June 2006 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 historytaking, with questions about which prescriptions and over-the-counter (OTC)

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, or

pain relieving, properties. Studies have

shown that properly managed medical

Prescription Pain and 

Other Medications
June 2006 Page 2 of 8

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 its

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 life-threatening 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 supervised when stopping use

in order to reduce or avoid withdrawal

symptoms. Symptoms of withdrawal can
June 2006 Page 3 of 8

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. 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.
June 2006 Page 4 of 8

CNS depressants should not be combined with any medication or substance

that causes drowsiness, including 

prescription pain medicines, certain

OTC 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 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.
June 2006 Page 5 of 8

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 OTC 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

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.

Trends in Prescription

Medication Abuse ———

2005 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

survey showed that lifetime, annual, and

30-day** use of tranquilizers had

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. In

general, 8th-graders’ rates of reported
June 2006 Page 6 of 8

tranquilizer use have been considerably

lower than those observed in the upper

grades. These figures remained statistically unchanged in 2005, with 6.8 

percent of 12th-graders, 4.8 percent 

of 10th-graders, and 2.8 percent of 

8th-graders reporting annual use of 

tranquilizers.

Only 12th grade data are reported for

use of sedatives. Lifetime use of sedatives among high school seniors

remained statistically unchanged

between 2004 (9.9 percent) and 2005

(10.5 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 controlledrelease 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, 9.5 percent in 2004,

and 9.0 percent in 2005. 

Beginning in 2002, new items asking

specifically about the use of OxyContin

and Vicodin were also added to the survey. Annual use of OxyContin by 12thgraders has risen from 4.0 percent in

2002 to 5.5 percent in 2005. Annual

OxyContin use has remained more stable in the lower grades since 2002, with

1.8 percent of 8th-graders and 3.2 percent of 10th-graders reporting annual

use in 2005. The annual prevalence rate

for Vicodin was considerably higher

than for OxyContin, at 9.5 percent

among 12th-graders, 5.9 percent

among 10th-graders, and 2.6 percent

among 8th-graders in 2005. Considering

the addictive potential of oxycodone

and hydrocodone, these are disturbingly

high rates of use. 

2004 National Survey on Drug

Use and Health (NSDUH)***

According to the 2004 NSDUH, an 

estimated 6.0 million persons, or 2.5

percent of the population age 12 or

older had used prescription psychotherapeutic medications nonmedically in the

month prior to being surveyed. This

includes 4.4 million using pain relievers,

1.6 million using tranquilizers, 1.2 million using stimulants, and 0.3 million

using sedatives.

The estimated number of people aged

12 or older abusing OxyContin in their

lifetime increased from 1.9 million in

2002 to 3.1 million in 2004. Increased

rates of lifetime OxyContin abuse were

seen in each age group, with the largest

increase (from 2.6 percent to 4.3 percent) occurring among young adults

aged 18 to 25. Also among young

adults, lifetime abuse of tranquilizers

increased from 11.2 percent in 2002 to

12.2 percent in 2004, and the propor-
June 2006 Page 7 of 8

tions abusing any pain reliever and any

prescription drug in their lifetime and

during the past month also increased

over that period. Among youth aged 12

to 17, past year abuse of prescription

stimulants declined from 2.6 percent to

2.0 percent.

2004 Drug Abuse Warning

Network (DAWN)****

The Drug Abuse Warning Network

(DAWN), which monitors medications

and illicit drugs reported in emergency

departments (EDs) across the Nation,

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). 

For 2004, DAWN estimates 495,732

ED visits involved in the nonmedical use

(i.e., misuse or abuse) of prescription

drugs or OTC pharmaceuticals or

dietary supplements. Multiple drugs

were involved in more than half (57 

percent) of these ED visits. 

In 2004, benzodiazepines accounted

for 144,385 mentions that were classified as drug abuse cases, and opioid

pain relievers accounted for more than

132,207 ED mentions. Methylphenidate,

a central nervous system stimulant that

has recently captured much public attention, occurred much less frequently.

DAWN estimates 1,541 ED visits associated with methylphenidate abuse.

For more information on addiction to prescription medications, visit 

http://www.drugabuse.gov/drugpages/prescription.html. 

* These data are from the 2005 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, DHHS, 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. “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.
June 2006 Page 8 of 8

*** 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 the National Clearinghouse for Alcohol and Drug Information at

800-729-6686.

**** 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 are available

at 800-729-6686 or online 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.