A prescription drug is a pharmaceutical medication that can only legally be obtained and dispensed with a medical prescription. A prescription, often abbreviated Rx, is a health care program written by a physician or other qualified professional. It authorizes the use of a prescription drug and instructs the pharmacist how to dispense it and the patient how to use it. Prescription drugs are generally more potent than over-the-counter medications, which may have more severe side effects if misused.
The Substance Abuse and Mental Health Services Administration calls prescription drug abuse the fastest-growing drug problem in the United States.
Across the United States, 40 people die every day from narcotic prescription overdoses, the most commonly abused being opioid painkillers and benzodiazepines, a sedative medication commonly used to treat anxiety. These drugs are not only extremely addictive but are likewise deadly when misused. The overprescribing of opioid medications like Oxycontin was a major catalyst for today's drug epidemic in the United States.
The History of Prescription Drugs
Each prescription drug has its own history and its unique timeline. But prescription drugs as a whole share the same characteristic of being restricted by law, so we look to the inception of the prescription to examine how "prescription drugs" came to be.
As far as we can tell, humans have prescribed drugs since the ancient Mesopotamian times, around 2100 BC.
This is when the first records of prescriptions appear in history as clay tablet etchings and have been witnessed in various forms and cultures ever since. But these initial prescriptions were more akin to recipes, giving instructions for how to prepare and consume various herbs and medicines rather than license to possess them.
The symbol for prescription Rx has questionable origins. Rx is Latin for "recipe." But many believe that it has deeper roots, evolving from the Eye of Horus, an ancient Egyptian symbol of healing. But what is certain is that prescriptions have existed for thousands of years. Several events culminated in the prescription's modern usage, particularly its authority to dispense otherwise illegal substances. The Pure Food and Drug Act of 1906 was the first governmental attempt to control the use of addictive substances by requiring them to be listed as ingredients on the product. This was the inception of the Food and Drug Administration, as it was determined that some branch of government must oversee such laws. But the gaping holes that this act left unaddressed became apparent with time, and it was eventually replaced by the Federal Food, Drug, and Cosmetic Act of 1938. This law allowed the now-formed FDA to review the safety of drugs, food items, cosmetics, and medical devices. This revision came as a response to more than 100 patients dying from an improperly manufactured medication and revised multiple times since.
The last factor to influence the development of the current prescription was the Controlled Drug Act of 1970, a policy under which the manufacture, importation, possession, distribution, and use of certain substances are regulated. This came about to combine all existing federal laws concerning the nation's narcotics problem into a single statute and was implemented under Nixon as part of his "War on Drugs." It classifies drugs by their abuse potential, along with accepted medical uses, and controls them per these classifications, or "Schedules." Prescribing laws are based upon the scheduling of drugs per the Controlled Drug Act, and it has remained the prevailing system of controlling drugs in the United States since its inception.
Now, the term "prescription drug" refers to any medication scheduled in a way that requires a prescription to obtain it. Other drugs are either wholly illegal or have no restrictions whatsoever. The latter is known as an over-the-counter medication or substance. Things like Ibuprofen and Tums are examples of over-the-counter drugs.
It is crucial to keep in mind that the evolution described above was a concerted effort over time to prevent drug abuse and addiction. Yet, in 2018, the DEA reported drug overdose deaths as the leading cause of injury-related death in the United States, outnumbering deaths due to firearms, motor vehicle accidents, suicide, and homicide for the first time in history.
What do Prescription Drugs Look Like?
There are a vast number of prescription drugs. The most commonly abused ones are hydrocodone, oxycodone, codeine, Xanax, Ativan, Valium, Ambien, Adderall, Ritalin, and Vyvanse.
Here are a few examples of prescription drugs.
80 MG OXYCODONE
30 MG CODEINE
Effects of Prescription Drugs
Since there are so many, we will only cover the three main categories of abused prescription drugs.
Opioids are one of the most commonly abused substances in the United States, so it should come as no surprise that prescription opioids are in high demand. As one of the only effective modern solutions to pain, opioids have some severe side effects and can easily cause addiction. They belong to a group of drugs known as central nervous system depressants, including any medication that slows down brain and body functions. Opioids work to block pain signals at nerve receptor sites by binding to opioids receptors throughout the system. This also produces intense euphoria and sedation, sensations which can be pleasurable. This "reward" can lead to tolerance, dependence, and addiction.
Opioids cause virtually all body systems to slow down but have a profound effect on the respiratory system. They slow breathing and other involuntary functions like heart rate, blood pressure, and digestion. When too much of the drug is ingested, these effects can be so dramatic that it causes the person to stop breathing and overdose.
Benzos are drugs that are commonly prescribed for anxiety and sleep disorders. They cause the activity of the brain to slow down, which has a calming and sedating effect. They can also produce euphoria and a strong sense of well-being, leading the user to take them again and again to recreate these effects. The drugs' effects diminish rapidly, requiring larger doses over time to produce similar sedation levels.
Thus, people can quickly become dependent on benzos and experience rebound symptoms when they stop taking the drug. Rebound symptoms are where the issue that was being treated returns but is now worse.
If the person was struggling with insomnia and took a drug for a week to help, they may now have even worse insomnia and return to the drug for relief. Benzodiazepines are notorious for this kind of insidious addiction, as well as some other peculiar phenomena. They can easily cause a blackout similar to when consuming large quantities of alcohol; however, the person may be more coordinated and active. This can lead them to do strange things like driving while "asleep" or engaging in acts of theft, which they have no recollection of.
Stimulants are any drug that causes an increase in the activity of the central nervous system. When discussing prescription stimulants, most of these drugs are used by psychiatrists and physicians to alter children's and young adults' behavior. But these drugs can be hazardous and are commonly misused. Most prescription stimulants are variations of amphetamine. Common prescription stimulants include Adderall, Ritalin, and Vyvance. They all cause the brain and body's activity to increase, resulting in alertness, increased energy, and euphoria. They can also cause the heart rate and blood pressure to rise dramatically and can lead to overheating, seizures, and heart attacks when abused. Stimulants reduce appetite and produce insomnia. They can also be called "study drugs" because people often use them in high school and college to achieve enhanced focus and stay up for extended periods studying before exams. They are also abused recreationally at parties and raves due to the enhanced mood and energy they create, particularly when combined with other substances. Athletes may also misuse prescription stimulants for performance-enhancing effects and weight loss.
Prescription Drug Overdose
Every prescription drug can cause an overdose if enough is consumed. For some drugs, this may be a little as one pill. Other drugs may require ingesting the whole bottle or more. But when we're talking about commonly abused prescription drugs, overdose can occur relatively quickly. Overdose deaths involving prescription opioids were more than four times higher in 2018 than in 1999.
Opioids are one of the most commonly prescribed drugs in the United States. When too much of the drug is consumed, the person quickly becomes sedated and loses consciousness. This is not uncommon when abusing opioids; so many people have no idea that anything is wrong. After losing consciousness, they will begin to struggle to breathe. As their body slows down, their skin usually turns bluish and pale, and they will soon suffocate. Nearly 70% of the 67,367 overdose deaths in 2018 involved an opioid.
Thankfully, naloxone exists as a lifesaving intervention. The drug can be administered as an injection or a nasal spray to rapidly revive the person and rapidly reverse the effects of opioids. Since being developed, naloxone has saved many lives and continues to be more accessible. But even if administered and effective, one should still call 911. Sometimes so much of the opioid has been consumed that multiple doses of naloxone are required. There may also be severe complications that occur even if the person is alive.
Benzodiazepines are another prescription drug that kills. Overdose deaths involving benzodiazepines increased from 1,135 in 1999 to 8,791 in 2015. Because they are a central nervous system depressant, benzos can have overdose symptoms similar to opioids. These include slow and labored breathing, as well as sedation and unconsciousness. Since there is no drug readily available to reverse a benzodiazepine overdose, emergency medical personnel must be immediately contacted so they can treat the person.
Stimulant overdose is another tragedy that is on the rise in the United States. In 2005, 2.3 million teenagers (age 12-17) took a prescription stimulant. These drugs are often overlooked but can easily kill when misused. Because stimulants increase the central nervous system's activity, virtually every part of the body goes into overdrive when too much is taken. This includes increased brain and cardiac activity, which can cause heart attack and death. Stimulants can also lead to seizures or overheating, which can also cause death. Similar to benzodiazepines, stimulant overdose must be treated by a medical professional immediately.
Prescription Drug Addiction
Misuse of prescription drugs is highest among young adults ages 18 to 25, with 14.4 percent reporting nonmedical use in the past year.
Increases in prescription drug abuse over the last 15 years are reflected in increased emergency room visits, overdose deaths associated with prescription drugs, and treatment admissions for prescription drug addiction.
Addiction begins as it does with any other drug. The person first is struggling with some issue, such as pain. This could be physical pain or even mental and emotional anguish.
For this purpose, let's examine how easily someone can become addicted to opioid painkillers.
If someone were struggling with back pain and their physician prescribed them Vicodin, this may seem like a good deal at first. Not only does their back not hurt when they take the pill, but they discover that it improves their mood, which has been depressed due to the pain. They feel great, and perhaps their spouse notices and comments that it's so lovely to be around them lately. They are much more productive at work and feel like things are turning around. After a few days, one pill occasionally won't handle the pain completely, so they take two.
The prescription only says to take one every four hours as needed, but they figure that they'll go to bed early, so they would've taken another one anyway. Two pills work great, so the next day, when their backs are killing them in the morning, they hesitate but take two pills again. Soon, the prescription is gone, and the pain is back. They fight with their spouse and struggle at work. They return to their doctor but cannot say that all the pills are gone well before they should be. So, they explain that they didn't help much, only giving slight relief.
This is the crucial juncture where it becomes the responsibility of the medical community to discourage addiction. But sadly, people lie, and not all physicians err on the side of caution. In this example, if the physician increases their prescription to something more powerful, this person will likely become addicted to opioids. If they try to stop taking them or run out, they will begin to experience withdrawal symptoms, a consequence of physical dependence. In the case of opioids, these are wretched and painful symptoms that include increased pain, thus perpetuating addiction.
In the case of other prescription drugs like benzodiazepines and barbiturates, withdrawal itself can be deadly. They create such strong chemical dependence that without the drug, seizure, and death can occur. Just because a medication is prescribed does not mean it is safe. Another way that this could occur would be a person who struggles with anxiety. This could be a significant factor in their lives, limiting them, preventing them from feeling comfortable, having a social circle, or even leaving their house. Perhaps after years, they begin seeing a new doctor who prescribes them Valium, a benzodiazepine tranquilizer to treat their anxiety. For the person struggling, it is a godsend. They take their first pill and within an hour feel like a completely different person. They can relax, want to leave the house, and have an urge to be social. They have the best day of their life.
When the Valium runs out, and the doctor won't give them a refill because it's addictive, they call a friend they remember offered them one a few months ago. Then, they rejected the idea of taking someone else's prescription.
But now, they are willing to buy them illegally. As you can see, this is a slippery slope. Addiction to prescription drugs can be insidious. It often develops under the false sense that it is safe because it is from a doctor. The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors but likely include ease of access as a primary factor. The number of prescriptions for some of these medications has increased dramatically since the early 1990s, particularly opioid and benzodiazepine drugs.
How to help a loved one addicted to Prescription Drugs
If someone you know or love is addicted to prescription drugs, it's a very serious matter. Often, people can lose perspective as they grow accustomed to the obvious problem, but it really is a matter of life and death. The worst thing that you can do is wait.
It has become a cliché in the treatment industry that you cannot help someone until they are ready to help themselves. This is perhaps the biggest lie ever perpetrated on patients and families of those who struggle with addiction and is completely untrue.
This point can easily be disproven any time you see a child being picked up off the ground after falling or someone who hires a personal trainer. More extreme examples include unwilling students who are finally gotten through to by a caring teacher, etc. How these sayings originated is quite explainable, but how they became "fact" preached to people by professionals in the treatment industry is astounding.
When people lose a loved one to addiction, they always feel guilty. They blame themselves for missing the signs or not doing something about it before it was too late. Now, in many cases, this feeling isn't misplaced. They ignored signs of drug use and didn't act when they could have to save a life. It's the blunt truth.
But there is no point in torturing a grieving person by pointing these facts put, so when they begin to point it out and blame themselves, their friends and loves ones say "No." They will tell them that it was not their fault and that they did everything they could. There was no way to know. It wouldn't have mattered because they weren't ready etc., etc. These all serve to excuse the responsibility that the person feels towards the tragedy, and it allows them to accept it and move on, in theory.
Unfortunately, though the intention is good, people who further this kind of thinking are furthering a falsehood, which is that you cannot help someone who doesn't want it. Well, interventions work every day and save lives. They work because when a person is on drugs, they are not thinking clearly. You're not dealing with the person really, it's a chemical version of themselves. So, if you can get them to dry out for long enough to think clearly, they may just decide that they want to be clean and like it better.
This does not mean that intervention is always successful. But it is certainly better than doing nothing. Doing nothing while a loved one uses prescription drugs is always the wrong thing to do. Without help, they can easily die and will likely move on to illicit drugs and crime.
Prescription Drug Treatment
Due to the wide variety of prescription drugs abused, no one set treatment for prescription drug addiction exists. But thankfully, this means that many substance abuse treatment options are available to draw upon when treating prescription drug addiction.
There are two primary forms of treatment for any addiction, inpatient and outpatient. Inpatient drug treatment is the most intensive and consists of the person living at the facility round the clock until their treatment is complete. This is usually for four weeks but may be even longer in the case of severe addiction or relapse proneness. Outpatient treatment is a less restrictive form that allows the person to live at home and travel to the facility for treatment sessions. These can be up to several hours long and be as frequent as daily at first. As the person progresses, their schedule may relax. While this may seem initially the easy choice, outpatient treatment is less successful at treating severe addictions due to its lack of structure and restrictions in early sobriety.
Within these two forms of treatment, patients may select programs that fit their individual needs or preferences. This could mean attending a holistic program where patients are not given replacement narcotics or drugs to mitigate cravings and withdrawal symptoms. For many, this is the only way to achieve long-term recovery and decide based upon their desired quality of life. Addiction to opioids can be so powerful that some people cannot overcome withdrawing from their drug of choice and enduring months or even years of disturbances in their sleep, mood, and many other life areas.
Instead of total abstinence, they utilize Medication Assisted Treatment. MAT uses opioid medications like Suboxone and Methadone to prevent withdrawal and maintain opioids in the person's system. This is often continued for the person's life, allowing them to leave behind some of the behaviors that come with addiction, like committing crimes.
They can resume a somewhat normal life but are physically dependent on opioids. These are now obtained via prescription, and so they are less likely to engage in harmful behaviors or overdose.
Regardless of which form of treatment you choose, doing something about addiction is always better than doing nothing.
Prescription Drug Statistics
- Among youth ages 12 to 17, 4.9 percent reported past-year nonmedical use of prescription medications.
- After alcohol, marijuana, and tobacco, prescription drugs (taken nonmedically) are among the most commonly used drugs by 12th graders.
- In the case of prescription opioids, receiving a legitimate prescription for these drugs during adolescence is also associated with a greater risk of future opioid misuse, particularly in young adults who have little to no history of drug use.
- More than 80 percent of older patients (ages 57 to 85 years) use at least one prescription medication daily, with more than 50 percent taking more than five medications or supplements daily.
- More than 5,700 youth in 2014 reported using prescription pain relievers without a doctor's guidance for the first time.
In 2015, an estimated 119.0 million Americans aged 12 or older used prescription psychotherapeutic drugs in the past year, representing 44.5 percent of the population. About 97.5 million people used pain relievers (36.4 percent), 39.3 million used tranquilizers (14.7 percent), 17.2 million used stimulants (6.4 percent), and 18.6 million used sedatives (6.9 percent).
In 2015, 18.9 million people aged 12 or older (7.1 percent) misused prescription psychotherapeutic drugs in the past year. This number included 12.5 million people who misused pain relievers in the past year (4.7 percent), 6.1 million who misused tranquilizers (2.3 percent), 5.3 million who misused stimulants (2.0 percent), and 1.5 million who misused sedatives (0.6 percent).
In 2015, 2.1 million people aged 12 or older were recent initiates for pain reliever misuse (misused for the first time in the past year). That same year, 1.4 million were recent initiates for tranquilizer misuse, 1.3 million were recent initiates for stimulant misuse, and 425,000 were recent initiates for sedative misuse. On average, recent initiates aged 12 to 49 initiated the abuse of prescription drugs in their early to late 20s.
About 1.0 percent of people aged 12 or older (2.7 million) had a prescription drug use disorder in the past year, including 2.0 million people with a pain reliever use disorder, 688,000 with a tranquilizer use disorder, 426,000 with a stimulant use disorder, and 154,000 with a sedative use disorder.
In 2015, as part of their most recent substance use treatment, 822,000 people received treatment for pain reliever misuse. That same year, 293,000 people received treatment for tranquilizer misuse, 139,000 received treatment for stimulant misuse, and 116,000 received sedative misuse treatment.
Among people aged 12 or older who misused prescription pain relievers in the past year, the most commonly reported reason for their last misuse was to relieve physical pain (62.6 percent). Among past year misusers of tranquilizers, the most frequently reported reasons were to relax or relieve tension (44.9 percent) or to help with sleep (20.4 percent). Commonly reported reasons for misuse among stimulant misusers were to help be alert or stay awake, help concentrate, or help study (26.8, 26.5, and 22.5 percent, respectively). Among past year sedative misusers, the most common reason was to help with sleep (71.7 percent).
Among people aged 12 or older who misused pain relievers in the past year, the most common source for the last pain reliever that was misused was from a friend or relative (53.7 percent), and about one third misused a prescription from one doctor. About 1 in 20 people who misused pain relievers bought the last pain reliever they misused from a drug dealer or stranger.
Common Terminology for Prescription Drugs
|Prescription Drug||a pharmaceutical drug that legally requires a medical prescription to be dispensed.|
|Prescription||A prescription, often abbreviated ℞ or Rx, is a health care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient. The term often refers to a health care provider's written authorization for a patient to purchase a prescription drug from a pharmacist.|
|Over-the-Counter Drug||Any drug or medication which can be legally obtained without a prescription.|
|Stimulant||Any drug which increased the activity of the central nervous system.|
|Central Nervous System||It controls most functions of the body and mind. It consists of two parts: the brain and the spinal cord. The brain is the center of our thoughts, the interpreter of our external environment, and the origin of control over body movement.|
|Depressant||Any drug which decreases the activity of the central nervous system.|
|Opioid||Natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain and reduce the intensity of pain signals and feelings of pain. This class of drugs includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others.|
|Benzodiazepine||Sometimes called "benzos," these are sedatives often used to treat anxiety, insomnia, and other conditions. Combining benzodiazepines with opioids increases a person's risk of overdose and death.|
|Drug misuse||The use of illegal drugs and/or prescription drugs in a manner other than as directed by a doctor, such as use in greater amounts, more often, or longer than told to take a drug or using someone else's prescription.|
|Illicit drugs||A variety of drugs that are prohibited by law. These drugs can include amphetamine-type stimulants, marijuana/cannabis, cocaine, heroin, other opioids, and synthetic drugs, such as illicitly manufactured fentanyl (IMF) and ecstasy (MDMA).|