July 2008 Page 1 of 9

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 and can lead to addiction. 

Patients, healthcare professionals, and

pharmacists all have roles in preventing

the abuse1 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 overthe-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 healthcare 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.1

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:

Prescription and Over-the-Counter

Medications 
July 2008 Page 2 of 9

• 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 commonly prescribed

because of their effective analgesic, or

pain-relieving, properties. Studies have

shown that properly managed medical

use of opioid analgesic compounds

(taken exactly as prescribed) 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 that

can be 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).

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 a 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
July 2008 Page 3 of 9

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 substances slow breathing, their combined effects 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 to when it

was first prescribed) and 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

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. 

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 combined with

medications have proven effective.

Currently used medications are: 

• Methadone, a synthetic opioid that

eliminates withdrawal symptoms and

relieves craving, has been used for

more than 30 years to successfully

treat people addicted to heroin.

• 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

and has a better safety profile 

than methadone.

• 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 in 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
July 2008 Page 4 of 9

detoxified, since it can produce

severe withdrawal 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) slow normal brain function. In

higher doses, some CNS depressants

can be used as general anesthetics or

pre-anesthetics. 

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 are non-benzodiazepines

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 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.
July 2008 Page 5 of 9

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 both the heart

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 it 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 their 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, cognitivebehavioral 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.

Stimulants

What are Stimulants?

Stimulants such as amphetamines

(Adderal, Dexedrine) and

methylphenidate (Concerta, Ritalin) 

have chemical structures that are similar

to key brain neurotransmitters called

monoamines, which include dopamine

and norepinephrine—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. Stimulants increase alertness,

attention, and energy; and because they

increase dopamine, they can produce a

sense of euphoria.

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,

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 inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small

blood vessels. Stimulants have been
July 2008 Page 6 of 9

abused for both “performance enhancement” and recreational purposes (i.e., to

get high). 

How Do Prescription Stimulants

Affect the Brain?

All stimulants work by increasing

dopamine levels in the brain. Dopamine

is a brain chemical (neurotransmitter)

associated with pleasure, movement,

and attention. The therapeutic effect of

stimulants 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 reached. However, when taken

in doses and routes other than those prescribed, stimulants can increase brain

dopamine 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 Can Be

Associated with Stimulant Abuse?

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, which may enhance the

effects of a stimulant, or OTC cold medicines containing decongestants, which

may cause blood pressure to become

dangerously high or 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. 

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.
July 2008 Page 7 of 9

Dextromethorphan (DXM)

What is DXM?

Dextromethorphan is the active cough

suppressant 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.

What are the Consequences

Associated with the Abuse of

DXM?

In very large quantities, DXM can cause

effects similar to that of ketamine and

PCP by affecting 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 has

occurred due to the combination of 

DXM with decongestants often found in

these medications.

What are the Trends in the

Abuse of Prescription Drugs

and Cough Medicine?

Monitoring the Future (MTF)

Survey2

Each year, the Monitoring the Future

(MTF) survey assesses the extent of drug

use among 8th-, 10th-, and 12th-graders

nationwide. Nonmedical use of any prescription drug is reported only for 12thgraders. In 2007, 21.7 percent reported

lifetime3 use (down significantly from

2006); 15.4 percent reported past-year

use; and 7.6 percent reported pastmonth use. Prescription and OTC 

medications were the most commonly

abused drugs by high school students

after marijuana. They represent 6 of 

the top 10 illicit drugs reported by 

12th-graders.

Prescription Painkillers. In 2002, MTF

added questions to the survey about

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.

Rates of abuse 

in 2007 8th Grade 10th Grade 12th Grade

Vicodin 2.7% 7.2% 9.6%

OxyContin 1.8% 3.9% 5.2%
July 2008 Page 8 of 9

CNS Depressants. Nonmedical use 

of tranquilizers (benzodiazepines and

others) has remained stable for all three

grades in all prevalence periods (lifetime,

past-year, and past-month use). For 

sedatives (barbiturates), data are collected

only from 12th-graders. 

Stimulants. Nonmedical use of stimulants is broken up by the type of stimulant used: amphetamines, methamphetamine, and Ritalin. Amphetamine and

methamphetamine abuse have been

decreasing among 8th-, 10th-, and 12thgraders over the past 6 years; nonmedical use of Ritalin has decreased in 10thgraders during the same time period.

Cough Medicine. In 2006, a question

about the use of cough and cold medicines

to get high was asked for the first time. 

National Survey on Drug Use and

Health (NSDUH)4

According to the 2006 NSDUH, an estimated 7 million persons, or 2.8 percent

of the population, age 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, 1.2 million using stimulants, and 0.39 million

using sedatives. 

Past-month nonmedical use of prescription-type drugs among young adults

aged 18 to 25 increased from 5.4 percent in 2002 to 6.4 percent in 2006.

This was primarily due to an increase in

pain reliever use, which was 4.1 percent

in 2002 and 4.9 percent in 2006.

However, nonmedical use of tranquilizers also increased over the 5-year period, from 1.6 to 2.0 percent.

Among persons aged 12 or older who

used pain relievers nonmedically in the

past 12 months, 55.7 percent reported

that they got the drug most recently used

from someone they knew and that they

did not pay for it. Another 19.1 percent

reported that they obtained the drug

from one doctor. Only 3.9 percent purchased the pain reliever from a drug

dealer or other stranger, and only 0.1

percent reported buying the drug on 

the Internet. Among those who reported

getting the pain reliever from a friend or

relative for free, 80.7 percent reported

Rates of abuse 

in 2007 8th Grade 10th Grade 12th Grade

Tranquilizers 2.4% 5.3% 6.2%

Sedatives --- --- 6.2%

Rates of abuse 

in 2007 8th Grade 10th Grade 12th Grade

Amphetamines 4.2% 8.0% 7.5%

Methamphetamine 1.1% 1.6% 1.7%

Ritalin 2.1% 2.8% 3.8%

Rates of abuse 

in 2007 8th Grade 10th Grade 12th Grade

Cough Medicine 4.0% 5.4% 5.8%
July 2008 Page 9 of 9

in a followup question that the friend or

relative had obtained the drug from just

one doctor.

Other Information Sources

For more information on addiction 

to prescription medications, visit

http://www.drugabuse.gov/

drugpages/prescription.html.

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.

1 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.

2 These data are from the 2007 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.

3 “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. 

4 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.