June 2009 Page 1 of 9

Prescription and 

Over-the-Counter Medications 

Prescription medications such as 

pain relievers, central nervous system 

(CNS) depressants (tranquilizers and 

sedatives), and stimulants are highly 

beneficial treatments for a variety of 

health conditions. Pain relievers enable 

individuals with chronic pain to lead 

productive lives; tranquilizers can 

reduce anxiety and help patients with 

sleep disorders; and stimulants help 

people with attention-deficit hyperactivity 

disorder (ADHD) focus their attention. 

Most people who take prescription 

medications use them responsibly. But 

when abused—that is, taken by someone 

other than the patient for whom the 

medication was prescribed, or taken in a 

manner or dosage other than what was 

prescribed—prescription medications 

can produce serious adverse health 

effects, including addiction. 

Patients, health care professionals, and 

pharmacists all have roles in preventing 

the abuse† of and addiction to 

prescription medications. For example, 

patients should follow the directions for 

use carefully; learn what effects and side 

effects the medication could have; and 

inform their doctor/pharmacist whether 

they are taking other medications 

[including over-the-counter (OTC) 

medications or health supplements], 

since these could potentially interact with 

the prescribed medication. The patient 

should read all information provided by 

the pharmacist. Physicians and other 

health care providers should screen 

for past or current substance abuse in 

the patient during routine examination, 

including asking questions about what 

other medications 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 finished, as these may 

be indicators of abuse.† 

Similarly, some OTC medications, such 

as cough and cold medicines containing 

dextromethorphan, have beneficial 

effects when taken as recommended; 

but they can also be abused and lead 

to serious adverse health consequences. 

Parents should be aware of the potential 

for abuse of these medications, 

especially when consumed in large 

quantities, which should signal concern 

and the possible need for intervention.

Commonly Abused 

Prescription Medications

Although many prescription medications 

can be abused, the following three 

classes are most commonly abused:
June 2009 Page 2 of 9

How Are Opioids Abused?

Opioids can be taken orally, or the 

pills may be crushed and the powder 

snorted or injected. A number of 

overdose deaths have resulted from 

the latter routes of administration, 

particularly with the drug OxyContin, 

which was designed to be a slow-release 

formulation. Snorting or injecting opioids 

results in the rapid release of the drug 

into the bloodstream, exposing the 

person to high doses and causing many 

of the reported overdose reactions. 

How Do Opioids Affect the Brain?

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 one perceives as pleasure, 

resulting in the initial euphoria or sense 

of well-being that many opioids produce. 

Repeated abuse of opioids can lead to 

addiction—a chronic, relapsing disease 

characterized by compulsive drug 

seeking and abuse despite its known 

harmful consequences.

What Adverse Effects Can Be 

Associated With Opioids? 

Opioids can produce drowsiness, cause 

constipation, and, depending upon the 

• Opioids—usually prescribed to treat 

pain.

• CNS depressants—used to treat 

anxiety and sleep disorders. 

• Stimulants—prescribed to treat ADHD 

and narcolepsy.

Opioids

What Are Opioids? 

Opioids are analgesic, or pain-relieving, 

medications. Studies have shown 

that properly managed medical use 

(taken exactly as prescribed) of opioid 

analgesics is safe, can manage pain 

effectively, and rarely causes addiction. 

Among the compounds that fall within 

this class are hydrocodone (e.g., 

Vicodin), oxycodone (e.g., OxyContin—

an oral, controlled-release form of the 

drug), morphine, fentanyl, codeine, 

and related medications. Morphine 

and fentanyl are often used to alleviate 

severe pain, while codeine is used for 

milder pain. Other examples of opioids 

prescribed to relieve pain include 

propoxyphene (Darvon); hydromorphone 

(Dilaudid); and meperidine (Demerol), 

which is used less often because of its 

side effects. In addition to their effective 

pain-relieving properties, some of these 

medications can be used to relieve 

severe diarrhea (for example, Lomotil, 

also known as diphenoxylate) or severe 

coughs (codeine).
June 2009 Page 3 of 9

Are There Treatments for Opioid 

Addiction? 

Individuals who abuse or are addicted 

to prescription opioid medications 

can be treated. Initially, they may 

need to undergo medically supervised 

detoxification to help reduce withdrawal 

symptoms; however, that is just the first 

step. Options for effectively treating 

addiction to prescription opioids are 

drawn from research on treating heroin 

addiction. Behavioral treatments, usually 

combined with medications, have also 

been proven effective. Currently used 

medications are— 

• Methadone, a synthetic opioid that 

eliminates withdrawal symptoms 

and relieves craving, has been used 

successfully for more than 30 years to 

treat people addicted to heroin as well 

as opiates.

• Buprenorphine, another synthetic 

opioid, is a more recently approved 

medication for treating addiction to 

heroin and other opiates. It can be 

prescribed in a physician’s office.

• Naltrexone is a long-acting opioid 

receptor blocker that can be employed 

to help prevent relapse. It is not 

widely used, however, because of 

poor compliance, except by highly 

motivated individuals (e.g., physicians 

at risk of losing their medical license). 

It should be noted that this medication 

can only be used for someone who 

has already been detoxified, since 

it can produce severe withdrawal 

amount taken, depress breathing. Taking 

a large single dose could cause severe 

respiratory depression or death.

These medications are only safe to 

use with other substances under a 

physician’s supervision. Typically, 

they should not be used with alcohol, 

antihistamines, barbiturates, or 

benzodiazepines. Because these other 

substances slow breathing, their effects 

in combination with opioids could lead 

to life-threatening respiratory depression. 

What Happens When You Stop 

Taking Opioids? 

Patients who are prescribed opioids for 

a period of time may develop a physical 

dependence on them, which is not the 

same as addiction. Repeated exposure 

to opioids causes the body to adapt, 

sometimes resulting in tolerance (that is, 

more of the drug is needed to achieve 

the desired effect compared with when it 

was first prescribed) and in withdrawal 

symptoms upon abrupt cessation of drug 

use. Thus, individuals taking prescribed 

opioid medications should not only 

be given these medications under 

appropriate medical supervision, but 

they should also be medically 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. 
June 2009 Page 4 of 9

are nonbenzodiazepines that act 

at a subset of the benzodiazepine 

receptors and appear to have a lower 

risk for abuse and addiction. 

How Are CNS Depressants 

Abused? 

CNS depressants are usually taken 

orally, sometimes in combination with 

other drugs or to counteract the effects of 

other licit or illicit drugs (e.g., stimulants). 

How Do CNS Depressants Affect 

the Brain? 

Most of the CNS depressants have 

similar actions in the brain: they enhance 

the actions of the neurotransmitter 

gamma-aminobutyric 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, it is ultimately their common ability 

to increase GABA activity that produces 

a drowsy or calming effect. 

What Adverse Effects Can Be 

Associated With CNS Depressants?

Despite their 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 drowsiness, 

including prescription pain medicines, 

certain OTC cold and allergy 

medications, and alcohol. If combined, 

symptoms in a person continuing to 

abuse opioids. 

• Naloxone is a short-acting opioid 

receptor blocker that counteracts the 

effects of opioids and can be used to 

treat overdoses.

CNS Depressants

What Are CNS Depressants?

CNS depressants (e.g., tranquilizers, 

sedatives) are medications that slow 

normal brain function. In higher doses, 

some CNS depressants can be used as 

general anesthetics or preanesthetics. 

CNS depressants can be divided into 

three groups, based on their chemistry 

and pharmacology:

• Barbiturates, such as mephobarbital 

(Mebaral) and sodium pentobarbital 

(Nembutal), are used as 

preanesthetics, promoting sleep.

• Benzodiazepines, such as diazepam 

(Valium), alprazolam (Xanax), 

and estazolam (ProSom), can be 

prescribed to treat anxiety, acute 

stress reactions, panic attacks, 

convulsions, and sleep disorders. 

For the latter, benzodiazepines are 

usually prescribed only for short-term 

relief of sleep problems because of the 

development of tolerance and risk of 

addiction. 

• Newer sleep medications, such as 

zolpidem (Ambien), zaleplon (Sonata), 

and eszopiclone (Lunesta), are now 

more commonly prescribed to treat 

sleep disorders. These medications 
June 2009 Page 5 of 9

increase blood pressure and heart rate, 

constrict blood vessels, increase blood 

glucose, and open up the pathways 

of the respiratory system. Historically, 

stimulants were prescribed 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 prescribing of 

stimulants by physicians began to wane. 

Now, stimulants are prescribed for 

treating only a few health conditions, 

most notably ADHD, narcolepsy, and, in 

some instances, depression that has not 

responded to other treatments. 

How Are Stimulants Abused?

Stimulants may be taken orally, but 

some abusers crush the tablets, dissolve 

them in water, and then inject the 

mixture; complications can arise from 

this because insoluble fillers in the 

tablets can block small blood vessels. 

Stimulants have been abused for both 

“performance enhancement” and 

recreational purposes (i.e., to get high). 

How Do Prescription Stimulants 

Affect the Brain?

Stimulants have chemical structures that 

are similar to key brain neurotransmitters 

called monoamines, including dopamine 

and norepinephrine. Their therapeutic 

effect is achieved by slow and steady 

increases of dopamine that are similar 

to the natural production of this chemical 

by the brain. The doses prescribed 

by physicians start low and increase 

gradually until a therapeutic effect is 

they can slow both heart rate and 

respiration, which can be fatal.

What Happens When You Stop 

Taking CNS Depressants? 

Discontinuing prolonged use or abuse 

of high doses of CNS depressants can 

lead to serious withdrawal symptoms. 

Because the drug works by slowing the 

brain’s activity, when one stops taking 

a CNS depressant, this activity can 

rebound to the point that seizures can 

occur. Someone who is either thinking 

about ending use of a CNS depressant, 

or who has stopped and is suffering 

withdrawal should seek medical 

treatment.

Are There Treatments for Addiction 

to CNS Depressants? 

In addition to medical supervision 

during withdrawal, counseling in an 

inpatient or outpatient 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 his or her skills 

for coping with various life stressors.

Stimulants

What Are Stimulants?

Stimulants (amphetamines [Adderall, 

Dexedrine] and methylphenidate 

[Concerta, Ritalin]) increase alertness, 

attention, and energy. They also 
June 2009 Page 6 of 9

Depending on the patient’s situation, the 

first step in treating prescription stimulant 

addiction may be to decrease the 

drug’s dose slowly and attempt to treat 

withdrawal symptoms (mood changes, 

sleep and appetite disturbances). 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 

drug-free 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.

Dextromethorphan (DXM)

What Is DXM?

DXM is the active ingredient found 

in OTC cough and cold medications. 

When taken in recommended doses, 

these medications are safe and effective.

How Is DXM Abused?

DXM is taken orally. In order to 

experience the mind-altering effects 

of DXM, excessive amounts of liquid 

or gelcaps must be consumed. The 

availability and accessibility of these 

products make them a serious concern, 

particularly for youth, who tend to be 

their primary abusers.

reached. However, when taken in doses 

and routes other than those prescribed, 

stimulants can increase the brain’s 

dopamine levels in a rapid and highly 

amplified manner—as do most other 

drugs of abuse—disrupting normal 

communication between brain cells, 

producing euphoria, and increasing 

the risk of addiction. 

What Adverse Effects Are 

Associated With Stimulant Abuse?

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 some 

stimulants in high doses or repeatedly 

can lead to hostility or feelings of 

paranoia in some individuals.

Stimulants should not be mixed with 

antidepressants, which may enhance the 

effects of a stimulant; or with OTC cold 

medicines containing decongestants, 

which may cause blood pressure to 

become dangerously high or may lead 

to irregular heart rhythms.

Are There Treatments for Stimulant 

Addiction? 

Treatment of addiction to prescription 

stimulants 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. 
June 2009 Page 7 of 9

past-year nonmedical use of Vicodin 

and OxyContin. For Vicodin, past-year 

nonmedical use has remained stable 

at high levels for each grade since its 

inclusion in the survey. 

Rate of Past-Year Use in 2008

Drug Name 8th 

Grade

10th 

Grade

12th 

Grade

Vicodin 2.9% 6.7% 9.7%

OxyContin 2.1% 3.6% 4.7%

CNS Depressants. Nonmedical use 

of tranquilizers (benzodiazepines 

and others) by 10th-grade students 

decreased between 2001 and 2008 

for all prevalence periods (lifetime,†††

past-year, and past-month use). Use of 

sedatives (barbiturates), for which data 

are collected only from 12th-graders, 

has remained steady. 

Rate of Past-Year Use in 2008

Drug Name 8th 

Grade

10th 

Grade

12th 

Grade

Tranquilizers 2.4% 4.6% 6.2%

Sedatives --- --- 5.8%

Stimulants. Nonmedical use of 

stimulants is broken up by the type 

of stimulant used: amphetamines, 

methamphetamine, or Ritalin. For all 

three stimulants surveyed, rates have 

decreased significantly among 8th-, 

10th-, and 12th-graders in 2001–2008.

What Are the Consequences 

Associated With the Abuse 

of DXM?

In very large quantities, DXM can cause 

effects similar to those of ketamine 

and PCP because those drugs affect 

similar sites in the brain. These effects 

can include impaired motor function, 

numbness, nausea/vomiting, and 

increased heart rate and blood pressure. 

On rare occasions, hypoxic brain 

damage—caused by severe respiratory 

depression and a lack of oxygen to 

the brain—has occurred due to the 

combination of DXM with decongestants 

often found in the medication.

What Are the Trends in the 

Abuse of Prescription Drugs 

and OTC Medications?

Monitoring the Future (MTF) 

Survey††

Each year, the Monitoring the Future 

(MTF) survey assesses the extent of 

drug use among 8th-, 10th-, and 12thgraders nationwide. Nonmedical use 

of any prescription drug is reported 

only for 12th-graders, and in 2008, 

15.4 percent reported past-year use. 

Prescription and OTC medications were 

the most commonly abused drugs by 

high school students after marijuana. In 

addition, they represent 6 of the top 10 

illicit drugs reported by 12th-graders.

Prescription Painkillers. In 2002, MTF 

added questions to the survey about 
June 2009 Page 8 of 9

Past-month nonmedical use of 

prescription-type drugs among young 

adults aged 18 to 25 increased from 

5.5 percent in 2002 to 6 percent in 

2007. This was primarily due to an 

increase in pain reliever use, which was 

4.1 percent in 2002 and 4.6 percent 

in 2007. However, nonmedical use of 

tranquilizers remained the same over the 

6-year period.

Among persons aged 12 or older who 

used pain relievers nonmedically in the 

past 12 months, 56.5 percent reported 

that they got the drug most recently 

used from someone they knew and that 

they did not pay for it. Another 18.1 

percent reported that they obtained the 

drug from one doctor. Only 4.1 percent 

purchased the pain reliever from a drug 

dealer or other stranger, and just 0.5 

percent reported buying the drug on 

the Internet. Among those who reported 

getting the pain reliever from a friend 

or relative for free, 81 percent reported 

in a followup question that the friend or 

relative had obtained the drug from one 

doctor only.

Other Information Sources

For more information on addiction 

to prescription medications, visit 

www.drugabuse.gov/drugpages/

prescription.html.

Rate of Past-Year Use in 2008

Drug Name 8th 

Grade

10th 

Grade

12th 

Grade

Amphetamines 4.5% 6.4% 6.8%

Methamphetamine 1.2% 1.5% 1.2%

Ritalin 1.6% 2.9% 3.4%

Cough Medicine. In 2006, a question 

about the use of cough and cold 

medicines to get high was asked for the 

first time. 

Rate of Past-Year Use in 2008

Drug Name 8th 

Grade

10th 

Grade

12th 

Grade

Cough Medicine 3.6% 5.3% 5.5%

National Survey on Drug Use 

and Health (NSDUH)††††

According to the 2007 NSDUH, an 

estimated 6.9 million persons, or 

2.8 percent of the population, aged 

12 or older had used prescription 

psychotherapeutic medications 

nonmedically in the month prior to 

being surveyed. This includes 5.2 

million using pain relievers (an 

increase from 4.7 million in 2005), 

1.8 million using tranquilizers, 1.1 

million using stimulants, and 350,000 

using sedatives. 
June 2009 Page 9 of 9

† A common vocabulary has not been established in the field of prescription drug abuse. Because much of the survey 

data collected in this area refer to nonmedical use of prescription drugs, this definition of “abuse,” rather than that 

of the Diagnostic and Statistical Manual of Mental Disorders (DSM), is used. Also, because physical dependence to 

prescription medications can develop during medically supervised appropriate use, the term “addiction” is used to 

reflect dependence as defined by the DSM.

†† These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, 

National Institutes of Health, Department of Health and Human Services, and conducted annually 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. “Past year” refers to use at least once during 

the year preceding an individual’s response to the survey. “Past month” 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 of Americans 

age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest 

survey are available at www.samhsa.gov and from NIDA at 877–643–2644.