PRESCRIPTION

DRUGS

What is prescription

drug abuse? 

Although most people

take prescription medications responsibly,

there has been an increase in

the nonmedical use of or, as

NIDA refers to it in this report,

abuse1 of prescription drugs in

the United States. 

What are some 

of the commonly

abused prescription

drugs?

Although many prescription drugs can be

abused, there are several

classifications of medications

that are commonly abused. 

The three classes of 

prescription drugs that are

most commonly abused are:

■ Opioids, which are 

most often prescribed 

to treat pain;

■ Central nervous system

(CNS) depressants, which

are used to treat anxiety

and sleep disorders; and

■ Stimulants, which are 

prescribed to treat the

sleep disorder narcolepsy

and attention-deficit

hyperactivity disorder

(ADHD).

from the director

The nonmedical use or abuse of 

prescription drugs is a serious and

growing public health problem in this

country. The elderly are among those

most vulnerable to prescription drug

abuse or misuse because they are 

prescribed more medications than their

younger counterparts. Most people take

prescription medications responsibly;

however, an estimated 48 million people

(ages 12 and older) have used prescription drugs for nonmedical reasons in

their lifetimes. This represents approximately 20 percent of the U.S. population. 

Also alarming is the fact that the

2004 National Institute on Drug Abuse’s

(NIDA’s) Monitoring the Future survey

of 8th-, 10th-, and 12th-graders found

that 9.3 percent of 12th-graders reported

using Vicodin without a prescription in

the past year, and 5.0 percent reported

using OxyContin—making these 

medications among the most commonly

abused prescription drugs by adolescents. 

The abuse of certain prescription

drugs —opioids, central nervous system

(CNS) depressants, and stimulants—

can alter the brain’s activity and lead 

to addiction. While we do not yet

understand all of the reasons for the

increasing abuse of prescription drugs,

we do know that accessibility is likely 

a contributing factor. In addition to 

the increasing number of medicines

being prescribed for a variety of health

problems, some medications can be

obtained easily from online pharmacies.

Most of these are legitimate businesses

that provide an important service; however, some online pharmacies dispense

medications without a prescription 

and without appropriate identity verification, allowing minors to order the

medications easily over the Internet. 

NIDA hopes to decrease the prevalence

of this problem by increasing awareness

and promoting additional research on

prescription drug abuse. Prescription

drug abuse is not a new problem, but

one that deserves renewed attention. It

is imperative that as a Nation we make

ourselves aware of the consequences

associated with the misuse and abuse 

of these medications.

Nora D.Volkow, M.D.

Director

National Institute on Drug Abuse

U . S . Department of Health and Human Services • National Institutes of Health

ResearchReport

NATIONAL INSTITUTE ON DRUG ABUSE

SERIES

AbuseandAddiction

1 A common vocabulary has not been established in the field of prescription drug abuse.

Because much of the data collected in this area focuses on nonmedical use of prescription

drugs, the definition of abuse used in this report does not correspond to the definition of

abuse/dependence listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Opioids—

What are opioids?

Opioids are commonly

prescribed because of

their effective analgesic,

or pain-relieving, properties.

Medications that fall within

this class—referred to as 

prescription narcotics—include

morphine (e.g., Kadian,

Avinza), codeine, oxycodone

(e.g., OxyContin, Percodan,

Percocet), and related drugs.

Morphine, for example, is

often used before and after

surgical procedures to alleviate

severe pain. Codeine, on the

other hand, is often prescribed

for mild pain. In addition to

their pain-relieving properties,

some of these drugs—codeine

and diphenoxylate (Lomotil)

for example—can be used to

relieve coughs and diarrhea.

How do opioids affect

the brain and body?

Opioids act on the brain 

and body by attaching to 

specific proteins called opioid

receptors, which are found 

in the brain, spinal cord, and

gastrointestinal tract. When

these drugs attach to certain

opioid receptors, they can

block the perception of pain.

Opioids can produce drowsiness, nausea, constipation,

and, depending upon the

amount of drug taken, depress

respiration. Opioid drugs 

also can induce euphoria 

by affecting the brain regions

that mediate what we perceive

as pleasure. This feeling is

often intensified for those 

who abuse opioids when

administered by routes other

than those recommended. For

example, OxyContin often is

snorted or injected to enhance

its euphoric effects, while at

the same time increasing the

risk for serious medical 

consequences, such as opioid

overdose.2

What are the possible

consequences of opioid

use and abuse?

Taken as directed, opioids 

can be used to manage pain

effectively. Many studies 

have shown that the properly 

managed, short-term medical

use of opioid analgesic drugs

is safe and rarely causes

addiction—defined as the

compulsive and uncontrollable

use of drugs despite adverse

consequences—or dependence, which occurs when the

body adapts to the presence

of a drug, and often results 

in withdrawal symptoms 

when that drug is reduced 

or stopped. Withdrawal symptoms include restlessness,

muscle and bone pain, insomnia, diarrhea, vomiting, cold

flashes with goose bumps

(“cold turkey”), and involuntary

leg movements. Long-term use

of opioids can lead to physical

dependence and addiction.

Taking a large single dose of

an opioid could cause severe

respiratory depression that can

lead to death.

Is it safe to use 

opioid drugs with other 

medications?

Only under a physician’s

supervision can opioids be

used safely with other drugs.

Typically, they should not be

used with other substances

that depress the CNS, such as

2NIDA RESEARCH REPORT SERIES

Over-the-counter (OTC) medicines, such as certain cough 

suppressants (including dextromethorphan); sleep aids (such

as doxylamine, an ingredient in Unisom); antihistamines (such as

diphenhydramine, found in Benadryl); and dimenhydrinates (in

Gravol or Dramamine) can be abused for their psychoactive

effects. OTC medicines also can be abused when not taken as

directed. It is also important to note that OTC medications can

produce dangerous health effects when taken with alcohol.

Over-the-Counter (OTC) Medicines Can Be Abused

2 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.
alcohol, antihistamines, 

barbiturates, benzodiazepines,

or general anesthetics, because

these combinations increase

the risk of life-threatening 

respiratory depression.

CNS depressants—

What are CNS depressants?

C

NS depressants, sometimes

referred to as sedatives

and tranquilizers, are substances that can slow normal

brain function. Because of 

this property, some CNS

depressants are useful in 

the treatment of anxiety and

sleep disorders. Among the

medications that are commonly

prescribed for these purposes

are the following:

■ Barbiturates, such as

mephobarbital (Mebaral)

and pentobarbital sodium

(Nembutal), are used to

treat anxiety, tension, and

sleep disorders.

■ Benzodiazepines, such 

as diazepam (Valium),

chlordiazepoxide HCl

(Librium), and alprazolam

(Xanax), are prescribed 

to treat anxiety, acute

stress reactions, and panic

attacks. The more sedating

benzodiazepines, such as

triazolam (Halcion) and

estazolam (ProSom) are

prescribed for short-term

treatment of sleep disorders. Usually, benzodiazepines are not prescribed

for long-term use.

How do CNS depressants

affect the brain and body?

There are numerous CNS

depressants; most act on 

the brain by affecting the 

neurotransmitter gammaaminobutyric acid (GABA).

Neurotransmitters are brain

chemicals that facilitate 

communication between 

brain cells. GABA works 

by decreasing brain activity.

Although the different classes

of CNS depressants work in

unique ways, it is through

their ability to increase GABA

activity that they produce a

drowsy or calming effect that

is beneficial to those suffering

from anxiety or sleep disorders.

What are the possible 

consequences of CNS

depressant use and abuse?

Despite their many beneficial

effects, barbiturates and 

benzodiazepines have the

potential for abuse and should

be used only as prescribed.

During the first few days of

taking a prescribed CNS

depressant, a person usually

feels sleepy and uncoordinated,

but as the body becomes

accustomed to the effects of

the drug, these feelings begin

to disappear. If one uses these

drugs long term, the body 

will develop tolerance for the

drugs, and larger doses will 

be needed to achieve the

same initial effects. Continued

use can lead to physical

dependence and—when 

use is reduced or stopped—

withdrawal. Because all CNS

depressants work by slowing

the brain’s activity, when an

individual stops taking them,

the brain’s activity can rebound

and race out of control, potentially leading to seizures and

other harmful consequences.

Although withdrawal from

benzodiazepines can be 

problematic, it is rarely life

threatening, whereas withdrawal from prolonged use 

of other CNS depressants can

have life-threatening complications. Therefore, someone

who is thinking about discontinuing CNS depressant therapy

or who is suffering withdrawal

from a CNS depressant should

speak with a physician or seek

medical treatment. 

Is it safe to use CNS

depressants with other

medications?

CNS depressants should be

used in combination with

other medications only under

a physician’s close supervision.

Typically, they should not 

be combined with any other

medication or substance that

causes CNS depression,

including prescription pain

medicines, some OTC cold

and allergy medications, and

alcohol. Using CNS depressants

with these other substances—

particularly alcohol—can slow

both the heart and respiration

and may lead to death.

NIDA RESEARCH REPORT SERIES3
Stimulants—

What are stimulants?

As the name suggests,

stimulants increase 

alertness, attention, 

and energy, as well as elevate

blood pressure and increase

heart rate and respiration.

Stimulants historically were

used to treat asthma and other

respiratory problems, obesity,

neurological disorders, and a

variety of other ailments. But

as their potential for abuse and

addiction became apparent, the

medical use of stimulants began

to wane. Now, stimulants are

prescribed for the treatment of

only a few health conditions,

including narcolepsy, ADHD,

and depression that has not

responded to other treatments. 

How do stimulants affect

the brain and body?

Stimulants, such as dextroamphetamine (Dexedrine and

Adderall) and methylphenidate

(Ritalin and Concerta), have

chemical structures similar to a

family of key brain neurotransmitters called monoamines,

which include norepinephrine

and dopamine. Stimulants

enhance the effects of these

chemicals in the brain.

Stimulants also increase 

blood pressure and heart 

rate, constrict blood vessels,

increase blood glucose, and

open up the pathways of 

the respiratory system. The

increase in dopamine is 

associated with a sense of

euphoria that can accompany

the use of these drugs.

What are the possible

consequences of stimulant use and abuse?

As with other drugs of abuse,

it is possible for individuals to

become dependent upon or

addicted to many stimulants.

Withdrawal symptoms associated with discontinuing 

stimulant use include fatigue,

depression, and disturbance 

of sleep patterns. Repeated use

of some stimulants over a short

period can lead to feelings of

hostility or paranoia. Further,

taking high doses of a stimulant may result in dangerously

high body temperature and 

an irregular heartbeat. 

There is also the potential 

for cardiovascular failure or 

lethal seizures.

Is it safe to use stimulants

with other medications?

Stimulants should be used 

in combination with other

medications only under a

physician’s supervision.

Patients also should be aware

of the dangers associated with

mixing stimulants and OTC

cold medicines that contain

decongestants; combining

these substances may cause

blood pressure to become

dangerously high or lead to

irregular heart rhythms.

4NIDA RESEARCH REPORT SERIES

More than 6.3 Million Americans 

Reported Current Use of Prescription Drugs 

for Nonmedical Purposes in 2003

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 

National Survey on Drug Use and Health, 2004.

5.0

4.0 

3.0 

2.0

1.0

0 Stimulants Sedatives and

Tranquilizers

Opioid Pain

Relievers

Millions of Americans
NIDA RESEARCH REPORT SERIES5

Trends in 

prescription 

drug abuse

Although prescription

drug abuse affects 

many Americans, some

concerning trends can be

seen among older adults,

adolescents, and women.

Several indicators suggest that

prescription drug abuse is on

the rise in the United States.

According to the 2003 National

Survey on Drug Use and

Health (NSDUH), an estimated

4.7 million Americans used prescription drugs nonmedically

for the first time in 2002—

■ 2.5 million used pain

relievers

■ 1.2 million used 

tranquilizers

■ 761,000 used stimulants

■ 225,000 used sedatives

Pain reliever incidence

increased—from 573,000 

initiates in 1990 to 2.5 million

initiates in 2000—and has

remained stable through 2003.

In 2002, more than half (55

percent) of the new users

were females, and more than

half (56 percent) were ages 

18 or older.

The Drug Abuse Warning

Network (DAWN), which monitors medications and illicit

drugs reported in emergency

departments (EDs) across the

Nation, recently found that two

of the most frequently reported

prescription medications in

drug abuse-related cases 

are benzodiazepines 

(e.g., diazepam, alprazolam, 

clonazepam, and lorazepam)

and opioid pain relievers 

(e.g., oxycodone, hydrocodone,

morphine, methadone, and

combinations that include

these drugs). In 2002, benzodiazepines accounted for

100,784 mentions that were

classified as drug abuse cases,

and opioid pain relievers

accounted for more than

119,000 ED mentions. From

1994 to 2002, ED mentions of

hydrocodone and oxycodone

increased by 170 percent and

450 percent, respectively.

While ED visits attributed to

drug addiction and drug-taking

for psychoactive effects have

been increasing, intentional

overdose visits have remained

stable since 1995.

Older adults

Persons 65 years of age and

above comprise only 13 percent of the population, yet

account for approximately

one-third of all medications

prescribed in the United States.

Older patients are more likely

to be prescribed long-term and

multiple prescriptions, which

could lead to unintentional

misuse.

The elderly also are at risk

for prescription drug abuse, in

which they intentionally take

medications that are not medically necessary. In addition 

to prescription medications, 

a large percentage of older

adults also use OTC medicines

and dietary supplements.

Because of their high rates 

of comorbid illnesses, changes 

Past Month Use of Selected Illicit Drugs 

Among Youths, by Age: 2003

18%

15

12 

9 

6

3

0

Age 12 or 13

Percent Using in Past Month

Age 14 or 15 Age 16 or 17

Marijuana

Psychotherapeutics

Inhalants

Hallucinogens

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 

National Survey on Drug Use and Health, 2004.
in drug metabolism with age,

and the potential for drug

interactions, prescription and

OTC drug abuse and misuse

can have more adverse health

consequences among the 

elderly than are likely to be

seen in a younger population.

Elderly persons who take 

benzodiazepines are at

increased risk for cognitive

impairment associated with

benzodiazepine use, leading

to possible falls (causing hip

and thigh fractures), as well 

as vehicle accidents. However,

cognitive impairment may be

reversible once the drug is 

discontinued.

Adolescents and 

young adults

Data from the 2003 NSDUH

indicate that 4.0 percent of 

youth ages 12 to 17 reported

nonmedical use of prescription

medications in the past month.

Rates of abuse were highest

among the 18–25 age group

(6.0 percent). Among the

youngest group surveyed, ages

12–13, a higher percentage

reported using psychotherapeutics (1.8 percent) than 

marijuana (1.0 percent). 

The NIDA Monitoring the

Future survey of 8th-, 10th-,

and 12th-graders found that

the nonmedical use of opioids,

tranquilizers, sedatives/barbiturates, and amphetamines

was unchanged between 2003

and 2004. Specifically, the 

survey found that 5.0 percent

of 12th-graders reported using

OxyContin without a prescription in the past year, and 

9.3 percent reported using

Vicodin, making Vicodin one

of the most commonly abused

licit drugs in this population.

Past year, nonmedical use of

tranquilizers (e.g., Valium,

Xanax) in 2004 was 2.5 percent

for 8th-graders, 5.1 percent for

10th-graders, and 7.3 percent

for 12th-graders. Also within

the past year, 6.5 percent of

12th-graders used sedatives/

barbiturates (e.g., Amytal,

Nembutal) nonmedically, 

and 10.0 percent used

amphetamines (e.g., Ritalin,

Benzedrine).

Youth who use other drugs

are more likely to abuse 

prescription medications.

According to the 2001 National

Household Survey on Drug

Abuse (now the NSDUH), 

63 percent of youth who had

used prescription drugs nonmedically in the past year 

had also used marijuana in 

the past year, compared with

17 percent of youth who had

not used prescription drugs

nonmedically in the past year.

Gender differences

Studies suggest that women

are more likely than men to

be prescribed an abusable

prescription drug, particularly

narcotics and antianxiety

drugs—in some cases, 

55 percent more likely.

Overall, men and women

have roughly similar rates of

nonmedical use of prescription

drugs. An exception is found

among 12- to 17-year-olds. In

this age group, young women

are more likely than young

men to use psychotherapeutic

6NIDA RESEARCH REPORT SERIES

Past-Year Use of Other Drugs Reported 

by Prescription Drug Abusers: 

Persons Aged 12 to 25, 2001

70

60

50 

40 

30

20

10

0

Marijuana

Percent Using in Past Month

Hallucinogens Inhalants Heroin Cocaine 

(including 

crack)

Past Year Use of

Prescription Drugs

No Past Year Use of

Prescription Drugs

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 

The NHSDA Report, January 16, 2003.
NIDA RESEARCH REPORT SERIES7

drugs nonmedically. In addition, research has shown that

women are at increased risk

for nonmedical use of narcotic

analgesics and tranquilizers

(e.g., benzodiazepines).

Preventing and 

recognizing prescription

drug abuse

The risks for addiction to 

prescription drugs increase

when the drugs are used in

ways other than for those 

prescribed. Healthcare

providers, primary care physicians, and pharmacists, as

well as patients themselves, all

can play a role in identifying

and preventing prescription

drug abuse.

Physicians. Because about

70 percent of Americans

(approximately 191 million

people) visit their primary care

physician at least once every 

2 years, these doctors are in a

unique position—not only to

prescribe medications, but also

to identify prescription drug

abuse when it exists, help the

patient recognize the problem,

set recovery goals, and seek

appropriate treatment.

Screening for prescription drug

abuse can be incorporated

into routine medical visits by

asking about substance abuse

history, current prescription

and OTC use, and reasons 

for use. Doctors should take

note of rapid increases in the

amount of medication needed,

or frequent, unscheduled refill

requests. Doctors also should

be alert to the fact that those

addicted to prescription drugs

may engage in “doctor shopping”—moving from provider

to provider—in an effort to

obtain multiple prescriptions

for the drug(s) they abuse.

Preventing or stopping 

prescription drug abuse is an

important part of patient care.

However, healthcare providers

should not avoid prescribing

or administering stimulants,

CNS depressants, or opioid

pain relievers if needed. (See

text box on “Pain Treatment

and Addiction.”)

Pharmacists. By providing

clear information on how to

take a medication appropriately

and describing possible side

I

t is estimated that more than 50 million Americans suffer from

chronic pain. When treating pain, healthcare providers have

long wrestled with a dilemma: How to adequately relieve a

patient’s suffering, while avoiding the potential for that patient 

to become addicted to the pain medication.

Many healthcare providers underprescribe opioid pain relievers,

such as morphine and codeine, because they overestimate the

potential for patients to become addicted. This fear of prescribing

opioid pain medications is known as “opiophobia.” Although

these drugs carry a risk for addiction and physicians should

watch for signs of abuse and addiction in their patients, the 

likelihood of patients with chronic pain becoming addicted to 

opioids is low (with the exception of those with a personal 

or family history of drug abuse or mental illness). The risk of

becoming addicted to prescription pain medications is also 

minimal in those who are treated on a short-term basis. More

research is needed to better understand what other factors 

predispose people to addiction to prescription pain relievers, 

and what can be done to prevent addiction among those at risk.

Pain management for patients who have substance abuse 

disorders is particularly challenging, but these patients can still 

be treated successfully with opioid pain medications. Developing

new and effective addiction and pain medications that are less

likely to be abused is a priority for NIDA. For example, the 

medication buprenorphine/naloxone (Suboxone), developed by

NIDA in collaboration with the pharmaceutical industry for treating opioid addiction, may provide an alternative medication for

pain that has less abuse potential than other pain medications,

while also having a much greater safety margin. However, further

research is needed before this practice can be recommended.

Pain Treatment and Addiction
effects or drug interactions,

pharmacists also can play 

a key role in preventing 

prescription drug abuse.

Moreover, by monitoring 

prescriptions for falsification

or alterations and being aware

of potential “doctor shopping,”

pharmacists can be the first

line of defense in recognizing

prescription drug abuse. Some

pharmacies have developed

hotlines to alert other pharmacies in the region when a

fraudulent prescription is

detected. 

Patients. There are also

steps a patient can take to ensure that they use prescription

medications appropriately.

Patients should always follow

the prescribed directions, be

aware of potential interactions

with other drugs, never stop

or change a dosing regimen

without first discussing it with

their healthcare provider, and

never use another person’s

prescription. Patients should

inform their healthcare professionals about all the prescription and OTC medicines and

dietary and herbal supplements

they are taking, in addition to

a full description of their presenting complaint, before they

obtain any other medications.

Treating prescription

drug addiction

Years of research have shown

us that addiction to any drug

(illicit or prescribed) is a brain

disease that, like other chronic

diseases, can be treated 

effectively. No single type of

treatment is appropriate for 

all individuals addicted to 

prescription drugs. Treatment

must take into account the

type of drug used and the

needs of the individual.

Successful treatment may 

need to incorporate several

components, including detoxification, counseling, and in

some cases, the use of pharmacological therapies. Multiple

courses of treatment may be

needed for the patient to

make a full recovery.

The two main categories 

of drug addiction treatment

are behavioral and pharmacological. Behavioral treatments

encourage patients to stop

drug use and teach them how

to function without drugs,

handle cravings, avoid drugs

and situations that could lead

to drug use, and handle a

relapse should it occur. When

delivered effectively, behavioral

treatments—such as individual

counseling, group or family

counseling, contingency 

management, and cognitive–

behavioral therapies—also 

can help patients improve

their personal relationships

and their ability to function at

work and in the community.

Some addictions, such 

as opioid addiction, can be

treated with medications.

These pharmacological treatments counter the effects of

the drug on the brain and

behavior, and can be used to

relieve withdrawal symptoms,

treat an overdose, or help

overcome drug cravings.

Although a behavioral or 

pharmacological approach

alone may be effective for

treating drug addiction,

research shows that, at least 

in the case of opioid addiction, a combination of both 

is most effective.

8NIDA RESEARCH REPORT SERIES
Treating addiction to

prescription opioids

Several options are available

for effectively treating prescription opioid addiction.

These options are drawn from

research regarding the treatment of heroin addiction, 

and include medications such

as naltrexone, methadone, 

and buprenorphine, as well 

as behavioral counseling

approaches.

Naltrexone is a medication

that blocks the effects of 

opioids and is used to treat

opioid overdose and addiction. Methadone is a synthetic

opioid that blocks the effects

of heroin and other opioids,

eliminates withdrawal 

symptoms, and relieves drug

craving. It has been used 

successfully for more than 

30 years to treat heroin 

addiction. The Food and Drug

Administration (FDA) approved

buprenorphine in October

2002, after more than a decade

of research supported by

NIDA. Buprenorphine, which

can be prescribed by certified

physicians in an office setting,

is long lasting, less likely to

cause respiratory depression

than other drugs, and is well

tolerated. However, more

research is needed to determine the effectiveness of these

medications for the treatment 

of prescription drug abuse. 

A useful precursor to longterm treatment of opioid

addiction is detoxification.

Detoxification in itself is not a

treatment. Rather, its primary

objective is to relieve withdrawal symptoms while the

patient adjusts to being drug

free. To be effective, detoxification must precede long-term

treatment that either requires

complete abstinence or incorporates a medication, such as

methadone or buprenorphine,

into the treatment program.

Treating addiction to 

CNS depressants

Patients addicted to barbiturates and benzodiazepines

should not attempt to stop

taking them on their own.

Withdrawal symptoms 

from these drugs can be 

problematic, and—in the case

of certain CNS depressants—

potentially life-threatening.

Although no research regarding

the treatment of barbiturate

and benzodiazepine addiction

exists, addicted patients

should undergo medically

supervised detoxification

because the treatment dose

must be gradually tapered.

Inpatient or outpatient counseling can help the individual

during this process. Cognitivebehavioral therapy, which

focuses on modifying the

patient’s thinking, expectations, and behaviors, while at

the same time increasing skills 

for coping with various life

stressors, also has been used

successfully to help individuals

adapt to the discontinuation 

of benzodiazepines.

Often barbiturate and benzodiazepine abuse occurs in

conjunction with the abuse of

another substance or drug,

NIDA RESEARCH REPORT SERIES9

Many Physicians Have Difficulty Discussing

Substance Abuse With Patients

Over 40% of physicians report having difficulty discussing substance abuse, including abuse of 

prescription drugs, with their patients. In contrast, less than 20% have difficulty discussing depression.

National Center on Addiction and Substance Abuse at Columbia University (CASA). Missed Opportunity: National Survey of

Primary Care Physicians and Patients on Substance Abuse, New York: CASA, 2000.

50

40

30 

20 

10

0 Depression

Percent of Physicians

Alcohol Abuse Prescription Drug Abuse
10NIDA RESEARCH REPORT SERIES

OPIOIDS

■ Oxycodone (OxyContin, Percodan, Percocet)

■ Propoxyphene (Darvon)

■ Hydrocodone (Vicodin, Lortab, Lorcet)

■ Hydromorphone (Dilaudid)

■ Meperidine (Demerol)

■ Diphenoxylate (Lomotil)

■ Morphine (Kadian, Avinza, MS Contin)

■ Codeine

■ Fentanyl (Duragesic)

■ Methadone

Generally prescribed for

■ Postsurgical pain relief

■ Management of acute or chronic pain

■ Relief of cough and diarrhea 

In the body

Opioids attach to opioid receptors in the brain 

and spinal cord, blocking the perception of pain.

Effects of short-term use

■ Alleviates pain

■ Drowsiness 

■ Constipation

■ Depressed respiration (depending on dose)

Effects of long-term use

■ Potential for physical dependence and addiction

Possible negative effects

■ Severe respiratory depression or death 

following a large single dose 

Should not be used with

Other substances that cause CNS depression, including:

■ Alcohol 

■ Antihistamines

■ Barbiturates

■ Benzodiazepines

■ General anesthetics

CNS DEPRESSANTS

Barbiturates

■ Mephobarbital (Mebaral)

■ Pentobarbital sodium (Nembutal)

Benzodiazepines

■ Diazepam (Valium)

■ Chlordiazepoxide hydrochloride (Librium)

■ Alprazolam (Xanax)

■ Triazolam (Halcion)

■ Estazolam (ProSom)

■ Clonazepam (Klonopin)

■ Lorazepam (Ativan)

Generally prescribed for

■ Anxiety

■ Tension

■ Panic attacks

■ Acute stress reactions

■ Sleep disorders

■ Anesthesia (at high doses)

In the body

CNS depressants slow brain activity through actions 

on the GABA system, producing a calming effect.

Effects of short-term use

■ A “sleepy”and uncoordinated feeling 

during the first few days; as the body 

becomes accustomed (tolerant) to the 

effects, these feelings diminish.

Effects of long-term use

■ Potential for physical dependence and addiction

Possible negative effects

■ Seizures following a rebound in brain 

activity after reducing or discontinuing use 

Should not be used with

Other substances that cause CNS depression, including:

■ Alcohol 

■ Prescription opioid pain medicines 

■ Some OTC cold and allergy medications

STIMULANTS

■ Dextroamphetamine (Dexedrine and Adderall)

■ Methylphenidate (Ritalin and Concerta)

Generally prescribed for

■ Narcolepsy

■ Attention-deficit hyperactivity disorder (ADHD) 

■ Depression that does not respond to other treatment

In the body

Stimulants enhance brain activity, causing an increase

in alertness, attention, and energy.

Effects of short-term use

■ Elevated blood pressure

■ Increased heart rate

■ Increased respiration

■ Suppressed appetite

■ Sleep deprivation

Effects of long-term use

■ Potential for physical dependence and addiction

Possible negative effects

■ Dangerously high body temperature or an 

irregular heartbeat after taking high doses 

■ Cardiovascular failure or lethal seizures

■ For some stimulants, hostility or feelings 

of paranoia after taking high doses 

repeatedly over a short period of time 

Should not be used with

■ OTC decongestant medications

■ Antidepressants, unless supervised by a physician

■ Some asthma medications

Use and Consequences of Commonly Prescribed Medications
such as alcohol or cocaine. 

In these cases of polydrug

abuse, the treatment approach

must address the multiple

addictions.

Treating addiction to

prescription stimulants

Treatment of addiction to 

prescription stimulants, such

as Ritalin, is often based on

behavioral therapies that have

proven effective in treating

cocaine and methamphetamine

addiction. At this time, there

are no proven medications 

for the treatment of stimulant

addiction. However, NIDA is

supporting a number of studies

on potential medications for

treating stimulant addiction.

Depending on the patient’s

situation, the first steps in

treating prescription stimulant

addiction may be tapering the

drug dosage and attempting 

to ease withdrawal symptoms.

The detoxification process

could then be followed by one

of many behavioral therapies.

Contingency management, 

for example, uses a system

that enables patients to earn

vouchers for drug-free urine

tests. (These vouchers can 

be exchanged for items that

promote healthy living.)

Cognitive-behavioral therapy

also may be an effective 

treatment for addressing 

stimulant addiction. Finally,

recovery support groups 

may be helpful in conjunction

with behavioral therapy.

NIDA RESEARCH REPORT SERIES11

Glossary

Addiction: A chronic, relapsing disease characterized by compulsive drug seeking and use,

despite harmful consequences, and by neurochemical and molecular changes in the brain.

Barbiturate: A type of CNS depressant often

prescribed to promote sleep.

Benzodiazepine: A type of CNS depressant

often prescribed to relieve anxiety. Valium and

Librium are among the most widely prescribed

medications.

Buprenorphine: Medication approved by the

FDA in October 2002 for treatment of opioid

addiction.

Central nervous system (CNS): The brain

and spinal cord.

CNS depressants: A class of drugs that 

slow CNS function (also called sedatives and 

tranquilizers), some of which are used to treat

anxiety and sleep disorders; includes barbiturates

and benzodiazepines.

Detoxification: A process that enables the 

body to rid itself of a drug, while at the same

time managing the individual’s symptoms 

of withdrawal; often the first step in a drug 

treatment program.

Dopamine: A neurotransmitter present in

regions of the brain that regulate movement,

emotion, motivation, and feelings of pleasure.

Methadone: A long-acting synthetic medication

that is effective in treating opioid addiction.

Narcolepsy: A disorder characterized by 

uncontrollable episodes of deep sleep.

Norepinephrine: A neurotransmitter present 

in some areas of the brain and the adrenal

glands; decreases smooth muscle contraction and

increases heart rate; often released in response

to low blood pressure or stress.

Opioids: Controlled drugs or narcotics most

often prescribed for the management of pain;

natural or synthetic chemicals based on opium’s

active component—morphine—that work by

mimicking the actions of pain-relieving chemicals

produced in the body.

Opiophobia: A healthcare provider’s fear that

patients will become addicted to opioids even

when using them appropriately; can lead to the

underprescribing of opioids for pain management.

Physical dependence: An adaptive 

physiological state that can occur with regular

drug use and results in withdrawal when drug 

use is discontinued. (Physical dependence alone 

is not the same as addiction, which involves 

compulsive drug seeking and use, despite its

harmful consequences.) 

Polydrug abuse: The abuse of two or more

drugs at the same time, such as CNS depressants

and alcohol.

Prescription drug abuse: The intentional 

misuse of a medication outside of the normally

accepted standards of its use.

Prescription drug misuse: Taking a 

medication in a manner other than that 

prescribed or for a different condition than that

for which the medication is prescribed.

Psychotherapeutics: Drugs that have an effect

on the function of the brain and that often are

used to treat psychiatric disorders; can include

opioids, CNS depressants, and stimulants.

Respiratory depression: Depression of 

respiration (breathing) that results in the reduced

availability of oxygen to vital organs.

Sedatives: Drugs that suppress anxiety 

and relax muscles; the National Survey on 

Drug Use and Health classification includes 

benzodiazepines, barbiturates, and other types 

of CNS depressants.

Stimulants: Drugs that increase or enhance 

the activity of monamines (such as dopamine 

and norepinephrine) in the brain, which leads 

to increased heart rate, blood pressure, and 

respiration; used to treat only a few disorders,

such as narcolepsy and ADHD.

Tolerance: A condition in which higher doses of

a drug are required to produce the same effects

as experienced initially.

Tranquilizers: Drugs prescribed to promote

sleep or reduce anxiety; this National Survey 

on Drug Use and Health classification includes

benzodiazepines, barbiturates, and other types 

of CNS depressants.

Withdrawal: A variety of symptoms that occur

after chronic use of some drugs is reduced or

stopped.
12NIDA RESEARCH REPORT SERIES

American Chronic Pain Association. 

Press Release: Survey Shows Myths,

Misunderstanding about Pain Common

Among Americans, 2000.

Baillargeon, L.; et al. Discontinuation of 

benzodiazepines among older insomniac

adults treated with cognitive-behavioural 

therapy combined with gradual tapering: 

a randomized trial. CMAJ 169:1015–1020,

2003.

Baum, C.; Kennedy, D.L.; Knapp, D.E.; Juergens,

J.P.; and Faich, G.A. Prescription drug use in

1984 and changes over time. Med Care

26(2):105–114, 1988.

Boyer, E.W. Dextromethorphan abuse. Pediatr

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Cowan, D.R.; Wilson-Barnett, J.; Griffiths, P.; 

and Allan, L.G. A survey of chronic noncancer

pain patients prescribed opioid analgesics.

Pain Medicine 4(4):340–351, 2003.

CSAT. Substance Abuse Among Older Adults

(TIP #26). DHHS Pub. No. BKD250. 

SAMHSA, 1997. 

Fishbain, D.A.; Rosomoff, H.L.; and Rosomoff,

R.S. Drug abuse, dependence and addiction 

in chronic pain patients. Clin J Pain

8:77–85, 1992.

Helling, D.K.; Lemke, J.H.; Semla, T.P.; Wallace,

R.B.; Lipson, D.P.; and Cornoni-Huntley, J.

Medication use characteristics in the elderly:

the Iowa 65+ Rural Health Study J Am

Geriatr Soc 35(1):4–12, 1987.

Johnston, L.D.; O’Malley, P.M.; and Bachman,

J.G. Monitoring the Future: National Survey

Results on Drug Use, Overview of Key

Findings 2004. Bethesda, MD, NIDA, 

NIH, DHHS (2005). Available at: 

www.monitoringthefuture.org. 

Joransson, D.E.; Ryan, K.M.; Gilson, A.M.; 

and Dahl, J.L. Trends in medical use and

abuse of opioid analgesics. JAMA

283(13):1710–1714, 2000.

Michna, E.; Ross, E.L.; Hynes, W.L.; Nedeljkovic,

S.S.; Soumekh, S.; Janfaza, D.; Palombi, D.;

and Jamison, R.N. Predicting aberrant drug

behavior in patients treated for chronic pain:

importance of abuse history. J Pain Symptom

Manage 28(3):250–258, 2004.

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for Addiction Treatment. NIDA NOTES 17(4),

2002.

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Opioids to Relieve Pain. NIDA NOTES 15(1),

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Department Trends from the Drug Abuse

Warning Network, Final Estimates 1995–

2002. DHHS Pub. No. (SMA) 03-3780.

SAMHSA, 2003.

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of National Findings. DHHS Pub. No. (SMA)

02–3758. SAMHSA, 2002.

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Drug Use and Health: National Findings. DHHS

Pub. No. (SMA) 04-3964. SAMHSA, 2004.

Paterniti, S.; Dufouil, C.; and Alperovitch, A.

Long-term benzodiazepine use and cognitive

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22(3):285–293, 2002.

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Access information 

on the NIDA Web site

■ Information on 

prescription drugs and

other drugs of abuse

■ Selected Prescription

Drugs with Potential 

for Abuse chart

(www.drugabuse.gov/

DrugPages/PrescripDrugs

Chart.html)

■ Publications and 

communications 

(including NIDA NOTES)

■ Calendar of events

■ Links to NIDA 

organizational units

■ Funding information 

(including program

announcements 

and deadlines)

■ International activities

■ Links to related 

Web sites (access to 

Web sites of many 

other organizations in

the field)

NIDA Web Sites

www.drugabuse.gov

www.steroidabuse.org

www.clubdrugs.org

National Clearinghouse

for Alcohol and Drug

Information (NCADI)

Web Site: www.health.org

Phone No.: 800-729-6686

References

NIH Publication Number 05-4881

Printed July 2001, Revised August 2005

Feel free to reprint this publication.