February 2005 Page 1 of 8

Prescription medications such as pain

relievers, tranquilizers, stimulants, and

sedatives are very useful treatment tools

but sometimes people do not take them as

directed and may become addicted. Pain

relievers make surgery possible, and

enable many individuals with chronic

pain to lead productive lives. Most people

who take prescription medications use

them responsibly. However, the inappropriate or nonmedical use of prescription

medications is a serious public health

concern. Nonmedical use of prescription

medications like opioids, central nervous

system (CNS) depressants, and stimulants

can lead to addiction, characterized by

compulsive drug seeking and use.

Patients, healthcare professionals, and

pharmacists all have roles in preventing

misuse and addiction to prescription medications. For example, when a doctor prescribes a pain relief medication, CNS

depressant, or stimulant, the patient

should follow the directions for use carefully, learn what effects the medication

could have, and determine any potential

interactions with other medications. The

patient should read all information provided by the pharmacist. Physicians and

other healthcare providers should screen

for any type of substance abuse during

routine history-taking, with questions

about which prescriptions and over-thecounter medicines the patient is taking

and why. Providers should note any rapid

increases in the amount of a medication

needed or frequent requests for refills

before the quantity prescribed should

have been used, as these may be indicators of abuse.

Commonly Abused

Prescription

Medications ———

While many prescription medications can

be abused or misused, these three classes

are most commonly abused:

• Opioids—often prescribed to treat

pain.

• CNS Depressants—used to treat

anxiety and sleep disorders. 

• Stimulants—prescribed to treat

narcolepsy and attention deficit/

hyperactivity disorder.

Opioids

Opioids are commonly prescribed

because of their effective analgesic,

Prescription Pain and

Other Medications
or pain relieving, properties. Studies have

shown that properly managed medical

use of opioid analgesic compounds is

safe and rarely causes addiction. Taken

exactly as prescribed, opioids can be

used to manage pain effectively.

Among the compounds that fall within this

class—sometimes referred to as narcotics—are morphine, codeine, and related medications. Morphine is often used

before or after surgery to alleviate severe

pain. Codeine is used for milder pain.

Other examples of opioids that can be

prescribed to alleviate pain include oxycodone (OxyContin—an oral, controlled

release form of the drug); propoxyphene

(Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine

(Demerol), which is used less often

because of side effects. In addition to their

effective pain relieving properties, some

of these medications can be used to

relieve severe diarrhea (Lomotil, for

example, which is diphenoxylate) or

severe coughs (codeine).

Opioids act by attaching to specific proteins called opioid receptors, which are

found in the brain, spinal cord, and gastrointestinal tract. When these compounds

attach to certain opioid receptors in the

brain and spinal cord, they can effectively

change the way a person experiences

pain. 

In addition, opioid medications can affect

regions of the brain that mediate what we

perceive as pleasure, resulting in the initial euphoria that many opioids produce.

They can also produce drowsiness, cause

constipation, and, depending upon the

amount taken, depress breathing. Taking

a large single dose could cause severe

respiratory depression or death.

Opioids may interact with other medications and are only safe to use with other

medications under a physician’s supervision. Typically, they should not be used

with substances such as alcohol, antihistamines, barbiturates, or benzodiazepines.

Since these substances slow breathing,

their combined effects could lead to lifethreatening respiratory depression.

Long-term use also can lead to physical

dependence—the body adapts to the

presence of the substance and withdrawal

symptoms occur if use is reduced abruptly. This can also include tolerance, which

means that higher doses of a medication

must be taken to obtain the same initial

effects. Note that physical dependence is

not the same as addiction—physical

dependence can occur even with appropriate long-term use of opioid and other

medications. Addiction, as noted earlier,

is defined as compulsive, often uncontrollable drug use in spite of negative

consequences.

Individuals taking prescribed opioid medications should not only be given these

medications under appropriate medical

supervision, but also should be medically

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supervised when stopping use in order to

reduce or avoid withdrawal symptoms.

Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with

goose bumps (“cold turkey”), and involuntary leg movements.

Individuals who become addicted to prescription medications can be treated.

Options for effectively treating addiction

to prescription opioids are drawn from

research on treating heroin addiction.

Some pharmacological examples of

available treatments follow:

• Methadone, a synthetic opioid that

blocks the effects of heroin and other

opioids, eliminates withdrawal symptoms and relieves craving. It has been

used for over 30 years to successfully

treat people addicted to opioids.

• Buprenorphine, another synthetic opioid, is a recent addition to the arsenal

of medications for treating addiction

to heroin and other opiates.

• Naltrexone is a long-acting opioid

blocker often used with highly motivated individuals in treatment programs

promoting complete abstinence.

Naltrexone also is used to prevent

relapse.

• Naloxone counteracts the effects of

opioids and is used to treat overdoses.

Central Nervous System

(CNS) Depressants

CNS depressants slow normal brain function. In higher doses, some CNS depressants can become general anesthetics.

Tranquilizers and sedatives are examples

of CNS depressants. 

CNS depressants can be divided into two

groups, based on their chemistry and

pharmacology:

• Barbiturates, such as mephobarbital

(Mebaral) and pentobarbitalsodium

(Nembutal), which are used to treat

anxiety, tension, and sleep disorders.

• Benzodiazepines, such as diazepam

(Valium), chlordiazepoxide HCl

(Librium), and alprazolam (Xanax),

which can be prescribed to treat anxiety, acute stress reactions, and panic

attacks. Benzodiazepines that have

a more sedating effect, such as estazolam (ProSom), can be prescribed

for short-term treatment of sleep

disorders.

There are many CNS depressants, and

most act on the brain similarly—they

affect the neurotransmitter gammaaminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate

communication between brain cells.

GABA works by decreasing brain activity.

Although different classes of CNS depressants work in unique ways, ultimately it is

their ability to increase GABA activity that

produces a drowsy or calming effect.
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Despite these beneficial effects for people

suffering from anxiety or sleep disorders,

barbiturates and benzodiazepines can

be addictive and should be used only

as prescribed.

CNS depressants should not be combined

with any medication or substance that

causes sleepiness, including prescription

pain medicines, certain over-the-counter

cold and allergy medications, or alcohol.

If combined, they can slow breathing,

or slow both the heart and respiration,

which can be fatal.

Discontinuing prolonged use of high

doses of CNS depressants can lead to

withdrawal. Because they work by slowing the brain’s activity, a potential consequence of abuse is that when one stops

taking a CNS depressant, the brain’s

activity can rebound to the point that

seizures can occur. Someone thinking

about ending their use of a CNS depressant, or who has stopped and is suffering

withdrawal, should speak with a physician and seek medical treatment.

In addition to medical supervision, counseling in an in-patient or out-patient setting can help people who are overcoming

addiction to CNS depressants. For example, cognitive-behavioral therapy has

been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on

modifying a patient’s thinking, expectations, and behaviors while simultaneously

increasing their skills for coping with

various life stressors.

Often the abuse of CNS depressants

occurs in conjunction with the abuse of

another substance or drug, such as alcohol or cocaine. In these cases of polydrug

abuse, the treatment approach should

address the multiple addictions.

Stimulants

Stimulants increase alertness, attention,

and energy, which are accompanied by

increases in blood pressure, heart rate,

and respiration.

Historically, stimulants were used to treat

asthma and other respiratory problems,

obesity, neurological disorders, and a

variety of other ailments. As their potential for abuse and addiction became

apparent, the use of stimulants began

to wane. Now, stimulants are prescribed

for treating only a few health conditions,

including narcolepsy, attention-deficit

hyperactivity disorder (ADHD), and

depression that has not responded to

other treatments. Stimulants may also be

used for short-term treatment of obesity

and for patients with asthma.

Stimulants such as dextroamphetamine

(Dexedrine) and methylphenidate (Ritalin)

have chemical structures that are similar

to key brain neurotransmitters called

monoamines, which include norepinephrine and dopamine. Stimulants increase

the levels of these chemicals in the brain
February 2005 Page 5 of 8

and body. This, in turn, increases blood

pressure and heart rate, constricts blood

vessels, increases blood glucose, and

opens up the pathways of the respiratory

system. In addition, the increase in

dopamine is associated with a sense of

euphoria that can accompany the use of

stimulants.

Research indicates that people with ADHD

do not become addicted to stimulant medications, such as Ritalin, when taken in

the form and dosage prescribed. However, when misused, stimulants can be

addictive.

The consequences of stimulant abuse can

be extremely dangerous. Taking high

doses of a stimulant can result in an irregular heartbeat, dangerously high body

temperatures, and/or the potential for

cardiovascular failure or seizures. Taking

high doses of some stimulants repeatedly

over a short period of time can lead to

hostility or feelings of paranoia in some

individuals.

Stimulants should not be mixed with antidepressants or over-the-counter cold medicines containing decongestants. Antidepressants may enhance the effects of a

stimulant, and stimulants in combination

with decongestants may cause blood

pressure to become dangerously high

or lead to irregular heart rhythms.

Treatment of addiction to prescription

stimulants, such as methylphenidate and

amphetamines, is based on behavioral

therapies proven effective for treating

cocaine or methamphetamine addiction.

At this time, there are no proven medications for the treatment of stimulant addiction. Antidepressants, however, may be

used to manage the symptoms of depression that can accompany early abstinence

from stimulants.

Depending on the patient’s situation, the

first step in treating prescription stimulant

addiction may be to slowly decrease the

drug’s dose and attempt to treat withdrawal symptoms. This process of detoxification could then be followed with one

of many behavioral therapies. Contingency management, for example, improves treatment outcomes by enabling

patients to earn vouchers for drugfree urine tests; the vouchers can be

exchanged for items that promote healthy

living. Cognitive-behavioral therapies,

which teach patients skills to recognize

risky situations, avoid drug use, and cope

more effectively with problems, are proving beneficial. Recovery support groups

may also be effective in conjunction with

a behavioral therapy.

Trends in Prescription

Medication Abuse ———

2004 Monitoring the Future

(MTF) Survey*

MTF assesses the extent and perceptions

of drug use among 8th, 10th, and 12th

grade students nationwide. In 2003, the
February 2005 Page 6 of 8

survey showed that lifetime, annual, and

30-day** use of tranquilizers declined

significantly from 2002 for 10th- and

12th-graders. This was the first year of

decline for 12th-graders after a decade of

gradual increase; past year use went from

7.7 percent in 2002 to 6.7 percent in

2003. For 10th-graders, it was the second year of decline for annual use, down

from 7.3 percent in 2001 to 5.3 percent

in 2003. In general, 8th-graders’ rates of

reported tranquilizer use have been considerably lower (about 2.7 percent for

annual use) than those observed in the

upper grades. These figures remained

statistically unchanged in 2004.

Lifetime use of sedatives among high

school seniors also remained statistically

unchanged between 2003 (8.8 percent)

and 2004 (9.9 percent).

Only 12th grade data are reported for

abuse of narcotics other than heroin in

the MTF. The annual prevalence of this

class of drugs had risen considerably,

from 3.3 percent in 1992 to 7 percent in

2000 and 6.7 percent in 2001. In 2002,

the survey item was changed to incorporate three new specific pain relievers,

OxyContin (a controlled-release form of

oxycodone that can cause severe health

consequences if crushed and ingested),

Vicodin (hydrocodone), and Percocet.

Following this change, past year use

was reported by 9.4 percent of seniors

in 2002, 9.3 percent in 2003, and 9.5

percent in 2004. 

Beginning in 2002, new items asking

specifically about the use of OxyContin

and Vicodin were also added to the survey. Although not significantly higher than

in 2003, annual OxyContin use was

reported in 2004 by 5.0 percent of 12thgraders, 3.5 percent of 10th-graders, and

1.7 percent of 8th-graders. The annual

prevalence rate for Vicodin was considerably higher than for OxyContin, at 9.3

percent in 12th-graders, 6.2 percent in

10th-graders, and 2.5 percent in 8thgraders in 2004. Considering the addictive potential of oxycodone and hydrocodone, these are disturbingly high rates

of use. 

2003 National Survey

on Drug Use and Health

(NSDUH)***

According to the 2003 NSDUH, an estimated 6.3 million persons, or 2.7 percent

of the population age 12 and older had

used prescription psychotherapeutic medications nonmedically in the month prior

to being surveyed. This includes 4.7 million using pain relievers, 1.8 million using

tranquilizers, 1.2 million using stimulants,

and 0.3 million using sedatives.

There was a significant increase in lifetime

nonmedical use of pain relievers between

2002 and 2003 among persons aged 12

or older, from 29.6 million to 31.2 million.

Lifetime prevalence of pain reliever abuse

among youth aged 12 or 13 increased

significantly, from 4.8 percent in 2002 to
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5.7 percent in 2003. Among young adults

aged 18 to 25, the rate increased from

22.1 percent in 2002 to 23.7 percent in

2003.

In 2003, approximately 2.8 million

people aged 12 and older had used

OxyContin nonmedically at least once in

their lifetimes, a significant increase from

2002. An estimated 415,000 Americans

received treatment for pain reliever abuse

in the past year. The number of new pain

reliever users increased from 573,000 in

1990 to 2.5 million in 2000. In 2001

and 2002, there was no change in the

number of initiates, and in 2002 more

than half (55 percent) of the new users

were female.

Lifetime nonmedical use of sedatives increased significantly from 2002 to 2003

for males aged 12 to 17 (0.7 percent to

1.0 percent). 

2002 Drug Abuse Warning

Network (DAWN)****

DAWN collects data on drug-related

hospital emergency department (ED)

episodes. The latest DAWN findings indicate that drug abuse-related ED episodes

involving certain prescription drugs, particularly the benzodiazepines and narcotic analgesics (pain relievers), continued to

rise between 1995 and 2002. ED mentions of benzodiazepines increased 38

percent, and mentions of narcotic analgesics/combinations increased from

45,000 to nearly 120,000. By the end

of 2002, ED mentions of benzodiazepines

and narcotic analgesics/combinations

were about as frequent as mentions of

heroin or marijuana but ranked below

cocaine and alcohol.

Long-term findings indicate that ED mentions of unspecified narcotics, as well as

those containing hydrocodone, oxycodone, and methadone rose substantially

from 1995 to 2002, increasing 160 percent for hydrocodone combinations, 176

percent for methadone, 341 percent for

unspecified narcotic analgesics, and 560

percent for oxycodone/combinations. ED

mentions of oxycodone/combinations

doubled from 2000 to 2002.

From 2001 to 2002, ED mentions of narcotic analgesics/combinations rose 20

percent. From 2000 to 2002, the increase

was 45 percent, and over the 8-year period from 1995 to 2002, ED mentions rose

163 percent. Overall, narcotic analgesics/combinations comprised 10 percent of total ED mentions in the United

States in 2002.

In 2002, there were 105,752 mentions

of benzodiazepines in hospital EDs,

an increase of 16 percent from 2000.

Mentions of alprazolam (Xanax) rose

25 percent during that period. 

For more information on addiction

to prescription medications, visit

http://www.drugabuse.gov/

drugpages/prescription.html.
February 2005 Page 8 of 8

* These data are from the 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National

Institutes of Health, DHHS, and conducted by the University of Michigan’s Institute for Social Research. The survey has

tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to

the study. The latest data are online at www.drugabuse.gov. 

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during the

year preceding an individual’s response to the survey. “30-day” refers to use at least once during the 30 days preceding

an individual’s response to the survey.

*** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey conducted

by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at

www.samhsa.gov.

**** These data are from the annual Drug Abuse Warning Network, funded by the Substance Abuse and Mental

Health Services Administration, DHHS. The survey provides information about emergency department visits that are

induced by or related to the use of an illicit drug or the nonmedical use of a legal drug. The latest data (2002) are

at www.samhsa.gov.

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

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.