Drug overdose death rates have never been higher. In the United States alone, 100 people die from drug overdoses every day, most of them caused by prescription drugs. The Centers for Disease Control and Prevention (CDC) has officially declared prescription drug abuse in the US an epidemic.

Prescription drug abuse is defined as taking a medicine in any way that is different from what the doctor originally prescribed, such as taking drugs prescribed for someone else, taking a larger dose, taking it in a different way to that in which the drug is designed to be consumed (crushing tablets and then snorting or injecting them, for example), or using the medicine for another purpose, such as getting high. What makes these drugs appealing is the fact that they can have effects similar to illicit drugs when taken in higher quantities than prescribed, or in the absence of symptoms.

Opioids

Although many types of prescription drugs are abused, prescription opioids take the lead. Chronic pain is frequently treated with prescription opioids, the clinical use of which nearly doubled from 2000 to 2010. This increase was accompanied by a rise in opioid abuse; it’s estimated that over two million people in the US currently abuse prescription opioids. Nearly 75% of prescription drug overdoses are caused by prescription opioid painkillers; these drugs are involved in more deaths than cocaine and heroin combined. In 2010, pharmaceutical drug overdoses were established as one of the leading causes of death in the US; drug overdoses were more lethal than firearms or motor vehicle accidents.

Opioids can create a feeling of euphoria, cause physical dependence, and lead to addiction. But these drugs can have many other health effects. Opioids can cause drowsiness, constipation, and impaired breathing. The latter effect makes opioids particularly dangerous, especially when snorted, injected, or combined with other drugs or alcohol. Depressed respiration decreases brain oxygenation, a condition called hypoxia, which can have short- and long-term effects, including coma and permanent brain damage. Long-term abuse of opioids can also cause deterioration of the brain’s white matter, affecting behavior, decision-making, and responses to stress. The abuse of prescription painkillers leads to the need of larger doses to achieve an effect and reduce withdrawal symptoms, which in turn can cause breathing to slow down so much that it stops, resulting in a fatal overdose.

Opioids such as Oxycontin and Vicodin can have effects similar to heroin when taken in high doses or in ways other than prescribed. A progression from pain pills to heroin is quite common, since it provides the same euphoric high but is cheaper and easier to obtain than prescription opioids. In fact, heroin use rose by 75 percent between 2007 and 2011, according to the Substance Abuse and Mental Health Services Administration (SAMSHA).

Other drugs

But opioids are not the only class of prescription drugs being abused. Stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin act on the same neurotransmitter systems as cocaine. Prescription central nervous system (CNS) depressants for relieving anxiety, such as Valium or Xanax produce sedating or calming effects in the same way as the club drugs GHB and rohypnol. Over-the-counter (OTC) drugs are also abused, mostly cough and cold remedies containing dextromethorphan, that, when taken in very high doses acts on the same receptors as PCP or ketamine, producing similar out-of-body experiences. When abused, these drugs cause an increase in dopamine in the brain that is perceived as pleasurable. Repeatedly seeking such pleasure can lead to addiction.

The health risks of these drugs are also abundant. Stimulants can have strong effects on the cardiovascular system, dangerously raise body temperature and cause irregular heartbeat or even heart failure or seizures. High dose or repeated use of some stimulants can lead to hostility or paranoia. CNS depressants decrease brain activity, causing sleepiness and loss of coordination, and continued use can lead to withdrawal symptoms associated with physical dependence.

ADHD drugs may boost alertness and are often abused by students aiming to improve their performance. However, there is little evidence they improve cognitive functioning in the absence of a medical condition. Dextromethorphan can cause impaired motor function, numbness, nausea or vomiting, and increased heart rate and blood pressure. In extreme cases, hypoxic brain damage can occur due to the combination of dextromethorphan with decongestants present in the medication. Also, as with other drugs, abuse of prescription and OTC drugs can alter a person’s judgment and decision making, leading to dangerous behaviors.

All of these drugs have the potential for addiction, and this risk is amplified when they are abused. Concerns over addiction and drug abuse are causing some primary care physicians to prescribe fewer opioids for chronic pain, according to a recent national survey on prescription drug abuse. But an increase in the awareness of the prescription drug abuse epidemic is still urgently needed so that adequate prevention measures are set in motion.

References

Centers for Disease Control and Prevention (CDC) (2013). Vital signs: overdoses of prescription opioid pain relievers and other drugs among women–United States, 1999-2010. MMWR. Morbidity and mortality weekly report, 62 (26), 537-42 PMID: 23820967

DrugFacts: Prescription and Over-the-Counter Medications, NIH National Institute on Drug Abuse. Accessed 19 January 2015.

Hwang CS, Turner LW, Kruszewski SP, Kolodny A, & Alexander GC (2014). Prescription Drug Abuse: A National Survey of Primary Care Physicians. JAMA internal medicine PMID: 25485657

Policy Impact: Prescription Painkiller Overdoses, Centers for Disease Control and Prevention. Accessed 19 January 2015.

Prescription Drug Abuse Statistics, Center for Lawful Access and Abuse Deterrence. Accessed 19 January 2015.

Prescription Drug Overdose in the United States: Fact Sheet, Centers for Disease Control and Prevention. Accessed 19 January 2015.

Warner M, Chen LH, & Makuc DM (2009). Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS data brief (22), 1-8 PMID: 19796521

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