PRESCRIPTION DRUG ABUSE

Prescription drug abuse is of special note here because it has risen sharply in the last decade. The nonmedical use of prescription drugs, such as opioids, central nervous system depressants and stimulants, can lead to abuse and addiction, characterized by compulsive drug seeking and use. Particularly, the use of prescription opioids, like oxycontin, has led to an epidemic of heroin addiction.

The use of these prescription drugs, especially mixed with alcohol, is potentially lethal.
The abuse of methylphenidate (Ritalin®), commonly used to treat attention-deficit/hyperactivity disorder (ADHD), is now common. By crushing the tablets and snorting the drug, individuals attain a “cocaine-like” high. In fact, Ritalin® has been shown to affect the brain in much the same way as cocaine.

Pain relievers, such as oxycodone with aspirin (Percodan®), hydrocodone (Vicodin®) and the latest scourge, oxycontin, are on the rise. The Drug Abuse Warning Network reported that in 2003, nonmedical use of opiates/opioid analgesics (pain relievers) accounted for 17 percent of emergency room visits.

These powerful prescription medications that can quickly develop dependency are increasingly available over the internet as well as from illegal domestic sources, not to mention a parent or friend’s medicine cabinet.

Signs of Prescription Drug Abuse

• Changes in appearance, including weight loss or weight gain
• Loss of interest in school, work or once-enjoyable activities
• Lethargy and sleep problems, including insomnia or sleeping too much
• Frequent illness or physical complaints. Many trips to the doctor for vague and poorly defined symptoms.
• Change in bowel habits
• Change of friends and activities
• Irritability and restlessness or abrupt changes in mood or attitude
• Unexplained absences
• Missing medications from a family member
• Unexplained money problems
• Stealing
• Blackouts and memory lapses
• Inability to stop using

Treating Prescription Drug Addiction

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 to make a full recovery.

Cognitive-behavioral interventions, which focus on modifying the patient’s thinking, expectations, and behaviors, while at the same time increasing skills for coping with various life stressors, have been found to be very effective.

Some addictions, such as opioid addiction, can also be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior. Medications can also be used to relieve the symptoms of withdrawal, to treat an overdose, or to 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.

Treating Addiction to Prescription Opioids

Several options are available for effectively treating prescription opioid addiction, like oxycontin, including 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.

Detoxification, though not in itself a treatment, may be necessary to relieve withdrawal symptoms, while adjusting 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 Depressant

You should not attempt to stop taking barbiturates and benzodiazepines on your own, as withdrawal from these drugs can be problematic, and, in the case of certain CNS depressants, potentially life-threatening. It is highly advised to undergo a medically supervised detoxification because the dose must be gradually tapered off. Counseling using cognitive-behavioral therapy can help during this process. Often barbiturates and benzodiazepines abuse occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of poly-substance 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 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 steps in treating prescription stimulant addiction may be tapering off the drug’s dose and attempting to treat withdrawal symptoms. The detoxification process could then be followed by one of many behavioral therapies. Recovery support groups may also be effective in conjunction with behavioral therapy.

Source: National Institute on Drug Abuse, Research Report Series, “Prescription Drugs: Abuse and Addiction”, www.nida.nih.gov/ResearchReports/Prescription/prescription7.html