The misuse and abuse of prescription drugs is
rampant in our community, most commonly amongst young people who have
little idea of what they are taking! They use 'uppers' to pick
themslves up, and 'downers' to settle themselves back down, regularly
with unexpected, and sometimes fatal, results.
Most people who take prescription medications use
them responsibly. However, the inappropriate or non-medical use of
prescription medications is a serious public health concern.
Non-medical use of prescription medications like opioids, central
nervous system (CNS) depressants, and stimulants can lead to addiction,
characterized by compulsive drug seeking and use.
Patients, healthcare professionals, and
pharmacists all have roles to play in preventing misuse and addiction
to prescription medications. Patients should read all information
provided by the pharmacist. Healthcare providers should screen for any
type of substance abuse during routine history-taking, with questions
about which prescriptions and over-the-counter (OTC) medicines the
patient is taking and why, and should note any rapid increases in the
amount of a medication needed or frequent requests for refills before
the quantity prescribed should have been used, as these may be
indicators of abuse.
While many prescription medications can be abused
or misused, these three classes are most commonly abused:
* Opioids - often prescribed to treat pain.
* CNS Depressants - used to treat anxiety and sleep disorders.
* Stimulants - prescribed to treat narcolepsy and attention
Opioids are commonly prescribed because of their
effective analgesic, or pain relieving, properties. Studies have shown
that properly managed medical use of opioid analgesic compounds is safe
and rarely causes addiction. Taken exactly as prescribed, opioids can
be used to manage pain effectively. Among the compounds that fall
within this class - sometimes referred to as narcotics - are morphine,
codeine, and related medications. Morphine is often used before or
after surgery to alleviate severe pain. Codeine is used for milder pain.
Opioids act by attaching to specific proteins
called opioid receptors, which are found in the brain, spinal cord, and
gastrointestinal tract. When these compounds attach to certain opioid
receptors in the brain and spinal cord, they can effectively change the
way a person experiences pain. In addition, opioid medications can
affect regions of the brain that mediate what we perceive as pleasure,
resulting in the initial euphoria that many opioids produce. They can
also produce drowsiness, cause constipation, and, depending upon the
amount taken, depress breathing. Taking a large single dose could cause
severe respiratory depression or death.
Opioids may interact with other medications and
are only safe to use with other medications under a physician's
supervision. Typically, they should not be used with substances such as
alcohol, antihistamines, barbiturates, or benzodiazepines. Since these
substances slow breathing, their combined effects could lead to
life-threatening respiratory depression. Long-term use also can lead to
physical dependence�the body adapts to the presence of the substance
and withdrawal symptoms occur if use is reduced abruptly. This can also
include tolerance, which means that higher doses of a medication must
be taken to obtain the same initial effects.
Central Nervous System (CNS) Depressants
CNS depressants slow normal brain function. In
higher doses, some CNS depressants can become general anesthetics.
Tranquilizers and sedatives are examples of CNS depressants. CNS
depressants can be divided into two groups, based on their chemistry
Barbiturates, such as mephobarbital (Mebaral) and
pentobarbitalsodium (Nembutal), which are used to treat anxiety,
tension, and sleep disorders.
Benzodiazepines, such as diazepam (Valium),
chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which can be
prescribed to treat anxiety, acute stress reactions, and panic attacks.
There are many CNS depressants, and most act on
the brain similarly - they affect the neurotransmitter
gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals
that facilitate communication between brain cells. GABA works by
decreasing brain activity.
Although different classes of CNS depressants work
in unique ways, ultimately it is their ability to increase GABA
activity that produces a drowsy or calming effect. Despite these
beneficial effects for people suffering from anxiety or sleep
disorders, barbiturates and benzodiazepines can be addictive and should
be used only as prescribed.
CNS depressants should not be combined with any
medication or substance that causes drowsiness, including prescription
pain medicines, certain OTC cold and allergy medications, or alcohol.
If combined, they can slow breathing, or slow both the heart and
respiration, which can be fatal.
Discontinuing prolonged use of high doses of CNS
depressants can lead to withdrawal. Because they work by slowing the
brain's activity, a potential consequence of abuse is that when one
stops taking a CNS depressant, the brain's activity can rebound to the
point that seizures can occur. Someone thinking about ending their use
of a CNS depressant, or who has stopped and is suffering withdrawal,
should speak with a physician and seek medical treatment.
Stimulants increase alertness, attention, and
energy, which are accompanied by increases in blood pressure, heart
rate, and respiration. Historically, stimulants were used to treat
asthma and other respiratory problems, obesity, neurological disorders,
and a variety of other ailments. As their potential for abuse and
addiction became apparent, the use of stimulants began to wane.
Now, stimulants are prescribed for treating only a
few health conditions, including narcolepsy, attention-deficit
hyperactivity disorder (ADHD), and depression that has not responded to
other treatments. Stimulants may also be used for short-term treatment
of obesity and for patients with asthma. Stimulants such as
dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) have
chemical structures that are similar to key brain neurotransmitters
called monoamines, which include norepinephrine and dopamine.
Stimulants increase the levels of these chemicals
in the brain and body. This, in turn, increases blood pressure and
heart rate, constricts blood vessels, increases blood glucose, and
opens up the pathways of the respiratory system. In addition, the
increase in dopamine is associated with a sense of euphoria that can
accompany the use of stimulants.
Research indicates that people with ADHD do not
become addicted to stimulant medications, such as Ritalin, when taken
in the form and dosage prescribed. However, when misused, stimulants
can be addictive. The consequences of stimulant abuse can be extremely
dangerous. Taking high doses of a stimulant can result in an irregular
heartbeat, dangerously high body temperatures, and/or the potential for
cardiovascular failure or seizures. Taking high doses of some
stimulants repeatedly over a short period of time can lead to hostility
or feelings of paranoia in some individuals.
Stimulants should not be mixed with
antidepressants or OTC cold medicines containing decongestants.
Antidepressants may enhance the effects of a stimulant, and stimulants
in combination with decongestants may cause blood pressure to become
dangerously high or lead to irregular heart rhythms.
Treatment of addiction to prescription stimulants,
such as methylphenidate and amphetamines, is based on behavioral
therapies proven effective for treating cocaine or methamphetamine
addiction. At this time, there are no one proven medications for the
treatment of stimulant addiction. Antidepressants, however, may be used
to manage the symptoms of depression that can accompany early
abstinence from stimulants.
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