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Prescription medications are abused more commonly than cocaine, heroin and
methamphetamine. Unfortunately there is a public misperception that prescription
medications are safer than and not as addictive as street drugs. THIS IS WRONG!!! The
difference is that prescription drugs have accepted medical use and the benefit outweighs the
risk to treat the disease. Medical practitioners must take extra measures compared to other
medications to ensure their safe use.
In an address given in February by the Director of the Centers for Disease Control, Thomas
Frieden, MD, MPH, illustrates the magnitude of the problem:
 ”The rise in abuse of and deaths from prescription opioid narcotics has reached
epidemic proportions….”
 “There were more than 27,000 deaths from prescription drug overdoses in 2007, a
number that has risen five-fold since 1990….”
 “…overdose deaths from prescription opioids are exceeding deaths from heroin and
cocaine overdoses combined….”
 “Also, the overall number of drug-induced deaths -- which includes all drugs, not just
prescription painkillers, although it is attributable in large part to those -- is approaching
the number of deaths from motor vehicle crashes.”
 “Drug abuse deaths have also surpassed the number of deaths from suicide, homicide,
and fire arms….”
These prescription medications include opioid (synthetic opiate) painkillers such as oxycodone
and hydrocodone, anti-anxiety medications like Xanax and Valium and stimulants like
Dexedrine, Adderall or Ritalin commonly used for ADD and ADHD.
Before a discussion of these substances, one needs to understand the differences between
physical dependence, tolerance and addiction:
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Tolerance-this is when the body adapts to a substance being ingested needing
more substance to get the same effect. This does not define addiction; we do not
call a diabetic an addict for needing more insulin.
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Physical dependence-this is another adaptation by the body to a substance
resulting in a particular set of withdrawal symptoms upon reduction or cessation
of a particular compound. Again, this is not addiction; when one has a headache
from not having morning coffee it is not necessarily addiction.
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Addiction-a simple definition is that it is a compulsion to use a substance despite
continued adverse psychological, social and physical consequences. A good
example of an addict without physical dependence would be a “binge-alcoholic”.
A ‘binge alcoholic” is addicted to alcohol and continues to drink despite DWI’s,
arrests, cirrhosis or other consequences yet does not develop withdrawal.
The Breakdown:
Opiates/opioids
These are medications based on opium derived from the poppy plant. Technically, the correct
term for naturally occurring compounds such as morphine is opiates and the synthetic
compounds are referred to as opioids. The medical community generally refers to all as opiates
as opioids in professional discussions.
This class includes morphine, hydrocodone (e.g.-Vicodin, etc.), oxycodone (e.g.-OxyContin,
Roxicodone, Percocet, etc.), fentanyl (e.g.-Duragesic, Actiq, Fentora, etc.), hydromorphone
(e.g.-Dilaudid), oxymorphone (e.g.-Opana and Opana ER), methadone, Heroin (at one time a
legal prescription drug.)
These are powerful pain relieving medications that work in the brain to decrease and block pain
signals thus relieving the patient of suffering. When inappropriately prescribed and/or
inappropriately taken, these are potentially highly addictive. They can cause euphoria (a
powerful sense of well-being which may be accompanied by emotional highs and low) and they
kill by causing “respiratory depression”. This is when the opioid sedates the person and then
decrease the drive to breathe resulting in brain damage and likely death. As the afflicted
develops greater tolerance they try to “get the original high” and they overshoot the mark
resulting in sedation. An observer may note the afflicted nodding off at inappropriate times or
“zoning out” during conversations (the person is awake but frequently not able to follow simple
conversations coherently or stares off into space.) Please see below for further symptoms.
There are two main classes of opioid medications used for pain management, long acting and
short acting. The average effective half-life of these medications is on average four to six hours
but for chronic pain certain formulations have been made to allow their slow release over
anywhere from eight to twenty-four hours. These are available in much higher dosages indicted
for chronic pain patients that may have developed tolerance. Examples of the long-acting
preparations are: OxyContin, Opana ER, Exalgo, MS-Contin, Fentanyl patch (Duragesic). When
an addicted person wants to use these to get “high” they compromise the delivery system (e.g.-
crush to snort, put in solution to inject, etc.). It is for this reason that the manufacturers are
now required to make tamper resistant pills for all new opioid medications to try and decrease
and hopefully eliminate their abuse. An example of how much more valuable the immediate
release is to the afflicted, OxyContin 80 mg street price prior to January, 2010, was from $50 $80 per tablet. In January, 2010, the pill was reformulated to turn to paste when crushed,
foiling attempts to crush and snort or inject. Because of this the street value has dropped to
$20 - $30 per pill from $80. Immediate release Roxicodone has supplanted OxyContin as the
preferred drug for addicts and a 30mg pill of Roxicodone goes for the same price as an 80mg
OxyContin.
Some common signs of opioid addiction/abuse may be:
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Extreme mood changes – happy, sad, excited, anxious, etc.
Sleeping a lot more or less than usual, or at different times of day or night
Changes in energy – unexpectedly and extremely tired or energetic
Weight loss or weight gain
Unexpected and persistent coughs or sniffles
Seeming unwell at certain times, and better at other times
Pupils of the eyes seeming smaller or larger than usual
Secretiveness
Lying
Stealing
Financially unpredictable (large amounts of cash at times but broke at other times)
Changes in social groups, new and unusual friends, odd cell-phone conversations
Repeated unexplained outings, often with a sense of urgency
Drug paraphernalia such as unusual pipes, cigarette papers, small weighing scales, etc.
“Stashes” of drugs, often in small plastic, paper or foil packages
It should be made clear that the above symptoms can be seen with addiction to any substance
and often addicts abuse several drugs at the same time as part of a “cocktail”.
Symptoms of opioid withdrawal are similar to the symptoms of severe flu:
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Unbearable pain
Cold sweats, chills
Uncontrollable diarrhea
Nausea and vomiting
Aching limbs
Severe depression
Restlessness
Anxiety
Benzodiazepines/Anti-anxiety medications
Benzodiazepine medications are prescribed primarily for anxiety/panic attacks. They work in
the central nervous system to give a calming effect on the central nervous system hence their
use not just to calm a panic attack and help with sleep but to also acutely stop seizures (the
uncontrolled firing of nerve cells in the central nervous system). Examples include alprazolam
(Xanax), clonazepam (Klonopin), lorazepam (Ativan) and temazepam (Restoril).
Their abuse will cause marked sedation and this is potentiated with the use of other sedatives
such as alcohol or opioids. It is this affect that makes benzodiazepines as well as other “daterape” drugs possible.
Muscles relaxants are listed in the same category of Sedative/Hypnotics and one in particular
has developed a large following on the street, carisoprodol (Soma). This medication breaks
down into meprobamate in the body. This was a benzodiazepine developed in the 1950’s called
Miltown and subsequently removed from the market. It is also known as “Soma-Coma” and
when taken with Xanax and Vicodin it is called “The Holy Trinity” and will give a heroin-like high.
Signs of abuse can be similar to that of opioid, marked sedation in addition to the
aforementioned symptoms. Abuse can result in marked slowing of the heart rate and/or
marked respiratory depression which may result in death.
Signs of withdrawal may include:
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Extremely long withdrawal compared to other drugs of abuse (as much as 2-4 months)
Tremors
Chills/cold sweats
Anxiety
Insomnia
Nausea
Hallucinations
Seizures (may be fatal)
Stimulants (Cocaine, methamphetamine, amphetamine)
These medications cause a dramatic increase in central nervous system activity and are
commonly called “speed”. Amphetamines include the prescription medications such as
amphetamine salts (Adderall), methylphenidate (Ritalin) and dextroamphetamine (Dexedrine).
These are commonly used for the treatment of ADD/ADHD, narcolepsy and severe fatigue and
used as diet aids but are commonly abused by students to aid in study or to just get “high”.
Cocaine and methamphetamine have similar effects just much stronger and associated with a
higher rate of addiction but no accepted medical use. Overdose can include; seizures, abnormal
heart rhythm and possible heart attack, shortness of breath, hallucinations, anxiety, paranoia, a
form of muscle breakdown called rhabdomyolysis as well as kidney failure.
Signs of intoxication may include:
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Euphoria (increased alertness, energy, sociability or appetite)
Increased libido or impotence
Increased heart rate and respirations
Bruxism (grinding of teeth)
Chronic rhinitis (constant runny nose)
Twitching or involuntary movements
Signs of withdrawal may include:
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Fatigue
Insomnia
Increased appetite
Depression and suicidal thoughts
Anxiety
Craving for more stimulants
Impaired concentration and thinking