Mayo Clinic Health Library

Prescription drug abuse

Updated: 10-11-2012

Definition

Prescription drug abuse is the use of a prescription medication in a way not intended by the prescribing doctor, such as for the feelings you get from the drug. Prescription drug abuse or problematic use includes everything from taking a friend's prescription painkiller for your backache to snorting or injecting ground-up pills to get high. Drug abuse may become ongoing and compulsive, despite the negative consequences.

An increasing problem, prescription drug abuse can affect all age groups, but it's more common in young people. The prescription drugs most often abused include painkillers, sedatives, anti-anxiety medications and stimulants.

Early identification of prescription drug abuse and early intervention may prevent the problem from turning into an addiction.

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Symptoms

Signs and symptoms of prescription drug abuse depend on the particular drug. Because of their mind-altering properties, the most commonly abused prescription drugs are:

  • Opioids, such as oxycodone (Oxycontin) and those containing hydrocodone (Vicodin), used to treat pain
  • Anti-anxiety medications and sedatives, such as alprazolam (Xanax) and diazepam (Valium), and hypnotics, such as zolpidem (Ambien), used to treat anxiety and sleep disorders
  • Stimulants, such as methylphenidate (Ritalin), used to treat ADHD and certain sleep disorders

Signs and symptoms of prescription drug abuse

Opioid painkillersSedatives and anti-anxiety medicationsStimulants
  • Constipation
  • Depression
  • Low blood pressure
  • Decreased breathing rate
  • Confusion
  • Sweating
  • Poor coordination
  • Drowsiness
  • Confusion
  • Unsteady walking
  • Poor judgment
  • Involuntary and rapid movement of the eyeball
  • Dizziness
  • Weight loss
  • Agitation
  • Irritability
  • Insomnia
  • High blood pressure
  • Irregular heartbeat
  • Restlessness
  • Impulsive behavior

Other signs include:

  • Stealing, forging or selling prescriptions
  • Taking higher doses than prescribed
  • Excessive mood swings or hostility
  • Increase or decrease in sleep
  • Poor decision making
  • Appearing to be high, unusually energetic or revved up, or sedated
  • Continually "losing" prescriptions, so more prescriptions must be written
  • Seeking prescriptions from more than one doctor

When to see a doctor
Talk to your doctor if you think you may have a problem with prescription drug use. You may feel embarrassed to talk to your doctor about it — but remember that medical professionals are trained to help you, not judge you. Identifying prescription drug abuse as soon as possible is important. It's easier to tackle the problem early before it becomes an addiction and leads to more serious problems.

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Causes

Teens and adults abuse prescription drugs for a number of reasons. Some of these include:

  • To feel good or get high
  • To relax or relieve tension
  • To reduce appetite or increase alertness
  • To experiment with the mental effects of the substance
  • To maintain an addiction and prevent withdrawal
  • To be accepted by peers (peer pressure) or to be social
  • To try to improve concentration and academic or work performance
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Risk factors

Many people fear that they may become addicted to medications prescribed for legitimate medical conditions, such as painkillers prescribed after surgery. However, people who take potentially addictive drugs as prescribed rarely abuse them or become addicted.

Risk factors for prescription drug abuse include:

  • Past or present addictions to other substances, including alcohol
  • Younger age, specifically the teens or early 20s
  • Certain pre-existing psychiatric conditions
  • Exposure to peer pressure or a social environment where there's drug use
  • Easier access to prescription drugs, such as working in a health care setting
  • Lack of knowledge about prescription drugs

Older adults and prescription drug abuse
Prescription drug abuse in older adults is a growing problem. Having multiple health problems and taking multiple drugs can put seniors at risk of misusing drugs or becoming addicted, especially when they combine drugs with alcohol.

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Complications

Abusing prescription drugs can cause a number of problems. Prescription drugs can be especially dangerous when taken in high doses, when combined with other prescription medications or certain over-the-counter medications, or when taken with alcohol or illegal drugs.

Medical consequences
Examples of serious consequences of prescription drug abuse include the following.

  • Opioids can cause an increased risk of choking, low blood pressure, a slowed breathing rate and potential for breathing to stop, or a coma.
  • Sedatives and anti-anxiety medications (anxiolytics) can cause memory problems, low blood pressure and slowed breathing. Overdose can cause coma or death. Abruptly stopping the medication may be associated with withdrawal symptoms that can include hyperactivity of the nervous system and seizures.
  • Stimulants can cause dangerously high body temperature, heart problems, high blood pressure, seizures or tremors, hallucinations, aggressiveness, and paranoia.

Addiction
Because commonly abused prescription drugs activate the brain's reward center, it's possible to become addicted to them. People who are addicted continue to use a drug even when that drug makes their lives worse — just like people addicted to nicotine continue smoking cigarettes even when it harms their health and they want to quit.

Other consequences
Other potential consequences include engaging in risky behaviors because of poor judgment, using illegal drugs, being involved in crime, motor vehicle accidents, decreased academic or work performance, and troubled relationships.

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Preparing for your appointment

Your primary care doctor may be able to help you overcome a prescription drug abuse problem. However, if you have an addiction, your doctor may refer you to an addiction specialist or to a facility that specializes in helping people withdraw from drugs.

What you can do
To prepare for your appointment, make lists of:

  • All the medications you're taking, including the dose and how often you take each one, as well as over-the-counter medications, herbs and supplements
  • Any symptoms you may be experiencing
  • Key personal information, including any major stresses or recent life changes
  • Questions to ask your doctor

Questions to ask your doctor may include:

  • What are my treatment options?
  • How long does it take for treatment to work?
  • Should I see a specialist?
  • How can we manage my other health conditions during treatment?
  • Do you have any brochures or other printed material I could have? What websites do you recommend?

What to expect from your doctor
Your doctor will perform a physical exam and may ask these questions:

  • How long have you had this problem?
  • What, if anything, prompted it?
  • How severe are your symptoms?
  • Do you have a past history of drug abuse or addiction?
  • Has anyone in your family had a history of drug abuse or addiction?
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Tests and diagnosis

Doctors generally base a diagnosis of prescription drug abuse on medical history and answers to other questions. In some cases, certain signs and symptoms also provide clues.

Blood or urine tests can detect many types of drugs. These tests can also help track the progress of a person who's getting treatment.

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Treatments and drugs

Treatment options for prescription drug abuse vary, but counseling, also called talk therapy or psychotherapy, is typically a key part of treatment.

Counseling
Counseling — whether it's individual, group or family counseling — can help determine what factors may have led to the prescription drug abuse, such as an underlying mental health problem or relationship problems. Counseling can also help you learn the skills needed to resist cravings, avoid abuse of drugs and help prevent recurrence of prescription drug problems.

Through counseling, you can learn strategies for developing positive relationships and identify ways to become involved in healthy activities that aren't related to drugs.

Medications
Depending on the drug and usage, detoxification may be needed as part of treatment. Withdrawal can be dangerous and should be done under a doctor's care.

  • Opioid withdrawal. Buprenorphine, buprenorphine with naloxone (Suboxone) or methadone may be used by doctors under specific and regulated conditions to ease the symptoms of withdrawal from opioid painkillers. Other drugs — including clonidine (Catapres), a medication primarily used for high blood pressure — can be used to help manage opioid withdrawal symptoms.
  • Withdrawal from sedatives or anti-anxiety medications (anxiolytics). If you've used prescription sedatives or anti-anxiety medications for a long time, it may take weeks or even months to slowly taper off them. Because of lengthy withdrawal syndrome symptoms, it can take that long for your body to adjust to low doses of the medication and then get used to taking no medication at all. You may need other types of medications to stabilize your mood or help with anxiety, and you'll need to work closely with your doctor.
  • Stimulant withdrawal. There are no approved drugs used for treating stimulant withdrawal. Treatment typically focuses on tapering off the medication and relieving withdrawal symptoms — such as sleep, appetite and mood disturbances.
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Coping and support

Overcoming prescription drug abuse can be challenging and stressful, often requiring the support of family, friends or organizations. Here's where to look for help:

  • Trusted family members or friends
  • Twelve-step program, such as Alcoholics Anonymous or Narcotics Anonymous
  • Your church or religious organization, which may have a Celebrate Recovery program
  • School counselor or nurse
  • Support groups, either in person or on a trustworthy website
  • Your employee assistance program, which may offer counseling services for substance abuse problems

Ask family members and friends for understanding
You may be embarrassed to ask for help, or may be afraid that your family members will be angry or judgmental. You may worry that your friends will distance themselves from you. But in the long run, the people who truly care about you will respect your honesty and your decision to ask for help.

Helping a loved one
It can be difficult to approach your loved one about prescription drug abuse. Denial and anger are common reactions, and you may be concerned about creating conflict or damaging your relationship with that person.

Be understanding and patient. Let the person know that you care about his or her well-being. Encourage your loved one to be honest about drug use and to accept help if needed. A person is more likely to respond to feedback from someone they trust. If the problem continues, further intervention may be necessary.

Intervention
It can be challenging to help a loved one struggling with drug problems or other destructive behavior. People who struggle with addictive behaviors are often in denial about their situation or are unwilling to seek treatment, and they don't recognize the negative effects their behavior has on themselves and others. An intervention can motivate someone to seek help for addictive behaviors.

An intervention is a carefully planned process involving family and friends and others who care about a person struggling with addiction. Consulting an intervention professional (interventionist), an addiction specialist, psychologist or mental health counselor can help you organize an effective intervention. This is an opportunity to confront the person about the consequences of addiction and ask him or her to accept treatment. Think of an intervention as giving your loved one a clear opportunity to make changes before things get really bad.

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Prevention

Just being prescribed a medication doesn't put you at risk of abusing it or becoming addicted. Prescription drug abuse is rare in people who need painkillers, sedatives or stimulants to treat a medical condition. However, if you're taking a commonly abused drug, here are ways to decrease your risk:

  • Make sure you're getting the right medication. When you see your doctor, make sure the doctor clearly understands your condition and the signs and symptoms it's causing. Tell your doctor about all your prescriptions, as well as over-the-counter medications, herbs and supplements, and alcohol and drug use. Ask your doctor whether there's an extended-release version of a medication or an alternative medication with ingredients that have less potential for addiction.
  • Check in with your doctor. Talk with your doctor on a regular basis to make sure that the medication you're taking is working and you're taking the right dose.
  • Follow directions for use carefully. Use your medication the way it was prescribed. Don't stop or change the dose of a medication on your own if it doesn't seem to be working without talking to your doctor. For example, if you're taking a pain medication that isn't adequately controlling your pain, don't take more.
  • Know what your medication does. Ask your doctor or pharmacist about the effects of your medication so you know what to expect.
  • Never use another person's prescription. Everyone's different. Even if you have a similar medical condition, it may not be the right medication or dose for you.
  • Don't order prescriptions online unless they're from a trustworthy pharmacy. Some websites sell counterfeit prescription and nonprescription drugs that could be dangerous.

Preventing prescription drug abuse in teens
Young people are at especially high risk of prescription drug abuse. Follow these steps to help prevent your teen from abusing prescription medications.

  • Discuss the dangers with your teen. Emphasize to your teen that just because drugs are prescribed by a doctor doesn't make them safe — especially if they were prescribed to someone else or if your child is already taking other prescription medications.
  • Set rules about your child's prescription medications. Let your teen know that it's not OK to share medications with others — or to take medications prescribed for others. Emphasize the importance of taking the prescribed dose of medication and talking with the doctor before making changes.
  • Keep your prescription drugs safe. Keep track of quantities and keep them in a locked medicine cabinet.
  • Make sure your child isn't ordering drugs online. Some websites sell counterfeit and dangerous drugs that may not require a prescription.
  • Properly dispose of medications. Check the label or patient information guide for disposal instructions — don't flush the drugs down the toilet unless it says to do so or your pharmacist advises you to do so. You can ask your pharmacist or local trash and recycling service if there's a medicine take-back program that accepts unused medications. If not, put unused drugs in your household trash. But before throwing them out, remove them from the container and mix them in a sealed plastic bag with used coffee grounds, used kitty litter or another undesirable substance. Before tossing the container, remove the label and cross out identifying information.
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