Friends, Colleagues, and Parents:

Prescription drug abuse is an emerging problem in our country, and one that 

is showing an increasing trend. What is most disturbing about this trend is that

teenagers and young adults are counted among those who use these drugs 

nonmedically—which include prescription pain relievers, stimulants, sedatives,

and tranquilizers.

According to the National Institute on

Drug Abuse’s (NIDA’s) 2004 Monitoring

the Future survey, 9.3 percent of 

12th-graders reported using Vicodin without a prescription in the past year, and

5.0 percent reported using OxyContin. Another recent survey reports that approximately 48 million people—about 20 percent of the U.S. population—aged 12 or

older had used prescription drugs for nonmedical reasons in their lifetimes.

Elderly persons are particularly vulnerable to prescription drug abuse and misuse;

as a group, they are prescribed more medications than their younger counterparts,

placing them at higher risk for misuse, dependence, and addiction.

Accessibility to the drugs is likely a contributing factor to this growing trend.

More people are being prescribed medications today, for a variety of health 

reasons. This increase in prescriptions means more pills in our medicine cabinets.

To add to this supply, many people also are obtaining medications illegally

through Web sites that do not require a physician’s prescription. While most

online pharmacies are lawful businesses providing an important healthcare 

service, others, however, are not. In fact, some sites provide medications without

proper identity verification.

Prescription drugs can have great medical benefits when taken under the supervision of a physician. However, their inappropriate use can lead to addiction. 

As a physician, I want to raise awareness in the healthcare community about the

potential for prescription drug abuse. I also want to ask caretakers to safeguard

their prescribed medications so that young people in their households do not have

easy access to them.

NIDA is continuing to invest resources in researching this topic. We currently 

are testing medications for the treatment of prescription opioid abuse through our

Clinical Trials Network. For more information on prescription drug abuse, as well

as other drugs of abuse, please visit the NIDA Web site, www.drugabuse.gov,

or call the National Clearinghouse for Alcohol and Drug Information at

1–800–729–6686.

Sincerely,

Nora D. Volkow, M.D.

Director

National Institutes 

of Health

U.S. Department

of Health and 

Human Services

B ULLETIN

COMMUNITY DRUG ALERT

Prescription Drugs
What is prescription drug abuse?

Although most people take prescription medications responsibly, there has been an increase in the nonmedical use or, as

NIDA refers to it in this report, abuse of prescription drugs

in the United States. 

What are the concerns? 

A number of published reports indicate that prescription drug

abuse is on the rise in the United States. According to the

2003 National Survey on Drug Use and Health, 6.3 million

Americans aged 12 and older have used prescription medications for nonmedical purposes in the prior 30 days. 

An estimated—

■ 4.7 million used pain relievers

■ 1.8 million used tranquilizers 

■ 1.2 million used stimulants

■ 0.3 million used sedatives

The number of new nonmedical users of pain relievers

increased drastically—from 573,000 in 1990 to 2.5 million

in 2000. Overall, men and women have roughly similar

rates of nonmedical use of prescription drugs (an exception

is found among 12–17-year-olds, with more females likely

to abuse these drugs). 

The Drug Abuse Warning Network (DAWN), which 

monitors drug mentions (medications and drugs of abuse)

from emergency departments (EDs) across the Nation,

recently reported that two of the most frequently mentioned

prescription medications in drug abuse-related cases are

benzodiazepines (e.g., Valium, Xanax, Klonopin, and

Ativan) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that

include these drugs). In 2002, benzodiazepines accounted

for 100,784 ED visits categorized as drug abuse-related

cases and opioid pain relievers accounted for more than

119,000. Between 1994 and 2002, ED reports of hydrocodone and oxycodone overdoses increased by 170 percent

and 450 percent, respectively. While ED visits attributed to

drug addiction have been increasing, suicide-related visits

have remained stable since 1995.

What types of prescription medications

are commonly abused? 

Several classes of medications that are commonly abused

include opioids, central nervous system (CNS) depressants,

and stimulants. Certain over-the-counter (OTC) medicines

can also be abused when not taken as directed. It is important

to note that many prescription drugs or OTC medications

can produce dangerous health effects when taken concurrently or taken with alcohol.

■ Opioids. Opioids are commonly prescribed to treat pain.

Examples of prescription opioids include morphine

(Kadian, Avinza), codeine, oxycodone (e.g., OxyContin,

Percodan, Percocet), hydrocodone (Lortab, Lorcet,

Vicodin), propoxyphene (Darvon), fentanyl (Duragesic),

and hydromorphone (Dilaudid). Opioids work in the 

brain to diminish the perception of pain. Opioids also can

produce a sense of euphoria by affecting pleasure centers

in the brain. This is often intensified when opioids are

taken by routes other than those prescribed.1 For example,

OxyContin can be crushed and snorted, or injected 

intravenously—this can enhance the euphoric effects,

while at the same time increasing the risk for serious

medical consequences, such as overdose. 

■ CNS Depressants. CNS depressants commonly are 

prescribed to treat anxiety and sleep disorders because 

of their ability to slow normal brain function. These 

medications include barbiturates, such as mephobarbital

(Mebaral), pentobarbital sodium (Nembutal), butalbital

(Fioricet), and benzodiazepines such as diazepam

(Valium), chlordiazepoxide HCl (Librium), alprazolam

(Xanax), triazolam (Halcion), and others. 

■ Stimulants. Stimulants, including dextroamphetamine

(Dexedrine and Adderall) and methylphenidate (Ritalin

and Concerta), are used primarily to treat attention deficit

hyperactivity disorder, attention deficit disorder, and 

narcolepsy. These stimulants increase the amount of 

certain chemicals in the brain and peripheral nervous 

system. This can lead to increased blood pressure and

heart rate, and increased blood glucose.

PRESCRIPTION DRUGS COMMUNITY DRUG ALERT BULLETIN

WHAT IS ADDICTION?

Addiction is a complex brain disease, characterized by compulsive drug seeking and use, despite harmful consequences.

WHAT IS PHYSICAL DEPENDENCE? 

Chronic use of many medications, including use for legitimate medical reasons, can result in physical dependence—a state in which the body

adapts to the presence of the drug. This can include tolerance, which means that a user must take higher doses to achieve the same initial drug

effect. Withdrawal symptoms may occur when a user abruptly stops taking the drug. Although people who are addicted to a variety of drugs often

experience tolerance and withdrawal symptoms, physical dependence alone is not the same as addiction. 

1 This does not apply only to opioids. Changes in routes of administration also contribute

to the abuse of other prescription medications, and this practice can lead to serious medical

consequences. 
Who is most vulnerable? 

■ Adolescents. According to the 2003 National Survey 

on Drug Use and Health, 9.2 percent of youth aged 

12–17 had used a prescription psychotherapeutic drug 

for nonmedical reasons in the past year and 4.0 percent

were current users. Prescription opioids are a particularly

serious problem in this age group. NIDA’s 2004

Monitoring the Future survey of 8th-, 10th-, and 12thgraders found that 5.0 percent of 12th-graders reported

abusing OxyContin in the past year, and 9.3 percent

reported abusing Vicodin, making Vicodin one of the

most commonly abused prescription drugs in this population. Another troubling trend is the recent phenomena

known as “pharming,” where young people mix prescription medications and ingest some or all of them at once,

unaware of potentially severe drug interactions.

■ Elderly Adults. Although persons 65 years of age and

above comprise only 13 percent of the population, they are

prescribed approximately one-third of all medications in

the United States. In addition, older patients are likely to

be prescribed more long-term prescriptions, as well as

multiple prescriptions, which could potentially result in

unintentional misuse. A large percentage of older adults

also use OTC medicines and dietary supplements, along

with prescription medications, which could lead to dangerous results. The elderly also are at risk for prescription

drug abuse, in which they intentionally take medications

that are not medically necessary. Because of high rates 

of comorbid illnesses among the elderly, changes in drug

metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse or misuse can have

more adverse health consequences among this age group.

What can we do?

Healthcare providers, primary care physicians, pharmacists,

and patients themselves, can all play a role in identifying

and preventing prescription drug abuse.

Physicians. Because most people visit their primary care

physician at least once every 2 years, primary care physicians

are in a unique position—not only to prescribe medications,

but to identify prescription drug abuse and help the patient

find treatment. Screening for prescription drug abuse should

be incorporated into every routine medical visit. Doctors 

can begin by asking questions about substance abuse history,

current prescription and OTC use, and reasons for use.

Further, doctors should also be aware of other potential

signs of abuse, such as rapid increases in the amount of

medication the patient reportedly needs, or refill requests

before the refill date.

Pharmacists. It is a pharmacist’s responsibility to provide

clear information on how to take medications appropriately,

describe possible effects, and warn of possible drug interactions. The pharmacist also can be part of the first line of

defense in recognizing prescription drug abuse. By monitoring prescriptions for falsification or alterations and being

aware of potential “doctor shopping” (where patients get

multiple prescriptions from different doctors), pharmacists

play a valuable role in prevention.

Patients. There are also steps a patient can take to ensure

the appropriate use of prescription medications. Patients

should always follow the directions, be aware of potential

interactions, never stop or change a dose on their own, and

never take another person’s prescription. Patients should 

also inform their healthcare professionals about current 

prescription and OTC medicines they are taking, along with

any dietary or herbal supplements they might be taking.

What are the treatments 

for prescription drug abuse? 

Years of research have shown that addiction to any drug,

illicit or prescribed, like other chronic diseases, can be 

treated effectively. However, no single type of treatment 

is appropriate for all individuals with addictions. To be 

successful, treatment must take into account the type of

drug used as well as the needs of the user. Treatment may

incorporate several behavioral and pharmacological components, as well as detoxification. Because drug abuse is a

chronic and relapsing disease, multiple courses of treatment

may be needed for patients to make a full recovery. 

There are two main categories of drug addiction treatment—

behavioral and pharmacological. 

Behavioral Treatment

Behavioral drug abuse treatments—such as individual 

counseling, group or family counseling, contingency management, and cognitive-behavioral therapy—teach patients

how to stop using drugs, how to handle cravings, how to

prevent a relapse, and how to handle a relapse if one should

occur. When delivered effectively, behavioral treatments

also can help patients improve their personal relationships

and ability to function at work and within the community.

Pharmacological Treatment

Some addictions, such as opioid addiction, can be treated

with medications. Methadone and buprenorphine currently

are used to treat heroin addiction, but they also may prove

useful in treating addiction to pain relievers. Further research

is needed to determine whether these medications will 

provide an effective treatment for prescription drug abuse. 

COMMUNITY DRUG ALERT BULLETIN PRESCRIPTION DRUGS

OVER-THE-COUNTER (OTC) MEDICINES

OTC medicines, including sleep aids such as doxylamine (Unisom), antihistamines such as diphenhydramine (Benadryl) and dimenhydrinate (Gravol

or Dramamine), and cough suppressants containing dextromethorphan

(DXM), have been abused for their psychoactive effects. 
Research shows that a combination of both behavioral and pharmacological treatments is the 

most effective strategy, especially for treating opioid addiction.

What are some of the problems with prescribing pain medications?

There is a fine balance between under-prescribing and over-prescribing pain relievers,

particularly opioids. 

The data available to us so far suggests that the risk of becoming addicted to prescription pain

medication is minimal in those who are treated on a short-term basis. The risk for patients with

chronic pain is less well understood. Some studies have shown that those most vulnerable to

becoming addicted to prescription pain medications have a history of psychological disorders,

prior substance abuse problems, or a family history of these disorders. 

Pain management for patients who have substance abuse disorders is particularly challenging 

for the medical profession. However, these patients still can be successfully treated with opioid

pain medications; they may need to be admitted to a treatment or recovery program and 

monitored closely if prescribed controlled substances for pain. 

Developing effective treatments for addiction and pain medications that are less likely to be 

abused is a priority for NIDA. For example, the medication buprenorphine/naloxone (marketed 

as Suboxone), developed by NIDA in collaboration with the pharmaceutical industry for the 

treatment of opioid addiction, may provide an alternative treatment for pain that has less potential

for abuse than other pain medications. However, further research is needed before this practice can

be recommended.

PRESCRIPTION DRUGS COMMUNITY DRUG ALERT BULLETIN

Please visit

www.drugabuse.gov/drug

pages/prescription.html

for more information on the

health effects of prescription

drugs. NIDA’s “Selected

Prescription Drugs with

Potential for Abuse” chart 

is available online at

www.drugabuse.gov/

DrugPages/PrescripDrugs

Chart.html.

National Clearinghouse for

Alcohol and Drug Information

(NCADI): 1-800-729-6686

NIH Publication

Number 05-XXXX

Printed August 2005

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AND HUMAN SERVICES

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