Prescription Drug Misuse

• Opioids: usually prescribed to treat pain
• Central Nervous System (CNS) Depressants: used to treat anxiety (includes tranquilizers, sedatives, and hypnotics)
• Stimulants: most often prescribed to treat attention-deficit hyperactivity disorder (ADHD)

Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and "high" - which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin is one of the world's most dangerous opioids, and is never used as a medicine in the United States.

What are common prescription opioids?

• hydrocodone (Vicodin^®) oxycodone (OxyContin^®, Percocet^®)
• oxymorphone (Opana^®)
• morphine (Kadian^®, Avinza^®)
• codeine
• fentanyl

What are some possible effects of prescription opioids on the brain and body?

In the short term, opioids can relieve pain and make people feel relaxed and happy. However, opioids can also have harmful effects, including:

• drowsiness
• confusion
• nausea
• constipation
• euphoria
• slowed breathing

Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

What are the other health effects of opioid medications?

Older adults are at higher risk of accidental misuse or abuse because they typically have multiple prescriptions and chronic diseases, increasing the risk of drug-drug and drug-disease interactions, as well as a slowed metabolism that affects the breakdown of drugs. Sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV and from unprotected sex.

Can a person overdose on prescription opioids?

Yes, a person can overdose on prescription opioids. An opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death. When people overdose on an opioid medication, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage, or death.

How can an opioid overdose be treated?

If you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone. Naloxone is a medicine that can treat an opioid overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs.

Can use of prescription opioids lead to addiction?

Yes, repeated misuse of prescription opioids can lead to a substance use disorder (SUD), a medical illness which ranges from mild to severe and from temporary to chronic. Addiction is the most severe form of an SUD. An SUD develops when continued misuse of the drug changes the brain and causes health problems and failure to meet responsibilities at work, school, or home.

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include:

• muscle and bone pain
• sleep problems
• diarrhea and vomiting
• cold flashes with goose bumps
• uncontrollable leg movements
• severe cravings

These symptoms can be extremely uncomfortable and are the reason many people find it so difficult to stop using opioids. 

Central Nervous System (CNS) depressants are medicines that include sedatives, tranquilizers, and hypnotics. These drugs can slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders.

CNS depressants cause drowsiness; sedatives are often prescribed to treat sleep disorders like insomnia and hypnotics can induce sleep, whereas tranquilizers are prescribed to treat anxiety or to relieve muscle spasms.

Examples of CNS Depressants

• diazepam (Valium^®)
• clonazepam (Klonopin^®)
• alprazolam (Xanax^®)
• triazolam (Halcion^®)
• estazolam (Prosom^®)
• zolpidem (Ambien^®)
• eszopiclone (Lunesta^®)
• zaleplon (Sonata^®)

How do CNS depressants affect the brain?

Most CNS depressants act on the brain by increasing activity of gamma-aminobutyric acid (GABA), a chemical that inhibits brain activity. This action causes the drowsy and calming effects that make the medicine effective for anxiety and sleep disorders. People who start taking CNS depressants usually feel sleepy and uncoordinated for the first few days until the body adjusts to these side effects. Other effects from use and misuse can include:

• slurred speech
• poor concentration
• confusion
• headache
• light-headedness
• dizziness
• dry mouth
• problems with movement and memory
• lowered blood pressure
• slowed breathing

If a person takes CNS depressants long term, he or she might need larger doses to achieve therapeutic effects. Continued use can also lead to dependence and withdrawal when use is abruptly reduced or stopped. Suddenly stopping can also lead to harmful consequences like seizures.

Can a person overdose on CNS depressants?

Yes, a person can overdose on CNS depressants. An overdose occurs when the person uses enough of a drug to produce life-threatening symptoms or death.

When people overdose on a CNS depressant, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage.

How can a CNS depressant overdose be treated?

The most important step to take is to call 911 so a person who has overdosed can receive immediate medical attention. Flumazenil (Romazicon^®) is a medication that medical personnel can use to treat benzodiazepine overdose and has also been shown effective in treating overdose from sleep medicines. The drug might not completely reverse slowed breathing and can lead to seizures in some patients who are taking certain antidepressants. Flumazenil is short acting, and the patient may need more of it every 20 minutes until he or she recovers. For barbiturates and nonbenzodiazepines, body temperature, pulse, breathing, and blood pressure should be monitored while waiting for the drug to be eliminated.

Can prescription CNS depressant use lead to addiction and substance use disorder?

Yes, use or misuse of prescription CNS depressants can lead to problem use, known as a substance use disorder (SUD), which takes the form of addiction in severe cases. Long-term use of prescription CNS depressants, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. A SUD develops when continued use of the drug leads to negative consequences such as health problems or failure to meet responsibilities at work, school, or home, but despite all that the drug use continues.

Those who have become addicted to a prescription CNS depressant and stop using the drug abruptly may experience a withdrawal. Withdrawal symptoms-which can begin as early as a few hours after the drug was last taken—include:

• seizures
• shakiness
• anxiety
• agitation
• insomnia
• overactive reflexes
• increased heart rate, blood pressure, and temperature with sweating
• hallucinations
• severe cravings

People addicted to prescription CNS depressants should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be severe and—in the case of certain medications-potentially life—threatening.

Prescription stimulants are medicines generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy—uncontrollable episodes of deep sleep. They increase alertness, attention, and energy.

What are common prescription stimulants?

• dextroamphetamine (Dexedrine^®)
• dextroamphetamine/amphetamine combination product (Adderall^®)
• methylphenidate (Ritalin^®, Concerta^®).

How do prescription stimulants affect the brain and body?

Prescription stimulants increase the activity of the brain chemicals dopamine and norepinephrine. Dopamine is involved in the reinforcement of rewarding behaviors. Norepinephrine affects blood vessels, blood pressure and heart rate, blood sugar, and breathing.

Short-Term Effects

People who use prescription stimulants report feeling a "rush" (euphoria) along with the following:

• increased blood pressure and heart rate
• increased breathing
• decreased blood flow
• increased blood sugar
• opened-up breathing passages

At high doses, prescription stimulants can lead to a dangerously high body temperature, an irregular heartbeat, heart failure, and seizures.

What are the other health effects of prescription stimulants?

Repeated misuse of prescription stimulants, even within a short period, can cause psychosis, anger, or paranoia. If the drug is injected, it is important to note that sharing drug injection equipment and having impaired judgment from drug misuse can increase the risk of contracting infectious diseases such as HIV and hepatitis.

Can a person overdose on prescription stimulants?

Yes, a person can overdose on prescription stimulants. An overdose occurs when the person uses enough of the drug to produce a life-threatening reaction or death.

When people overdose on a prescription stimulant, they most commonly experience several different symptoms, including restlessness, tremors, overactive reflexes, rapid breathing, confusion, aggression, hallucinations, panic states, abnormally increased fever, muscle pains and weakness.

They also may have heart problems, including an irregular heartbeat leading to a heart attack, nerve problems that can lead to a seizure, abnormally high or low blood pressure, and circulation failure. Stomach issues may include nausea, vomiting, diarrhea, and abdominal cramps. In addition, an overdose can result in convulsions, coma, and fatal poisoning.

How can a prescription stimulant overdose be treated?

Because prescription stimulant overdose often leads to a heart attack or seizure, the most important step to take is to call 911 so a person who has overdosed can receive immediate medical attention. First responders and emergency room doctors try to treat the overdose with the intent of restoring blood flow to the heart and stopping the seizure with care or with medications if necessary.

Can prescription stimulant use lead to substance use disorder and addiction?

Yes, misuse of prescription stimulants can lead to a substance use disorder (SUD), which takes the form of addiction in severe cases. Long-term use of stimulants, even as prescribed by a doctor, can cause a person to develop a tolerance, which means that he or she needs higher and/or more frequent doses of the drug to get the desired effects. An SUD develops when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home. Concerns about use should be discussed with a health care provider.

If a person develops an SUD and stops use of the prescription stimulant, he or she can experience withdrawal. Withdrawal symptoms can include:

• fatigue
• depression
• sleep problems