asking for increased doses of medication or more frequent refills, false or altered prescription forms and multiple prescriptions for the same drug from different doctors.
Using prescription drugs safely
Addiction to a prescription drug is not likely when you need medication to treat a medical condition and you use the drug as prescribed. You can be sure you’re safe by following the Food and Drug Administration’s medication guides provided with your filled prescriptions. For commonly abused drugs, these guides typically provide the following safety directions:
- Report any history of drug abuse, pregnancy and other health conditions to your provider before taking the drug.
- Take the prescribed dosage without increasing or decreasing amounts and frequency.
- Do not stop taking the medication on your own.
- Do not crush or break timed-release pills.
- Avoid driving or operating machinery (if the drug has sedating effects).
- Avoid alcohol and other prescription and over-the-counter drugs (if the drug is subject to interactions).
- Never allow other people to use your prescribed medication.
Getting help for prescription drug abuse
Addiction to a prescription drug can sneak up on you if you take more than prescribed. Sometimes it's hard to tell the difference between a developing drug problem and a real need for increased doses to manage a medical problem. It's important to openly discuss medication dosage and risks with your health care provider.
If you're an active-duty service member, a military family member or a veteran, and you think you may have a problem with prescription drugs, help is available. Military treatment facilities, installation substance abuse programs, the Department of Veterans Affairs and TRICARE offer treatment services for prescription drug addiction. A Military OneSource consultant (800-342-9647) can work with you to assess your problem, review options for getting help and provide appropriate referrals.