Prescription Drug Misuse and Addiction, Part I: An Overview of the Problem

This first article discusses the problem of prescription drug misuse and addiction. It reviews signs and symptoms, reasons for using these drugs, and their effects on drug users and their families. The next article will discuss treatment and recovery for individuals and family members affected by the more serious problem of prescription drug addiction.

Many of us have a family member, friend or colleague who misuses or is addicted to prescription opioids, sedatives, tranquilizers or stimulants. This represents a serious public health problem due to the prevalence of this issue, especially among young adults ages eighteen to twenty-five, older adults (who often use multiple medications including those with addictive potential), and girls between twelve to seventeen years old (NIDA, 2016). Youth who misuse prescription drugs also have higher rates of cigarette smoking and heavy and episodic alcohol use, marijuana, cocaine, and other illicit drug use (NIDA, 2016). They are also at increased risk for injury (Wunsch, Gonzalez, Hopper, McMasters, & Boyd, 2014).   

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 119 million people in the US used these psychotherapeutic drugs in 2015, representing 44.5 percent of the population ages twelve or older (SAMHSA, 2016, 2017). The most common of these drugs included

•   Pain relievers such as hydrocodone, oxycodone, morphine, fentanyl, and other related opioid products (97.5 million)

• Tranquilizers, also referred to as CNS depressants, such as benzodiazepines and barbiturates used for anxiety and muscle relaxants (39.3 million)

•  Sedatives used for sleep problems (18.6 million)

• Stimulants such as amphetamine products used for attention deficit disorder or anorectics used for weight loss (17.2 million)

Nearly nineteen million people misused these drugs in 2015, and two million developed an addiction (SAMHSA, 2017). Some of these individuals also have problems with other drugs or alcohol. A small yet significant number transfer their prescription opioid drug addiction to cheaper and illicit drugs like heroin or fentanyl, which is over fifty times more potent than morphine and potentially deadly (Compton, Jones, & Baldwin, 2016; Rudd, Seth, David, & Scholl, 2016). Heroin users are nearly four times as likely to report nonmedical use of opioids and nearly three times as likely to report an opioid use disorder compared to persons who did not use heroin (Compton et al., 2016).

Signs of Prescription Drug Misuse and Addiction

A common form of drug misuse is the intentional or unintentional use of one of these medications not prescribed to the user. Over half of the people who misuse or become addicted to prescription drugs receive, borrow, buy or steal these drugs from family or friends. 

Other signs of misuse include taking more medications than prescribed, getting prescriptions from more than one physician, doctor shopping, exaggerating or lying to the prescriber about symptoms, claiming the prescription was lost or stolen, and mixing alcohol or other medications with these drugs, which increases the risk of negative effects. For example, 46 to 71 percent of patients receiving medication-assisted therapy (MAT) for opioid addiction use benzodiazepines (Douaihy & Daley, 2013).

Each drug category has a specific set of withdrawal symptoms that occur when the amount of the drug taken is reduced or stopped. The other physical sign of addiction is an increase in tolerance to the drug where more is needed to achieve the desired effect. Although some of these medications are initially intended for brief periods of use, many people use them for lengthy periods of time, develop a physical dependence, and suffer withdrawal if they do not gradually taper off of them.

Compulsion or a strong desire or craving to use drugs despite their negative effects is the hallmark of addiction. Related to this is obsession, or an intense mental focus on getting the drug. Drugs become far too important and may become the central focus of the patients’ lives. Other signs of addiction include being unable to stop once drugs are taken, using greater quantities than intended, strong cravings for the drug or continuing drug use despite medical, psychological, family, or other problems that are caused or worsened by use. 

Once addicted, the feelings caused by drugs in the brain may become more important than food, sex, work, relationships, or accomplishments. What happens is that addiction “hijacks” the brain and leads to an increase in the amount of release of certain brain chemicals, which produce euphoria. Drugs affect areas of the brain that control judgement, memory, decision making, self-control, and pleasure. This is why most people with addiction do not accept they have a problem or believe they need help. It also helps to explain why some addicted people do anything to get drugs, regardless of the negative consequences or risks they take. 

Reasons for Using Prescription Drugs

According to SAMHSA, the most common reasons for misuse of these prescription drugs are to relieve pain (62.3 percent), feel good or get high (12.9 percent), relax or relieve tension (10.8 percent), help with emotions (3.9 percent), or help with sleep (3.3 percent; SAMHSA, 2016). Over half of the individuals who misused these medications were given, bought, or stole these drugs from a friend or relative. Only 36.8 percent got these from prescriptions from one or more physicians or dentists, and fraudulent prescriptions are sometimes used to get these drugs (SAMHSA, 2016).  

Effects of Prescription Drug Misuse or Addiction

The effects depend on the amount and types of drugs used, methods of use, and behavior and overall health of the drug user. Increases in prescription drug misuse in the past fifteen years has led to a significant increase in emergency room visits, unintentional deaths from drug overdoses (especially opioids with or without benzodiazepines), and admissions to treatment programs for drug addiction (Compton et al., 2016). Over half of emergency room visits for nonmedical use of these prescription drugs involved multiple drug use (Soyka, 2017). 

Addiction is associated with a multiplicity of adverse medical, psychological, family, social, financial, legal, and spiritual problems for drug users (Douaihy & Daley, 2013). For example, use of benzodiazepines increases the risk of traffic accidents, falls, and fractures (Soyka, 2017). In addition, families and significant others are often harmed (Daley & Miller, 2001; Daley, 2017b). 

Medical and dental health may also be neglected as addiction progresses. Intravenous drug use and risky sexual behaviors increase the risk of acquiring or transmitting HIV, hepatitis B or C, and/or STDs. Many other medical conditions can be caused or worsened by drug addiction. Furthermore, there is a risk of drug overdose, especially when opioids are combined with tranquilizers or sedatives. As a result of high rates of drug misuse and addiction, deaths from overdose have increased significantly in the past decade with over 59,000 in the US in 2016 (CDC, 2017). People who die from overdoses leave behind family members, including children and others who often suffer from their loss (Daley, 2017a).

In addition, there are high rates of psychiatric comorbidity associated with drug addiction, especially mood and personality disorders (Douaihy & Daley, 2013). Any other area of functioning can be harmed, including work or school, financial status, legal status, or spirituality.   

The Impact on Family Members

The problems drug misuse or addiction causes in families depends on the severity of the drug problem, the behavior of the affected people, the presence of other significant medical or psychiatric problems, and the coping mechanisms and support available to family members. Not all families or members in the same family are affected similarly.

Drug problems often cause mistrust, worry, anxiety, fear, and anger among family members (Daley & Miller, 2001; Daley, 2017b). Family members may feel frustrated if they are unable to get their addicted loved ones to see their problem or get help for it. They worry their loved ones could overdose or experience other bad outcomes. 

Addiction problems in families contribute to higher rates of separation, divorce, abuse or neglect, children being sent to foster care, financial problems, and physical or mental health problems of family members. Some become so depressed and anxious that they need psychiatric help for themselves.

Children of parents with a drug addiction are at increased risk for substance use, medical, psychological, academic, behavioral, or substance use disorders (Daley & Miller, 2001). Infants born to mothers addicted to opioids are at increased risk for neonatal abstinence syndrome (NAS; McQueen & Murphy-Oikonen, 2016). Over half of opioid-exposed babies experience NAS symptoms within three days of birth. NAS symptoms in infants include blotchy skin, difficulty sleeping and eating, diarrhea, sweating, hyperactive reflects, and being difficult to soothe.

Recent years have seen an increase in children of addicted parents placed with relatives or in foster care (NCSACW, 2017). I am aware of grandparents taking care of grandchildren because a single parent is or both parents are in active addiction and unable to provide adequate care. While grandparents would do anything for these children, those who are not retired did not envision taking care of infants or young kids during their retirement years.

It is clear that prescription drug misuse and addiction (and other substance problems) cause or worsen problems in any area of functioning. In addition, family members and significant others are affected in many ways. 

The next article will focus on treatment and recovery for individuals with a drug problem and for their families. The good news is that there are many sources of medical and psychological help for individuals and families from professionals and mutual support programs that address prescription drug addiction and other SUDs. c

About the Author

Dennis C. Daley, PhD, served for fourteen years as the chief of Addiction Medicine Services (AMS) at Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh School of Medicine. Dr. Daley has been with WPIC since 1986 and previously served as director of family studies and social work. He is currently involved in clinical care, teaching, and research.

References

Centers for Disease Control and Prevention (CDC). (2017). Vital statistics rapid release: Provisional drug overdose death counts. Retrieved from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription opioid use and heroin use. The New England Journal of Medicine, 374(2), 154–63.

Daley, D. C., & Miller, J. (2001). Addiction in your family: Helping yourself and your loved ones. Holmes Beach, FL: Learning Publications.

Daley, D. C. (2017a). Death has no expiration date, part I: Losing a loved one to addiction. Counselor, 18(4), 19–21.

Daley, D. C. (2017b). The other addiction epidemic: Hope and help for families and children affected by substance use disorders. Westmont, IL: American Physician Institute.

Douaihy, A., & Daley, D. C. (2013). Substance use disorders. New York, NY: Oxford University Press.

McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal abstinence syndrome. The New England Journal of Medicine, 375(25), 2468–79.

National Center for Substance Abuse and Child Welfare (NCSACW). (2017). Bringing systems together for family recovery, safety, and stability. SAMSHA-sponsored webinar, September 6.

National Institute on Drug Abuse (NIDA). (2016). Misuse of prescription drugs. Retrieved from https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/summary

Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug- and opioid-involved overdose deaths – United States, 2010–2015. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm

Soyka, M. (2017). Treatment of benzodiazepine dependence. The New England Journal of Medicine, 376(12), 1147–57.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). Prescription drug use and misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm

Substance Abuse and Mental Health Services Administration (SAMHSA). (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

Wunsch, M. J., Gonzalez, P. K., Hopper, J. A., McMasters, M. G., & Boyd, C. J. (2014). Nonmedical use, misuse, and abuse of prescription medications. In R. K. Ries, D. A. Fiellin, S. C. Miller, & R. Saitz (Eds), The ASAM Principles of Addiction Medicine (5th ed.) (pp. 513–23). New York, NY: Wolters Kluwer Health.