Pharmacological treatment of mental and physical illness reigns within the Western medical industry, increasing the rates of use and dependence on prescription medication.
With the rise in pharmaceutical treatment of illness comes the added problems of misuse, addiction, and adverse side effects possibly related to concurrent use of multiple medications.
In addition to prescription medication, increased availability and use of over-the-counter (OTC) medications allows consumers to purchase drugs without a prescription for minor ailments. Whatever the problem, there is likely a medication to alleviate the symptoms!
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Increased Use and Availability
Increased availability of prescription medication is likely related to the recent rise in misuse of prescription medication, particularly by adolescents and young adults. [1]
Media campaigns warn parents against becoming “accidental drug dealers”, as many types of prescription medications elicit effects similar to those of illegal drugs. [2]
Comparable physiological responses occur when taking either opioid pain medications or heroin, stimulant medications or amphetamines- the chemical structures of illegal drugs are only slightly different from those of prescription medications.
Prescription medications tend to be weaker in strength than drugs sold on the street; however, this can lead to overuse and abuse of prescription medication in search of a high. [3]
Misuse of Prescription Medication
The rise in non-medical use of prescription medication has lead researchers to examine possible motivations for taking medication that was prescribed to someone else.
While many individuals report using these medications for self-treatment of ailments including pain, insomnia, and anxiety, others indicate taking these drugs for recreational purposes as well as or instead of therapeutic reasons.
Pain medications, like Vicodin or Percocet tend to be most misused for recreational purposes, followed by stimulant medications like Ritalin and Adderall. [4]
In addition to misusing prescription medication, OTC drugs like acetaminophen, sleeping aids, or stimulant-containing cold medications may be used recreationally.
Stimulant medication is particularly dangerous; for example, it is known that pseudoephedrine (an ingredient in many OTC cold medications) can be used to make methamphetamine.
Dextromethorphan hydrobromide, a common ingredient in cough medications, is known to create dissociative states and hallucinations at high doses. Mixing OTC medications with prescription medication in search of a buzz can be extremely dangerous. [5, 6]
Drug Interactions
Taking medication prescribed for someone else can be particularly risky, as the user may be unaware of the effects of taking too much of the drug, or taking concurrent medications.
The false perception that prescription or over-the-counter medication is safer than illegal street drugs may lead to overuse or adverse side effects, particularly when taking multiple medications at the same time.
A physician’s supervision is key in avoiding these negative outcomes, which would likely be absent for an individual using medications for recreational purposes.
Physicians should be made aware of any other medications a person is using, including OTC drugs, as certain medications can either reduce the effectiveness of another drug, or cause unwanted side effects.
The effects of combined medications are referred to as interactions, and are divided into three categories: major, moderate, or minor. [5]
Major Interaction
A major interaction refers to serious adverse side effects, typically affecting the central and/or autonomic nervous systems, the neuromuscular system, the cardiorespiratory system, or the gastrointestinal system.
A major interaction may result in side effects such as:
- Irritability
- Hallucinations
- Altered mental state
- Hyperexcitability of limbs
- Muscle twitches
- Increased heart rate and blood pressure
- Difficulty breathing
- Sweating
- Nausea
- Vomiting
- Diarrhea
These types of reactions typically require medical attention to avoid detrimental outcomes like coma or death.
An example of a major interaction between prescription and OTC medications would be fluoxetine (Prozac) and cold medications containing pseudoephedrine and dextromethorphan (ex. Robitussin) – certain ingredients in the cold medication may heighten the uptake of serotonin (the key ingredient in most anti-depressants), leading to a serious condition known as serotonin syndrome. Serotonin syndrome requires immediate medical attention and treatment to avoid potential fatality. [5, 6]
Moderate Interaction
Drugs with moderate interactions are those that should be avoided or limited, and used in combination only under the supervision of trained medical staff.
While not as severe as major interactions, adverse side effects like increased heart rate and blood pressure are more likely when mixing certain medications like Vyvanse (a new amphetamine-based medication for ADHD) and cold medications. [7]
In addition to increased heart rate and blood pressure, combining multiple stimulant medications can cause jitteriness and irritability, sweating, loss of appetite, and insomnia.
If sleeping patterns are affected by stimulant use, the risk of taking sleep aid medications increases, leading to further negative outcomes such as dependence or withdrawal. [3]
Minor Interaction
Minor interactions may occur with many medications, but these are unlikely to cause side effects requiring medical attention. Typically, the patient is able to continue concurrent use of medications despite the risk of minor interaction; however, a physician should be notified before a change in the dosage of one or more of the medications being used. [8]
Substance Use Disorders and Misuse of Medication
In addition to dangerous physiological outcomes of misusing medications, the risk of developing an addiction to certain medications may be heightened for some individuals.
Co-occurring substance use disorders were more likely to be identified in those who misused prescription medications for recreational purposes; misuse of pain and stimulant medication was also related to higher rates of smoking, binge drinking, marijuana use, and use of illicit drugs like cocaine or heroin.
How often an individual misuses prescription medication is related to the likelihood of developing a dependence. [3]
Research currently suggests that regular use of prescription stimulant medications (like those prescribed for ADHD) do not increase the risk of developing future substance use disorders; however, prescription pain medications (typically opioid medications) have a reinforcing effect, greatly increasing the risk for dependence and withdrawal.
Much like with illegal drugs, frequent use of certain medications can lead to symptoms of substance use disorders, including tolerance, dependence, and withdrawal. [3]
Thus, prescription medication should only be used as directed by a physician, to reduce the risks of potentially fatal side effects or addiction.
References:
1. McCabe, S. E., Cranford, J. A., & West, B. T. (2008). Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: Results from two national surveys. Addictive Behaviors, 33: 1297-1305.
2. Holcombe Behavioural Health Systems (2016). Don’t be an accidental dealer-Lock your meds. Rx Safes: Drug Security and Adherence.http://www.rxdrugsafe.com/dont-be-an-accidental-dealer-lock-your-meds/
3. Compton, W. M., & Volkow, N. D. (2006). Abuse of prescription drugs and the risk of addiction. Drugs and Alcohol Dependence, 83S, S4-S7.
4. McCabe, S. E., Boyd, C. J., & Teter, C. J. (2009). Subtypes of nonmedical prescription drug misuse. Drug and Alcohol Dependence, 10: 63-70.
5. Drugs.com (2016). Fluoxetine drug interactions. http://www.drugs.com/drug-interactions/fluoxetine-with-robitussin-cold-cough-and-flu-1115-0-58-10279.html?professional=1
6. Levine, D. A. (2007). ‘Pharming’: The abuse of prescription and over-the-counter drugs in teens. Current Opinion in Pediatrics, 19: 270-274.
7. Drugs.com (2016). Drug interactions between Vyvanse and 12 Hour Cold. http://www.drugs.com/drug-interactions/12-hour-cold-with-vyvanse-822-9327-1475-2533.html?professional=1
8. Drugs.com (2016). Drug interactions between acetaminophen/butalbital and fluoxetine. http://www.drugs.com/drug-interactions/acetaminophen-butalbital-with-fluoxetine-20-0-1115-0.html?professional=1
About the author:
Stephanie Sands is currently pursuing a Bachelor of Science degree in Kinesiology, majoring in Mind Sciences. She completed an Honors Degree in Psychology in 2012, focusing on eating disorders and personality. She intends to combine her educational background into a holistic wellness practice, to strengthen mental health through a combination of counselling, physical activity, and nutrition coaching.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 9, 2016
Published on AddictionHope.com