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DOCUMENT RESUME
ED 451 429 CG 030 784
TITLE Prescription Drugs: Abuse and Addiction. Research
ReportSeries.
INSTITUTION National Inst. on Drug Abuse (DHHS/PHS), Rockville,
MD.REPORT NO NIH-01-4881PUB DATE 2001-04-00NOTE 14p.AVAILABLE FROM
National Clearinghouse for Alcohol and Drug Information,
P.O. Box 2345, Rockville, MD 20847. Tel: 800-729-6686
(TollFree); Tel: 800-487-4899 (TTD); Web
site:http://www.health.org.
PUB TYPE Information Analyses (070)EDRS PRICE MF01/PC01 Plus
Postage.DESCRIPTORS Adolescents; Adults; Drug Education; *Drug Use;
Health
Services; Medical Services; Pharmacists; Prevention; Role;Sex
Differences; *Substance Abuse
IDENTIFIERS *Prescription Drugs
ABSTRACTThis publication answers questions about the
consequences of
abusing commonly prescribed medications including opioids,
central nervoussystem depressants, and stimulants. In addition to
offering information onwhat research says about how certain
medications affect the brain and body,this publication also
discusses treatment options. It examines prescriptiondrug abuse in
older adults as well as in adolescents and young adults,
anddiscusses sex differences in this abuse. The roles of health
care providers,pharmacists, and patients in the prevention and
detection of prescriptiondrug abuse are presented. This publication
was developed to help health careproviders discuss the consequences
of prescription drug abuse with theirpatients. According to a
recent national survey of primary care physiciansand patients
regarding substance abuse, 46.6% of physicians find it difficultto
discuss prescription drug abuse with their patients. (MKA)
Reproductions supplied by EDRS are the best that can be madefrom
the original document.
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National Institute on Drug AbuseResearch Report Series
Prescription Drugs: Abuse and Addiction
U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and
Improvement
EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)
This document has been reproduced asreceived from the person or
organizationoriginating it.Minor changes have been made toimprove
reproduction quality.
Points of view or opinions stated in thisdocument do not
necessarily representofficial OERI position or policy.
EST COPY AVAILABLE
2
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NATIONAL INSTITUTE ON DRUG ABUSE
Most people who take prescriptionmedications take them
responsibly;however, the nonmedical use orabuse of prescription
drugs remainsa serious public health concern.Certain prescription
drugsopioids,central nervous system (CNS) depres-sants, and
stimulantswhen abused,can alter the brain's activity andlead to
dependence and possiblyaddiction.
An estimated 4 million peopleaged 12 and older used
prescriptiondrugs for nonmedical reasons in1999 almost half of that
numberreported using prescription drugsnonmedically for the first
time in theprevious year. We would like to reversethis trend by
increasing awarenessand promoting additional researchon this
topic.
The National Institute on DrugAbuse (NIDA) has developed this
pub-lication to answer questions aboutthe consequences of abusing
com-monly prescribed medications. Inaddition to offering
information onwhat research has taught us abouthow certain
medications affect thebrain and body, this publication
alsodiscusses treatment options.
This publication was developed tohelp health care providers
discuss theconsequences of prescription drugabuse with their
patients. Accordingto a recent national survey of primarycare
physicians and patients regard-ing substance abuse, 46.6 percent
ofphysicians find it difficult to discussprescription drug abuse
with theirpatients.
Prescription drug abuse is not anew problem, but one that
deservesrenewed attention. We hope thisscientific report is useful
to the public,particularly to individuals workingwith the elderly,
who because of thenumber of medications they may take
for various medical conditions, maybe more vulnerable to misuse
orabuse of prescribed medications.
Alan I. Leshner, Ph.D.DirectorNational Institute on Drug
Abuse
rch ReportSERIES
Abuseand Addiction
What are someof the commonlyabused prescriptiondrugs?
Although many pre-scription drugs canbe abused or misused,
there are three classes ofprescription drugs that aremost
commonly abused:
Opioids, which are mostoften prescribed to treatpain;CNS
depressants, whichare used to treat anxietyand sleep disorders;
U.S. Department of Health and Human Services
Stimulants, which areprescribed to treat thesleep disorder
narcolepsy,attention-deficit hyper-activity disorder (ADHD),and
obesity.
OpioidsWhat are opioids?
Opioids are commonlyprescribed because oftheir effective
analgesic,
or pain-relieving, properties.Medications that fall withinthis
classsometimes referredto as narcoticsinclude mor-phine, codeine,
and relateddrugs. Morphine, for example,is often used before or
aftersurgery to alleviate severepain. Codeine, because it isless
efficacious than morphine,is used for milder pain. Otherexamples of
opioids that canbe prescribed to alleviate paininclude oxycodone
(OxyContin),propoxyphene (Darvon),hydrocodone (Vicodin),
andhydromorphone (Dilaudid),
National Institutes3
of Health rAC9)
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NIDA RESEARCH REPORT SERIES
3.0
2.5
2.0
1.5
10
Sedatives andTranquilizers
Pain Relievers
Source:, Office of Applied Studies, Substance Abuse and Mental
Health Services Administration.
`.National Household Survey on Drug Abuse, 1999.
as well as meperidine(Demerol), which is usedless often because
of its sideeffects. In addition to theirpain-relieving properties,
someof these drugsfor example,codeine and diphenoxylate(Lomotil)can
be used torelieve coughs and diarrhea.
Now do cjiioids affectthe brain and body?Opioids act by
attaching tospecific proteins called opioidreceptors, which are
found inthe brain, spinal cord, andgastrointestinal tract.
Whenthese drugs attach to certainopioid receptors, they canblock
the transmission of painmessages to the brain. Inaddition, opioids
can producedrowsiness, cause constipa-tion, and, depending upon
the amount of drug taken,depress respiration. Opioiddrugs also
can cause euphoriaby affecting the brain regionsthat mediate what
we perceiveas pleasure.
What are the possibleconsequences of opioiduse and abuse?Chronic
use of opioids canresult in tolerance for thedrugs, which means
that usersmust take higher doses toachieve the same initial
effects.Long-term use also can leadto physical dependence
andaddictionthe body adapts tothe presence of the drug,
andwithdrawal symptoms occurif use is reduced or stopped.Symptoms
of withdrawalinclude restlessness, muscleand bone pain,
insomnia,
4
diarrhea, vomiting, cold flasheswith goose bumps ("coldturkey"),
and involuntary legmovements. Finally, taking alarge single dose of
an opioidcould cause severe respiratorydepression that can lead
todeath. Many studies haveshown, however, that properlymanaged
medical use of opi-oid analgesic drugs is safe andrarely causes
clinical addiction,defined as compulsive, oftenuncontrollable use
of drugs.Taken exactly as prescribed,opioids can be used to man-age
pain effectively.
Is it safe to useopioid drugs withother medications?Opioids are
safe to usewith other drugs only undera physician's
supervision.Typically, they should not beused with other
substancesthat depress the centralnervous system, such asalcohol,
antihistamines,barbiturates, benzodiazepines,or general
anesthetics, assuch a combination increasesthe risk of
life-threateningrespiratory depression.
CNS depressantsWhat are CNS depressants?
CNS depressants aresubstances that can slownormal brain
function.
Because of this property, someCNS depressants are useful inthe
treatment of anxiety andsleep disorders. Among themedications that
are commonly
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NIDA RESEARCH REPORT SERIES
prescribed for these purposesare the following:
m Barbiturates, such asmephobarbital (Mebaral)and pentobarbital
sodium(Nembutal), which areused to treat anxiety, ten-sion, and
sleep disorders.Benzodiazepines, suchas diazepam
(Valium),chlordiazepoxide HC1(Librium), and alprazolam(Xanax),
which can beprescribed to treat anxiety,acute stress reactions,
andpanic attacks; the moresedating benzodiazepines,such as
triazolam (Halcion)and estazolam (ProSom)can be prescribed
forshort-term treatment ofsleep disorders.
In higher doses, some CNSdepressants can be used asgeneral
anesthetics.
How do CNS depressantsaffect the brain and body?There are
numerous CNSdepressants; most act on thebrain by affecting the
neuro-transmitter gamma-aminobutyricacid (GABA).
Neurotransmittersare brain chemicals that facili-tate communication
betweenbrain cells. GABA works bydecreasing brain activity.Although
the different classesof CNS depressants work inunique ways,
ultimately itis through their ability toincrease GABA activity
thatthey produce a drowsy orcalming effect that is beneficial
to those suffering from anxietyor sleep disorders.
What are the possibleconsequences of GISdepressant use and
abuse?Despite their many beneficialeffects, barbiturates and
ben-zodiazepines have the poten-tial for abuse and should beused
only as prescribed.During the first few days oftaking a prescribed
CNSdepressant, a person usuallyfeels sleepy and uncoordinat-ed, but
as the body becomesaccustomed to the effects ofthe drug, these
feelings beginto disappear. If one uses thesedrugs long term, the
body willdevelop tolerance for thedrugs, and larger doses will
beneeded to achieve the sameinitial effects. In addition,
con-tinued use can lead to physi-cal dependence andwhenuse is
reduced or stoppedwithdrawal. Because all CNSdepressants work by
slowingthe brain's activity, when anindividual stops taking
them,the brain's activity can reboundand race out of control,
possi-bly leading to seizures andother harmful
consequences.Although withdrawal frombenzodiazepines can be
prob-lematic, it is rarely life threat-ening, whereas
withdrawalfrom prolonged use of otherCNS depressants can
havelife-threatening complications.Therefore, someone who
isthinking about discontinuingCNS-depressant therapy orwho is
suffering withdrawal
5
from a CNS depressant shouldspeak with a physician or
seekmedical treatment.
Is it safe to use CNSdepressants with othermedications?CNS
depressants should beused with other medicationsonly under a
physician'ssupervision. Typically, theyshould not be combined
withany other medication or sub-stance that causes CNS depres-sion,
including prescriptionpain medicines, some over-the-counter cold
and allergymedications, or alcohol. UsingCNS depressants with
theseother substancesparticularlyalcoholcan slow breathing,or slow
both the heart andrespiration, and possibly leadto death.
StimulantsWhat are stimulants?
As the name suggests,stimulants are a class ofdrugs that enhance
brain
activitythey cause an increasein alertness, attention, andenergy
that is accompanied byelevated blood pressure andincreased heart
rate and respi-ration. Stimulants were usedhistorically to treat
asthma andother respiratory problems,obesity, neurological
disorders,and a variety of other ailments.But as their potential
for abuseand addiction became apparent,the medical use of
stimulantsbegan to wane. Now, stimulants
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NIDA RESEARCH REPORT SERIES
are prescribed for the treatmentof only a few health
conditions,including narcolepsy, attention-deficit hyperactivity
disorder,and depression that has notresponded to other
treatments.Stimulants may be used asappetite suppressants for
short-term treatment of obesity, andthey also may be used
forpatients with asthma who do notrespond to other medications.
EM do stimulants affectthe brain and body?Stimulants, such as
dextroam-phetamine (Dexedrine) andmethylphenidate (Rita lin),have
chemical structures thatare similar to a family of keybrain
neurotransmitters calledmonoamines, which includenorepinephrine and
dopamine.Stimulants increase the amountof these chemicals in the
brain.This, in turn, increases bloodpressure and heart rate,
con-stricts blood vessels, increasesblood glucose, and opensup the
pathways of the respi-ratory system. In addition,the increase in
dopamine isassociated with a sense ofeuphoria that can accompanythe
use of these drugs.
What are the possibleconsequences of stimu-lant use and
abuse?The consequences of stimu-lant abuse can be
dangerous.Although their use may notlead to physical dependenceand
risk of withdrawal, stimu-lants can be addictive in thatindividuals
begin to use them
compulsively. Taking high dosesof some stimulants repeatedlyover
a short time can lead tofeelings of hostility or para-noia.
Additionally, taking highdoses of a stimulant may resultin
dangerously high bodytemperatures and an irregularheartbeat. There
is also thepotential for cardiovascularfailure or lethal
seizures.
Is it safe to use stimulantswith other medic basis?Stimulants
should be usedwith other medications onlywhen the patient is under
aphysician's supervision. Forexample, a stimulant may beprescribed
to a patient takingan antidepressant. However,health care providers
andpatients should be mindfulthat antidepressants enhancethe
effects of a stimulant.Patients also should be awarethat stimulants
should not bemixed with over-the-countercold medicines that
containdecongestants, as this com-bination may cause bloodpressure
to become danger-ously high or lead to irregularheart rhythms.
Trends inprescriptiondrug abuse
prescription drug abuse ison the rise in the UnitedStates.
According to the
1999 National HouseholdSurvey on Drug Abuse, in1998, an
estimated 1.6 million
6
Americans used prescriptionpain relievers nonmedicallyfor the
first time. This repre-sents a significant increasesince the 1980s,
when therewere generally fewer than500,000 first-time users
peryear. From 1990 to 1998, thenumber of new users of painrelievers
increased by 181 per-cent; the number of individualswho initiated
tranquilizer useincreased by 132 percent; thenumber of new sedative
usersincreased by 90 percent; andthe number of people initiat-ing
stimulant use increased by165 percent. In total, in 1999,an
estimated 4 million peoplealmost 2 percent of the popula-tion aged
12 and olderwereusing certain prescriptiondrugs nonmedically:
painrelievers (2.6 million users),sedatives and tranquilizers(1.3
million users), and stimu-lants (0.9 million users).
Although prescription drugabuse affects many Americans,some
trends of concern canbe seen among older adults,adolescents, and
women. Inaddition, health care profes-sionalsincluding
physicians,nurses, pharmacists, dentists,anesthesiologists, and
veteri-nariansmay be at increasedrisk of prescription drug
abusebecause of ease of access, aswell as their ability to
self-prescribe drugs. In spite ofthis increased risk, recent
sur-veys and research in the early1990s indicate that health
careproviders probably suffer fromsubstance abuse, including,
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NIDA RESEARCH REPORT SERIES 5
OPIOIDS (Morphine Derivatives)Oxycodone (OxyCantin)Propoxyphene
(Darvon)Hydrocodone (Vioodin)Hydromorphone (Dilaudid)Meperidine
(Demerol)Diphenoxylate (Lomobi)
CNS DEPRESSANTSBarbiturates
Mephobarbital (Mebard)Pentobarbital sodium (Nembutal)
BenzodiazepinesDiazepam (Valium)Chlordiazepoxide hydrochloride
(1thrium)Alprazolam (Xanax)Triazolam (Haldon)Estazolam (ProSom)
STIMULANTSDextromphetamine (Dexedrine)Methylphenidate
(Ritahn)Sibutromine hydrochloride monohydrate (Meridia)
Generally Prescribed forPostsurgical Uain reliefManagement of
acute or chronic painRelief of coughs and diarrhea
In the, bodyOpioids attach to opiaid receptors in the brainand
spinal cord, blocking the transmission of painmessages to the
brain.
Effects of short-term useBlocked pain
messagesDrowsinessConstipationDepressed respiration(depending on
dose)
Effects of long-term usePotential for tolerance,
physicaldependence, withdrawal, and/or addiction
Possible negative effectsSevere respiratory depression or
deathfollowing a large single dose
Should not be used withOther substances that cause CNS
depression, including
AlcoholAntihistaminesBarbituratesBenzodiazepinesGeneral
anesthetics
Generally prescribed forAnxietyTension
Panic attacksAcute stress reactionsSleep disordersAnesthesia (at
high doses)
In the bodyCNS depressants slow brain activity throughactions on
the GABA system and, therefore, producea calming effect.
Effects of short-term useA -sleepy" and uncoordinated
feelingduring the first few days, as the bodybecomes
accustomedtolerantto theeffects, these feelings diminish.
Effects of long-term usePotential for tolerance,
physicaldependence, withdrawal, and/or addiction
Possible negative effectsSeizures following a rebound in
brainactivity after reducing or discontinuing use
Should not be used withOther substances that cause CNS
depression, inducting
Alcohol
Prescription opioid pain medicinesSome over-the-counter cold and
allergymedications
Generally prescribed forNarcolepsyAttention-deficit
hyperactivity disorder (ADHD)Depression that does not respond to
other treatmentShod-term treatment of obesityAsthma that does not
respond to other treatment
In the bodyStimulants enhance brain activity, causing an
increasein alertness, attention, and energy.
Effects of short-term useElevated blood pressureIncreased heart
rateIncreased respirationSuppressed appetiteSleep deprivation
Effects of long-term usePotential for addiction
Possible negative effectsDangerously high body temperaturesor an
irregular heartbeat after takinghigh dosesCardiovascular failure or
lethal seizuresFor some stimulants, hostility or feelingsof
paranoia after taking high dosesrepeatedly over a short period of
time
Should not be used withOver-the-counter cold medicines
containingdecongestantsAntidepressants, unless supervised bya
physidonSome asthma medications
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6NIDA RESEARCH REPORT SERIESalcohol and drugs, at a ratesimilar
to rates in society asa whole, in the range of 8 to12 percent.
Older calultsData suggest that up to 17 per-cent of adults aged
60 or oldermay be affected by prescriptiondrug abuse. Elderly
personsuse prescription medicationsapproximately three times
asfrequently as the general pop-ulation and have been foundto have
the poorest rates ofcompliance with directions fortaking a
medication. In addi-tion, data from the VeteransAffairs Hospital
System suggestthat elderly patients may beprescribed
inappropriatelyhigh doses of medicationssuch as benzodiazepines
andmay be prescribed these med-ications for longer periodsthan are
younger adults. Ingeneral, older people shouldbe prescribed lower
doses ofmedications, because thebody's ability to metabolizemany
medications decreaseswith age.
An association between age-related morbidity and abuse
ofprescription medications likelyexists. For example,
elderlypersons who take benzodi-azepines are at increased riskfor
falls that cause hip andthigh fractures, as well as forvehicle
accidents. Cognitiveimpairment also is associatedwith
benzodiazepine use,although memory impairmentmay be reversible when
thedrug is discontinued. Finally,
la MarijuanaPsychotherapeutics
Inhalants
II Hallucinogens
Age 12 Age 14
Source: Office of Applied Studies, Substance Abuse and Mental
Health Services Administration.National Household Survey on Drug
Abuse, 1999.
use of benzodiazepines forlonger than 4 months is notrecommended
for elderlypatients because of the possi-bility of physical
dependence.
Adolescents andyou adultsData from the NationalHousehold Survey
on DrugAbuse indicate that the mostdramatic increase in new usersof
prescription drugs for non-medical purposes occurs in12- to
17-year-olds and 18- to25-year-olds. In addition, 12-to
14-year-olds reported psy-chotherapeutics (for example,painkillers
or stimulants) asone of two primary drugsused. The 1999 Monitoring
theFuture Survey showed that forbarbiturates, tranquilizers,
andnarcotics other than heroin,the general, long-term declinesin
use among young adults in
8
the 1980s leveled off in theearly 1990s, with modestincreases
again in the mid-tolate 1990s. For example, theuse of
methylphenidate(Ritalin) among adolescentsand young adults
increasedfrom an annual prevalence(use of the drug within
thepreceding year) of 0.1 percentin 1992 to an annual preva-lence
of 2.8 percent in 1997before reaching a plateau.According to a
recent surveyby the University of Wisconsin,one in five students
had usedRitalin nonmedically.
It also appears that collegestudents' nonmedical use ofpain
relievers such as oxy-codone with aspirin (Percodan)and hydrocodone
(Vicodin)is on the rise. The 1999 DrugAbuse Warning Network,which
collects data on drug-related episodes in hospital
7 7" COPY AVAILABLE
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NIDA RESEARCH REPORT SERIES 7emergency departments,reported that
mentions ofhydrocodone as a cause forvisiting an emergency
roomincreased by 37 percentamong all age groups from1997 to 1999.
Mentions of thebenzodiazepine clonazepam(Klonopin) increased by
102percent since 1992.
Gendea. differencesStudies suggest that womenare more likely
than men touse an abusable prescriptiondrug, particularly narcotics
andanti-anxiety drugsin somecases 48 percent more likely.This may
be in part becausewomen are two to three timesmore likely to be
diagnosedwith depression and thusare more often treated
withpsychotherapeutic drugs.
Overall, men and womenhave roughly similar rates ofnonmedical
use of prescrip-
tion drugs. An exception isfound among 12- to 17-year-olds: In
this age group, youngwomen are more likely thanyoung men to use
psychother-apeutic drugs nonmedically.In addition, research
hasshown that women and menwho use prescription opioidsare equally
likely to becomeaddicted. However, amongwomen and men who
usesedatives, anti-anxiety drugs,and hypnotics, women arealmost two
times more likelyto become addicted.
Preventing anddetecting prescrip-tion drug abuse
Although most patientsuse medications asdirected, abuse of
and
addiction to prescription drugsare public health problems
for
,
Have you ever felt the need to Cut down on your use
ofprescription drugs?Have you ever felt. Annoyed by remarks your
friends orloved ones made about your use of prescription drugs?Have
you ever felt Guilty or remorseful about your useof prescription
drugs?Have you Ever used prescription drugs as a way to"get going"
or to "calm down?"
Adapted from Ewing, J.A. "Detecting Alcoholism: The CAGE
Questionnaire."Journal of the American Medical Association
252(141:1905-1907, 1984.
9
many Americans. However,addiction rarely occurs amongthose who
use pain relievers,CNS depressants, or stimulantsas prescribed; the
risk foraddiction exists when thesemedications are used in
waysother than as prescribed.Health care providers suchas primary
care physicians,nurse practitioners, and phar-macists as well as
patients canall play a role in preventingand detecting
prescriptiondrug abuse.
Role of health careprovidersAbout 70 percent
ofAmericansapproximately191 million peoplevisit ahealth care
provider, such asa primary care physician, atleast once every 2
years. Thus,health care providers are in aunique position not only
toprescribe needed medicationsappropriately, but also toidentify
prescription drugabuse when it exists and helpthe patient recognize
theproblem, set goals for recov-ery, and seek appropriatetreatment
when necessary.Screening for any type ofsubstance abuse can
beincorporated into routinehistory taking with questionsabout what
prescriptions andover-the-counter medicinesthe patient is taking
andwhy. Screening also can beperformed if a patient presentswith
specific symptoms associ-ated with problem use of asubstance.
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NIDA RESEARCH REPORT SERIES
'It is estimated that more than 50 million Americanssuffer
fromchronic pain. When treating pain, heath carei:prthiders
Piave
long wrestled with a dilemma: Hot,tia.acreilluateljr refer
apatient's suffering while avoidinathpotentiar kir Teriftobecome
addicted to pain medication?"
Many health care providers undetprescribe painkillers
becausethey overestimate the potential for patients to become
addictedto medications such as morphine and codeine. Although
thesedrugs carry a heightened risk of addiction. research has
shownthat providers' concerns that patients will become addicted
topain medication are largely unfounded. This fear of
prescribingopioid pain medications is known as ..opiophobia.-
Most patients who are prescribed opioids for pain, even
thoseundergoing long-term therapy, do not become addicted to
thedrugs. The few patients who do develop rapid and markedtolerance
for and addiction to opioids usually have a historyof psychological
problems or prior substance abuse. In fact,studies have shown that
abuse potential of opioid medicationsis generally low in healthy,
nortdrucjobusing volunteers. Onestudy found that only 4 out of
morel.than 12,000 patients whowere given opioids for
ocutepairitiecame addicted. In a studyof 38 chronic pain patients,
most of whom received opioids for4 to 7 years, only 2 patients
became addicted, and both hada.history ofdrug..abuse.
The:issues of underprescription of opioids and the suffering
ofmilli8ns of patients who do not receive adequate pain reliefhas
led to the development of 'guidelines for pain treatment.11i4se
guidelines may help.bting an end to underprescribing,but
alternative forms of-OCtin control are still needed. NIDA-funded
scientists continue to search for new ways to controlpain and to
develop new pain medications that are effectivebut do not have the
potential for addiction.
Over time, providers shouldnote any rapid increases inthe amount
of a medication
neededwhich may indicatethe development of toleranceor frequent
requests for refills
before the quantity prescribedshould have been used. Theyshould
also be alert to thefact that those addicted toprescription
medications mayengage in "doctor shopping,"moving from provider
toprovider in an effort to getmultiple prescriptions forthe drug
they abuse.
Preventing or stoppingprescription drug abuse isan important
part of patientcare. However, health careproviders should not
avoidprescribing or administeringstrong CNS depressantsand
painkillers, if they areneeded. (See box on painand
opiophobia.)Role of pharmacistsPharmacists can play a keyrole in
preventing prescriptiondrug misuse and abuse byproviding clear
informationand advice about how to takea medication
appropriately,about the effects the medica-tion may have, and about
anypossible drug interactions.Pharmacists can help
preventprescription fraud or diversionby looking for false or
alteredprescription forms. Many phar-macies have
developed"hotlines" to alert other phar-macies in the region when
afraud is detected.
Role of patientsThere are several ways thatpatients can prevent
prescrip-tion drug abuse. When visitingthe doctor, provide a
complete
1 0 COPYAVAILABLEIFS
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NIDA RESEARCH REPORT SERIES 9medical history and a descrip-tion
of the reason for the visitto ensure that the doctorunderstands the
complaintand can prescribe appropriatemedication. If a doctor
pre-scribes a pain medication,stimulant, or CNS depressant,follow
the directions for usecarefully and learn about theeffects that the
drug couldhave, especially during thefirst few days during whichthe
body is adapting to themedication. Also be awareof potential
interactions withother drugs by reading allinformation provided by
thepharmacist. Do not increaseor decrease doses or abruptlystop
taking a prescriptionwithout consulting a healthcare provider
first. For exam-ple, if you are taking a painreliever for chronic
pain andthe medication no longerseems to be effectively con-
trolling the pain, speak withyour physician; do not increasethe
dose on your own. Finally,never use another
person'sprescription.
Treatingprescriptiondrug addiction
ears of research haveshown us that addictionto any drug, illicit
or
prescribed, is a brain diseasethat can, like other
chronicdiseases, be effectively treated.But no single type of
treatmentis appropriate for all individuals.addicted to
prescription drugs.Treatment must take intoaccount the type of drug
usedand the needs of the individual.To be successful, treatmentmay
need to incorporateseveral components, such ascounseling in
conjunction with
11
a prescribed medication, andmultiple courses of treatmentmay be
needed for the patientto make a full recovery.
The two main categories ofdrug addiction treatment arebehavioral
and pharmacolo-gical. Behavioral treatmentsteach people how to
functionwithout drugs, how to handlecravings, how to avoid drugsand
situations that could leadto drug use, how to preventrelapse, and
how to handlerelapse should it occur. Whendelivered effectively,
behav-ioral treatmentssuch as indi-vidual counseling, group
orfamily counseling, contingencymanagement, and
cognitive-behavioral therapiesalso canhelp patients improve
theirpersonal relationships andability to function at workand in
the community.
Some addictions, such asopioid addiction, can also betreated
with medications. Thesepharmacological treatmentscounter the
effects of the drugon the brain and behavior.Medications also can
be usedto relieve the symptoms ofwithdrawal, to treat an over-dose,
or to help overcomedrug cravings.
Although a behavioral orpharmacological approachalone may be
effective fortreating drug addiction,research shows that a
com-bination of both, whenavailable, is most effective.
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NIDA RESEARCH REPORT SERIES
Depression Alcohol PrescriptionAbase Drug Abuse
Over 40% of physicians report having difficulty
discussingsubstance abuse, including abuse of prescription
drugs,with their patients. In contrast, less than 20% have
difficultydiscussing depression.
National Center on Addiction and Substance Abuse at Columbia
University(CASA). Missed Opportunity: Notional Survey of Primary
Care Physicians andPatients on Substance Abuse. New York: CASA,
2000.
Treating addiction toprescription apioidsSeveral options are
availablefor effectively treating addic-tion to prescription
opioids.These options are drawnfrom experience and
researchregarding the treatment ofheroin addiction. They in-clude
medications, such asmethadone and
LAAM(levo-alpha-acetyl-methadol),and behavioral
counselingapproaches.
A useful precursor to long-term treatment of opioidaddiction is
detoxification.Detoxification in itself is not
a treatment foropioid addiction.Rather, its primaryobjective is
torelieve withdrawalsymptoms whilethe patient adjuststo being drug
free.To be effective,detoxification mustprecede long-termtreatment
thateither requirescomplete abstinenceor incorporates, amedication,
such asmethadone, intothe treatment plan.
Methadone is asynthetic opioidthat blocks theeffects of
heroinand other opioids,eliminates with-drawal symptoms,and
relieves drug
craving. It has been usedsuccessfully for more than30 years to
treat peopleaddicted to opioids. Othermedications include LAAM,an
alternative to methadonethat blocks the effects of opi-oids for up
to 72 hours, andnaltrexone, an opioid blockerthat is often employed
forhighly motivated individualsin treatment programs pro-moting
complete abstinence.Buprenorphine, another effec-tive medication,
is awaitingFood and Drug Administration(FDA) approval for
treatmentof opioid addiction. Finally,
12
naloxone, which counteractsthe effects of opioids, is usedto
treat overdoses.
Treating addiction toMS depressantsPatients addicted to
barbitu-rates and benzodiazepinesshould not attempt to stoptaking
them on their own, aswithdrawal from these drugscan be problematic,
and in thecase of certain CNS depressants,potentially
life-threatening.Although no extensive bodyof research regarding
the treat-ment of barbiturate and ben-zodiazepine addiction
exists,patients addicted to thesemedications should
undergomedically supervised detoxi-fication because the dosemust be
gradually tapered off.Inpatient or outpatient coun-seling can help
the individualduring this process. Cognitive-behavioral therapy
also hasbeen used successfully tohelp individuals adapt to
theremoval from benzodiazepines.
Often the abuse of barbitu-rates and benzodiazepinesoccurs in
conjunction withthe abuse of another substanceor drug, such as
alcohol orcocaine. In these cases ofpolydrug abuse, the
treatmentapproach must address themultiple addictions.
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Tredting addiction toprescription stimulantsTreatment of
addiction toprescription stimulants, suchas Rita lin, is often
based onbehavioral therapies proveneffective for treating cocaineor
methamphetamine addic-tion. At this time, there are noproven
medications for thetreatment of stimulant addic-tion. However,
antidepressantsmay help manage the symp-toms of depression that
canaccompany the early days ofabstinence from stimulants.
Depending on the patient'ssituation, the first steps intreating
prescription stimulantaddiction may be tapering offthe drug's dose
and attempt-ing to treat withdrawal symp-toms. The
detoxificationprocess could then be followedby one of many
behavioraltherapies. Contingency man-agement, for example, uses
asystem that enables patients toearn vouchers for drug-freeurine
tests. The vouchers canbe exchanged for items thatpromote healthy
living.
Another behavioral approachis cognitive-behavioral
inter-vention, which focuses onmodifying the patient's think-ing,
expectations, and behav-iors while at the same timeincreasing
skills for copingwith various life stressors.
Recovery support groupsmay also be effective in con-junction
with behavioraltherapy.
GlossaryAddidion: A chronic, relapsing disease,characterized by
compulsive drug seekingand use and by neurochemical and
molecularchanges in the brain.
Barbiturate: A type of central nervoussystem (CNS) depressant
often prescribedto promote sleep.
Benzodiazepine: A type of (NS depressantprescribed to relieve
anxiety; among the mostwidely prescribed medications,
includingValium and Librium.
Buprenorphine: A new medication awaitingFDA approval for
treatment of opiate addic-tion. It blocks the effects of opioids on
thebrain.
Central nervous system (CNS): The brainand spinal cord.
CNS depressants: A class of drugs thatslow CNS function, some of
which are used totreat anxiety and sleeping disorders;
includesbarbiturates and benzodiazepines.
Detoxification: A process that allows thebody to rid itself of a
drug while at the sametime managing the individual's symptoms
ofwithdrawal; often the first step in a drugtreatment program.
Dopamine: A neurotransmitter present inregions of the brain that
regulate movement,emotion, motivation, and feelings of
pleasure.
LAAM (levo-alpha-acetyl-methadol):An approved medication for the
treatment ofopiate addiction, taken 3 to 4 times a week.
Methadone: A long-acting syntheticmedication that is effective
in treating opiateaddiction.
Narcolepsy: A disorder characterized byuncontrollable episodes
of deep sleep.
Norepinephrine: A neurotransmitterpresent in some areas of the
brain and theadrenal glands; decreases smooth musclecontraction and
increases heart rate; oftenreleased in response to low blood
pressureor stress.
Opioids: Controlled drugs or narcotics mostoften prescribed for
the management of pain;natural or synthetic chemicals based on
13
opium's active componentmorphinethat work by mimicking the
actions of pain-relieving chemicals produced in the body.
Opiophobia: A health care provider'sunfounded fear that patients
will becomephysically dependent upon or addicted toopioids even
when using them appropriately;can lead to the underprescribing of
opioidsfor pain management.
Physical dependence: An adaptive physio-logical state that can
occur with regular druguse and results in withdrawal when drug
useis discontinued.
Polydrug abuse: The abuse of two or moredrugs at the same time,
such as CNS depres-sant abuse accompanied by abuse of alcohol.
Prescription drug abuse: The intentionalmisuse of a medication
outside of thenormally accepted standards of its use.
Prescription drug misuse: Taking a med-ication in a manner other
than that prescribedor for a different condition than that for
whichthe medication is prescribed.
Psychotherapeutics: Drugs that have aneffect on the function of
the brain and thatoften are used to treat psychiatric disorders;can
include opioids, CNS depressants, andstimulants.
Respiratory depression: Depression ofrespiration (breathing)
that results in thereduced availability of oxygen to vital
organs.
Stimulants: Drugs that enhance the activityof the brain and lead
to increased heart rate,blood pressure, and respiration; used to
treatonly a few disorders, such as narcolepsy andattention-deficit
hyperactivity disorder.
Tolerance: A condition in which higher dosesof a drug are
required to produce the sameeffect as experienced initially.
Tranquilizers: Drugs prescribed to promotesleep or reduce
anxiety; this NationalHousehold Survey on Drug Abuse
classificationincludes benzodiazepines, barbiturates, andother
types of CNS depressants.
Withdrawal: A variety of symptoms thatoccur after chronic use of
some drugs isreduced or stopped.
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1.4
Access informationon the NIDA web site
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abusePublications andcommunications(including NIDA NOTES)Calendar
of eventsLinks to !VIDAorganizationill unitsFunding
information(including programannouncementsand
deadlines)InternationalactivitiesLinks to relatedWeb sites (access
toWeb sites of manyother organizations inthe field)
NIDA Web Siteswww.drugabuse.gov
www.steroidabuse.orgwww.clubdrugs.org
National Clearinghousefor Alcohol and DrugInformation
(NCADI)
Web Site: www.health.orgPhone No.: 1-800-729-6686
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