Prescription and over-the-counter drug abuse is at epidemic levels. They both represent what a doctor prescribes (prescription drug) and what can be purchased over the counter (OTC). Both have immediate and long-term consequences. The consequences can be serious, even fatal.
The most commonly abused prescription medications are opioids. These include codeine, hydrocodone, morphine, oxycodone, hydromorphone and fentanyl. These are known as pain relievers. They are prescribed by doctors for pain related to surgery, chronic medical conditions, and dental procedures. Opioid addiction can occur after as little as a week of use. The risk of long-term opioid abuse increases after just 5 days of taking the medication. Some people who were only supposed to take opioids for a week are still taking them a year later. Current thinking encourages physicians to maximize the use of over-the-counter analgesics, such as Tylenol, for pain treatment and to use opioid analgesics only for the shortest time necessary. Other abused prescription medications include sedatives (to sleep), tranquilizers (to relax), and stimulants (to stay awake).
Over-the-counter medication abuse is also common. Over-the-counter medications treat a variety of things. These include coughs, colds, pain, constipation, fluid buildup, and more. The most commonly abused over-the-counter medications include cough syrups and antidiarrheal medications. Another abuse involves taking over-the-counter weight loss medications that are not designed for that purpose. This includes abusing laxatives, diuretics, and over-the-counter diet pills. People abuse over-the-counter medications to get high or take more doses than allowed to treat their symptoms.
Path to better health
There are important steps you or a family member can take to reduce the risk of prescription and over-the-counter drug abuse.
Prescription Drug Abuse Prevention:
- Plan ahead. Talk to your doctor about pain management if you or a family member is planning surgery. By sharing your concerns, your doctor may limit your prescription or suggest you use an over-the-counter pain reliever first. They may have other suggestions as well.
- Tell your doctor if you or a family member has a history of substance abuse.
- Follow dosage instructions. Do not take more than prescribed.
- Do not take someone else’s prescription medication. Do not share your medicine with other people.
- Do not take the medication in any other way (crushed, inhaled, or injected).
- Do not take prescription medications for another reason (to get high).
- If you have chronic pain due to a medical condition, seek alternative pain relief. This may involve working with a physical therapist to perform special exercises.
- Store prescription medications safely out of the reach of children, teens, and others.
- Properly dispose of old opioid medications. Look for closed, secured containers designed for this. Some pharmacies and many police departments have bins on site. Look for “drug take back” days in your community. These are special days when you can go to stores and other areas to drop off your old medications.
- Do not mix prescription medications with alcohol.
- Understand that there may be drug interactions when taking more than one prescription medication.
Preventing over-the-counter medication abuse:
- Follow dosage instructions. Do not take more than prescribed.
- Do not take the medication in any other way (crushed, inhaled, or injected).
- Don’t take over-the-counter medications for any other reason (to get high, lose weight, etc.).
- If you have chronic pain due to a medical condition, seek alternative pain relief. This may involve working with your doctor to try alternative treatments such as physical therapy, acupuncture, or other treatments. Too much over-the-counter pain reliever can permanently damage your kidneys or liver.
- Throw away expired medications.
- Understand drug interactions. You should not combine certain over-the-counter medications.
Drug abuse treatment:
Your doctor or a health care professional can diagnose opioid use disorder (opioid misuse), formerly called opioid addiction.
Opioid use disorder is a chronic disease and should be treated the same as other chronic diseases. Like these, it must be continually managed and monitored. You should feel comfortable discussing the treatment with your GP, who is appropriately trained in this treatment.
Treatment for opioid addiction is different for everyone. The main goal of treatment is to help you stop using the medication. Treatment can also help you avoid using it again in the future.
When you stop using opioids, your body will react. You will have a number of symptoms that may include nausea and vomiting, abdominal pain, and anxiety. This reaction is called withdrawal.
Your doctor may prescribe certain medications to help relieve symptoms of opioid abuse or opioid use disorder. They will also help you control your cravings. These medications include methadone (often used to treat heroin addiction), buprenorphine, and naltrexone.
| Medicines |
Methadone |
Buprenorphine
|
naltrexone |
| Guys
|
Tablet, liquid
|
Sublingual tablet (under the tongue), buccal film (small patch that sticks to the inside of the cheek), long-acting injection (injection) | Tablet, intramuscular injection (injection)
|
| Wear | Daily | · Diary for tablet
· Every 4 weeks for injection |
· Diary for tablet
· Every 4 weeks for injection |
| how to get medication | In an opioid treatment program | It can be prescribed by your primary care doctor. | It can be prescribed by any medical provider. |
| Desire reduction | +++ | ++ | + |
| Possible side effects | Drowsiness
Constipation Heart problems (such as heart disease) Interactions with other medications (there are medications that should not be used with methadone) Overdose if combined with certain other medications |
Headache
Nausea Constipation |
Injection site reactions
Headache Insomnia |
| Considerations | It should be seen daily at first. | You may need to see him 1 or 2 times a week at first and then you can move to monthly visits. | You should completely withdraw from opioids before starting treatment (usually 7 to 14 days).
May be seen monthly for injections. |
Table adapted with permission from Coffa and Snyder, 2019.
Things to consider
Misuse of prescription opioids can lead to the use of illegal drugs such as heroin, cocaine, and, increasingly, fentanyl. No matter what is being abused, drug abuse almost always leads to problems at work, with family, and in personal relationships. It can also have long-term health consequences, including death.
Certain risk factors are associated with prescription drug abuse. These include:
- low income
- Unemployment
- Personal or family history of substance abuse.
- early age of onset
- Criminal record or legal problems (including DUI)
- Associating with other substance abusers
- A history of family or work conflicts.
- Thrill Seeking Behavior
- Tobacco consumption
- Depression or anxiety
- High stress
- Female gender
Over-the-counter medication abuse can lead to serious health problems. These can include memory loss, kidney failure, heart problems, and even death. High doses of cough syrup can have serious side effects. Side effects may include slow or irregular breathing, fainting, extreme drowsiness, muscle spasms, palpitations/rapid heart rate, blood pressure changes, blurred vision, vomiting, and brain damage.
Questions to ask your doctor
- How do I know if I am predisposed to an addiction?
- What can I do if over-the-counter medications do not relieve my pain?
- What are the signs of prescription and over-the-counter drug abuse?
- Is it okay to drive a car while taking prescription and over-the-counter pain relievers?
Resources
National Institute on Drug Abuse: Over-the-Counter Medications
National Institute on Adolescent Drug Abuse: Prescription Pain Relievers (Opioids)
US Food and Drug Administration: Guide to the Safe Use of Pain Medications
Indivior, Inc. has provided financial support for this material to the American Academy of Family Physicians.
