“There’s obviously some potential obviously some potential for pharmaceutical companies to try to influence doctors and get them to prescribe their drug.” ~ Rob Varluck, Director of the Colorado Consortium for Prescription Drug Abuse Prevention
Quick—what is your idea of the “typical” drug addict? If you’re like most people, you think of a dirty, homeless derelict who buys their illegal drugs from a seedy-looking dealer in some inner-city back alley. That stereotype is inaccurate. Today, a drug-dependent person is more likely to be young, white, and living in the suburbs. And, because of the ongoing opioid epidemic, they probably get high from a prescription medication they were given by a doctor, friend, or family member.
Prescription Medication Abuse in the United States by the Numbers
According to the most recent data released by the Substance Abuse and Mental Health Services Administration’s Treatment Episode Data Set report, the misuse of prescription drugs is a major problem in the United States. The TEDS report reveals that there are three types of prescription medications that are most commonly misused – opioids, stimulants, and tranquilizers. Opioids – There are TWO MILLION people over the age of 12 in the United States who have a substance abuse disorder involving prescription opioid painkillers, according to the American Society of Addiction Medicine.
- Up to 26% of patients using opioids long-term for non-cancer pain will become dependent.
- 1 out of every 550 patients starting opioid therapy dies of opioid-related causes within two-and-a-half years of their first prescription.
Stimulants – College students are at particular risk of misusing prescription stimulants. The Center on Young Adult Health and Development reports that over 60% of students will be offered a stimulant at some point during their college careers.
- 1 out of 7 college students uses a prescription stimulant non medically.
- 90% of students who misuse, stimulants also engage in other dangerous substance-use behaviors, such as binge drinking or the use of illicit drugs.
Tranquilizers – 30% of prescription overdose deaths are due to benzodiazepine tranquilizers.
- 1996-2016, the number of US adults with a benzo prescription ballooned from 1 million to over 13 million.
- At the same time, dosages increased by 40%.
- Over the past 20 years, benzodiazepine-related deaths have more than tripled.
Let’s take a closer look at the most-abused medications in each class of drugs.
#1 Oxycodone – The Drug That Started the Opioid Epidemic?
“Oxycontin changed the face of addiction… It made addicts out of people who otherwise worked.” ~ Dan Smoot, President of Operation UNITE, an anti-drug organization in Kentucky
Oxycodone is a semi-synthetic opioid originally developed in Germany in 1917. Unlike many other opioids, it is synthesized from thebaine, an alkaloid of the Persian poppy, rather than morphine. Drugs containing oxycodone include:
There are several reasons why oxycodone is such a popular drug of abuse. FIRST, it is very potent, approximately twice as powerful as morphine. NEXT, it is extremely fast-acting. In some formulations, the onset of action is just 10 minutes and reaches peak effect in as little as 30 minutes. FINALLY, the effects can be short-lived. The duration of effect on some medications containing oxycodone can be as short as 3 hours. Since OxyContin was introduced, it has garnered $31 billion in sales for Purdue Pharma, its manufacturer. Right now, Purdue Pharma and other big drug companies are being sued by several states and even individual cities for the role they played in misleading both the medical community and the general public, thereby creating the opioid epidemic.
#2 Hydrocodone – The Official Opioid of the United States?
“When I took my first Vicodin, it was like this feeling of “Ahhh”. Like everything was not only mellow, but I didn’t feel any pain.” ~ Eminem
Hydrocodone is a semi-synthetic opioid originally developed in Germany in 1920. It is synthesized from codeine, itself an alkaloid of the opium poppy. Hydrocodone is equal in potency to morphine, and, like oxycodone, has a severe/high risk of misuse. The effects of hydrocodone can be felt in as little as 10 minutes, and can last between 4 and 6 hours. There are literally dozens of pain medications that contain Hydrocodone, including:
It is estimated that the United States uses 99% of the world’s supply of hydrocodone.
#3 Codeine – the World’s Most Popular Opiate
“Everybody wants me to stop all this and all that. It ain’t that easy. Do your history, do your research. It ain’t that easy – feels like death in your stomach when you stop doing that sh–. You gotta learn how to stop, you gotta go through detox. You gotta do all kinds of stuff.” ~ Rapper Lil Wayne, discussing his cough syrup addiction
Codeine is an alkaloid of the opium poppy. It was first isolated in France in 1832. Although it is only approximately 1/10th the potency of morphine, codeine is a very common drug of abuse because of its rapid onset of effects – 30 minutes – and its relatively short duration – 4 to 6 hours. Another reason codeine is so widely abused is because of availability – it is an ingredient in dozens of prescription medications, and used to treat such disparate conditions as pain, diarrhea, irritable bowel syndrome, and cough. In America, it is frequently misused by people who drink excessive amounts of codeine-containing prescription-strength cough syrups. In this form, the street names of codeine include “purple drank”, “sizzurp”, “lean”, and “syrup”. A few of the MANY medications that contain codeine include:
- Tylenol with Codeine
- Poly-Tussin D
- Robitussin AC
- Zotex C
Codeine is the most-used opiate in the world.
#4 Fentanyl – The Strongest Opioid Fit for Human Consumption
“This synthetic illegal lethal fentanyl is usually in powder form. It’s so deadly that you don’t have to ingest it, you don’t have to snort it. If you touch it in many cases, you’ll overdose.” ~ New Jersey Attorney General Chris Porrino
Fentanyl is a synthetic opioid first synthesized in Belgium in 1959. It is typically prescribed for cancer or post-operative pain. The risk of abuse is considered to be very high, for several reasons: FIRST, fentanyl is extremely potent – up to 100 times more powerful than morphine. Certain lab-made analogues of fentanyl are 10 THOUSAND times more potent. At this strength, a fatal dose can be measured in micrograms. An amount of pure fentanyl the size of 3 grains of salt can kill a full-grown man. SECOND, fentanyl’s effects are felt extremely rapidly – in as little as 5 minutes. THIRD, the duration of the effects is very short – between 30 minutes and one hour. This means that a fentanyl addict will want to use several times a day. This is what leads to overdose and death. It can take multiple administrations of the anti-opioid-overdose medication Narcan to revive someone who is overdosing on fentanyl. In one year, 2014-2015, fentanyl overdose deaths in the United States spiked by 79%. Formulations containing fentanyl include:
- Subsys (Sublingual Spray)
- Lazanda (Nasal Spray)
- Ionsys (automatic Transdermal Device)
- Fentora (Buccal Tablet)
- Durogesic (Transdermal Patch)
- Actiq (Lollipop/Lozenge)
- Abstral (Sublingual Tablet)
One of the analogues of fentanyl is carfentanil, called the “elephant tranquilizer” because it is used to sedate large animals. While carfentanil is an increasingly-popular and dangerous drug of abuse, it is far too potent for any legitimate medical application among humans.
Why Are Opioid Drugs so Addictive?
“Clients have described the high as imagining your happiest moment and multiplying it by 5, 10, 15.” ~ Dr. William Stanley, Summit Behavioral Health
When prescription opioids are taken into the body, they enter the bloodstream and make their way to the brain, where they are converted to morphine. Once these drugs reach the brain, they bind to specific receptors, which in turn produce massive amounts of dopamine, a neurotransmitter associated with pleasure, motivation, and learning. This opioid-caused dopamine increase causes intense feelings of relief from pain, euphoria, and pleasure. With chronic opioid abuse, the body stops making dopamine naturally. In other words, the only time, and opioid-dependent person can feel happy – or even normal – is when they are under the drug’s effects. Without the drug, they soon experience harshly unpleasant symptoms of withdrawal. Together, the drug-triggered high and the drug-craving withdrawal drive the worsening addiction. In addition, they also develop a tolerance for the drug – meaning they need greater and greater amounts in order to achieve the same painkilling or euphoric effects. Ever-increasing dosages is the major contributing factor behind opioid overdoses.
All about Opioid Withdrawal
During opioid withdrawal, the worst physical symptoms begin in as few as 12 hours following the last use, and persist approximately 5 days. In cases of severe addiction, withdrawal can last up to two weeks. Opioid withdrawal is not particularly dangerous, but the uncomfortable symptoms are considered to be among the worst:
- Heightened Anxiety
- Agitation and Restlessness
- Hot & Cold Flashes
- Sexual Dysfunction/Impotence
- Extreme Confusion/Inability to Concentrate or Focus
- Lack of Motivation
- Excessive Yawning and Fatigue
- Muscle Aches and Cramps
- Profuse Sweating
- Runny Nose and Sneezing
- Nausea and Vomiting
- Abdominal Cramps and Diarrhea
- Dilated Pupils
- Sensation of “Skin Crawling”
- Goosebumps – This is the origin of the term “Cold Turkey”
The most common complaint of someone suffering from opioid withdrawal is of a general feeling of being unwell – as if they have a severe cold or the flu. This is why opioid addicts in the throes of withdrawal say they are “sick”.
#5 Adderall—Faking ADHD
“While prescription stimulants carry real risks, they do not make people smarter.” ~The American Medical Association
Adderall is typically prescribed for adult Attention Deficit Hyperactivity Disorder (ADHD) that was first released in its current form in 1996. Among college students, it is an extremely-popular prescription drug of abuse. In recent years, Adderall use has shot up 67% among adults who do not have ADHD. Most of these are in the 18-25-year-old demographic, according to the Journal of Clinical Psychiatry. 95% of college students who abuse Adderall fake symptoms of ADHD in order to obtain the drug. Adderall is pure amphetamines –25% levoamphetamine and 75% dextroamphetamine. Adderall is so often abused because it acts as a(n):
- Cognition enhancer – Some reports say that at low doses, Adderall improves working memory, and the ability to focus when taken by healthy adults without ADHD.
This is why college students are so likely to misuse Adderall as a study aid.
- Performance enhancer – At therapeutic dosage levels, Adderall may improve endurance and strength.
Other ADHD prescription stimulants that are similar to Adderall include:
- Dexedrine/Dextrostat (dextroamphetamine)
- Vyvanse (lisdexamfetamine)
Adderall Is NOT A Good Study Buddy
“… ADHD has become the brain disorder some choose to fake.” ~ Alan Schwartz, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic
Despite its reputation as an effective study drug, the rumored “benefits” are canceled out by other factors. For instance – in general, students who misuse Adderall already tend to have lower grades. This means that any gains might just be because of studying. Also, students who use Adderall non-medically have rates of binge-drinking and drug use that are MUCH higher than normal. Compared to students who don’t misuse Adderall, abusers are:
- Three times more likely to report past-year marijuana use, 80% to 27%
- Eight times more likely to misuse prescription benzodiazepines, 24.5% to 3%
- Eight times more likely to use cocaine, 29% to 3.6%
- Five times more likely to abuse prescription painkillers, 45% to 9%
Any GPA improvements would be negated by that additional substance abuse. Furthermore, students who abuse Adderall skip more than 16% of their schedule classes, while students that don’t skip just 9%. This suggests that the “focus” benefit doesn’t carry over. Finally, according to a 2013 University of Pennsylvania study, Adderall use results in virtually no measurable boost that could be detected by memory or cognition tests. Interestingly, participants who were given Adderall still believed their performance was improved by the drug. This probably has less to do with any actual gains in mental efficiency and more to do with the euphoric effects of Adderall. Put another way, Adderall doesn’t seem to benefit memory or focus, but it probably makes studying seem more enjoyable.
Why Is Adderall so Addictive?
As with many other drugs of abuse, Adderall causes a euphoric state by increasing the body’s dopamine levels. At the regular prescribed dosage, addiction to Adderall is unlikely, even when the drug is taken long-term. But at higher recreational doses, Adderall dependence and addiction are a virtual certainty. For this reason, Adderall is classified as a Schedule II controlled substance. Adderall abuse leads to tolerance, higher dosages, and eventually, overdose. People with a tolerance to amphetamines might take up to 5 g of Adderall a day – 100 times the normal prescribed dose.
All about Adderall Withdrawal
88% of heavy Adderall abusers suffer withdrawal symptoms that manifest within 24 hours following the last use. Adderall withdrawal can last a month, and includes such symptoms as:
- Intense drug cravings
- Mood swings
- Emotional unease
- Sleep disturbances – insomnia or excessive sleepiness
- Lack of motivation
- Memory difficulties
- Suicidal thoughts
- Substantial weight gain, due to increased appetite
Heavy or long-time Adderall abusers can develop amphetamine psychosis, which manifests in a manner resembling schizophrenia– delusions, visual and auditory hallucinations, feelings of grandeur, etc. This symptom of prolonged amphetamine withdrawal can persist as long as six months. Some brain changes caused by amphetamine addiction are much longer-lasting. Long-term withdrawal symptoms may last for over a year include.
- Chronic fatigue
#6 Ritalin Created Generation Rx
“By the way, children on stimulant medications have twice the future rate of drug abuse.” ~ The Foundation for a Drug-Free World
Ritalin – also known as methylphenidate – was first introduced 1955. At first, it was a treatment for hyperactivity, which is now known to be merely part of a larger condition – ADHD. During the past two decades, prescriptions for Ritalin have increased substantially. In 2013 alone, there were nearly 2-and-a-half BILLION doses of Ritalin consumed globally – a 66% year-over-year increase from 2012. 80% of the world’s Ritalin is used in America. Unlike another ADHD drug, Adderall, Ritalin is not an amphetamine, although it is still considered to be a stimulant. Ritalin slows down the transmission of dopamine away from the areas of the brain that control the ability to pay attention. The instant-release formulation of Ritalin maintains peak effects for 2-4 hours, while the sustained-release version maintains the effects for 3-8 hours. Other similar methylphenidate medications include:
- Concerta – an extended-release formulation with effects that last 8-12 hours
- Daytrana – a methylphenidate transdermal patch that lasts up to 11 hours
- Focalin (dexmethylphenidate) – effects last 4-6 hours, with ER up to 12 hours
Why Is Ritalin so Addictive?
Because it alters natural dopamine levels, Ritalin is often taken for the resultant euphoria. One risky new trend being practiced by teenage/young adult Ritalin abusers is to drink heavily while on the medication. Ritalin counteracts the depressant effects of the alcohol, allowing that person to drink longer and more heavily. Tragically, this also increases the likelihood of alcohol poisoning. As stimulants, methylphenidate medications carry the same risks of dependence, abuse, and addiction as amphetamines, especially when they are misused at higher recreational doses. As with amphetamines, chronic Ritalin abuse can result in temporary or permanent psychosis. Likewise, Ritalin withdrawal is very similar to Adderall withdrawal. Because of this, Ritalin is also classified as a Schedule II drug. In 2017, the Journal of Neural Transmission reported that Ritalin abuse causes changes within the user’s brain that can result in:
- Increased risk-taking behaviors
- Unhealthy/extreme weight loss
- A disrupted sleep/wake cycle
Interestingly, Ritalin and other methylphenidate medications can potentially be used as methamphetamine replacement therapy in the same way that methadone is substituted for heroin.
#7 Xanax—America’s Favorite Benzodiazepine
“As a result of misinformation, I now found myself in the worst possible medical trouble, severely physically and mentally compromised; and a LONG way from being well.” ~ Jack Hobson-DuPont, The Benzo Book
Xanax is the brand name for the benzodiazepine medication alprazolam. It is the most-prescribed “benzo” tranquilizer in America. Almost 50 MILLION Xanax prescriptions are written annually, more than any other benzodiazepine. And, because Xanax is extremely habit-forming, this many users means more abusers. Xanax is extremely powerful and fast-acting, delivering 90% of its effects within the first 60 minutes. In fact, it is potent enough to cause a physical dependency in less than 4 weeks. To put it plainly, a person can get hooked on their first 30-day supply. First released in 1981, Xanax is prescribed as a treatment for several different psychological disorders, including:
- Panic disorder
- Social anxiety disorder
- Separation anxiety disorder
- Generalized anxiety disorder
- Specific phobias
Xanax is also the most-abused benzodiazepine in the United States. According to the Drug Enforcement Agency, alprazolam is among the “Top 3” most-diverted prescription medications. SAMHSA reports that the number of emergency department visits involving Xanax misuse MORE THAN DOUBLED in the United States 2005-2011, jumping from less than 58,000 to almost 124,000. More alarming, the National Institute on Drug Abuse reports that fatal overdoses involving Xanax and other benzodiazepine medications skyrocketed more than QUADRUPLED between 2002 and 2015. To get that increase perspective, the number of deaths caused by prescription pain medications were “only” doubled between 2002 and 2011.
# 8 Valium – Mother’s Little Helper
“But one led to two, two led to four, four led to eight, until at the end it was about 85 a day – the doctors could not believe I was taking that much. And that was just the valium – I’m not talking about the other pills I went through.” ~ Corey Haim
Valium is the brand name for the generic benzodiazepine medication diazepam. First introduced in 1963, it has since become one of the most-dispensed prescription medications in the world. Diazepam drugs are very versatile, and can be given for a wide range of conditions, including:
- Insomnia/Poor Sleep
- Alcohol or drug withdrawal
- Restless leg syndrome
- Muscle Spasms/Seizures
Valium has a rapid onset of action – oral, around 30 minutes, reaching peak levels in about 2 hours, and intravenously, within 5 minutes, peaking immediately. #9 Ativan — The High Price of a Good Night’s Sleep
“For people needing or using benzodiazepines, it seems crucial to encourage physicians to carefully balance the benefits and risks when renewing the prescription.” ~ Dr. Sophie Billotti de Gage, PhD, University of Bordeaux
Ativan is the brand name for the generic benzodiazepine medication lorazepam. Patented in 1963 and approved for sale in the US in 1977, it is prescribed as treatment for several conditions, including:
- Anxiety disorders
- Insomnia/Poor Sleep
- Alcohol withdrawal
- Nausea/Vomiting caused by chemotherapy
- The prevention of memories during surgery, or certain medical procedures
- To sedate mechanically-ventilated patients.
Because it is so versatile, Ativan is a very popular medication. For example, 28 million Ativan prescriptions were filled in 2011, trailing only Xanax as the most-prescribed benzodiazepine. Ativan’s effects are usually felt within 20-40 minutes, and they are relatively long-lasting—it has a half-life of between 9 and 16 hours. The two most popular benzodiazepines – Xanax and Ativan – are so frequently prescribed because of the overwhelming need in America – 18% of the population struggles with anxiety, while 30% suffers from insomnia or disrupted sleep.
#10 Restoril — Early to Bed and a Risk of Early Death
“This finding is shockingly not shocking. Sleeping pills are a huge problem. This study screams that many doctors do not know how to treat sleep patients. You have to develop a plan to deal with their sleep, not merely sedate them.” ~ Dr. Christopher Winter, a spokesman for the American Academy of Sleep Medicine, referring to a study of the hazards of sleeping pills
Restoril is one of the brand names for the generic benzodiazepine medication temazepam. First patented in 1965 and approved for sale in the United States in 1981, temazepam is a popular and effective hypnotic treatment for insomnia. In fact, is one of the preferred sleep medications used by the U.S. Air Force. As with other sleep-inducing benzodiazepines, Restoril is only recommended as a short-term remedy insomnia. A tolerance for Restoril can develop quickly, meaning it can lose its effectiveness in 3-14 days. After two weeks, higher doses are needed if the medication is to maintain its ability to induce and maintain sleep. Despite this, however, sleep medications are often prescribed long-term, even open-ended. Irresponsible prescribing is one of the factors contributing to prescription drug abuse. In a 2012 study published in BMJ, researchers made a link between the use of sleeping pills and premature death. Compared to people who don’t use sleeping pills, users are:
- 3.6 times more likely to die early if they take just 18 sleeping pills in a year’s time.
- 18-132 pills taken means a QUADRUPLED risk.
- Over 132 pills taken means a QUINTUPLED risk.
Among all hypnotics, Restoril, specifically, is strongly linked to cancer, with a more than 35% increased likelihood of a cancer diagnosis.
Statistics about Benzodiazepine Abuse in the United States
The American Journal of Public Health has reported surprising facts about benzodiazepine misuse in America:
- Benzodiazepine fatalities have more than QUADRUPLED since 1996.
- 1 out of 20 Americans has filled a benzo prescription within the past year.
- This is a 67% jump from since 1996.
- Meanwhile, on average, the amount of medication contained in those prescriptions has more than doubled.
- Each year, nearly 200,000 people misuse benzos for the first time.
Why Are Benzodiazepine Medications So Addictive?
There are two main reasons why benzodiazepines are so addictive, both having to do with the brain. Anti-anxiety benzos increase the levels of GABA–Gamma-Amino Butyric Acid—a neurotransmitter that calms the central nervous system. However, when a tolerance develops quickly, the user’s brain is desensitized to the drug and the medication decreases in effectiveness or even stops working altogether. Anxiety returns, and more and more medication is needed to get relief. In addition, since GABA levels are artificially elevated by the medication, the brain compensates – by reducing the number of specialized receptors. This means that without the drug, the person is physically and neurochemically unable to remain calm, unless they are under the influence of a benzodiazepine. This is similar to what happens because of the second reason. When most benzodiazepines are misused at higher-than-therapeutic doses, the user’s brain triggers the release of massive amounts of dopamine – the neurotransmitter associated with learning, memory, and pleasure. This is why a drug addict feels a euphoric high when using. But over time, and as a tolerance develops, the user’s body stops producing dopamine naturally, until it becomes impossible for them to feel pleasure, motivation, or even “normal” unless they are using a benzo drug.
All about Benzodiazepine Withdrawal
When a benzodiazepine-dependent or addicted person stops using, withdrawal symptoms typically start within 24-48 hours after the last dose. Of all abused drugs, benzodiazepines are the most dangerous to stop using. In fact, quitting abruptly can result in serious – even deadly – withdrawal symptoms, including:
- Homicidal thoughts
- Suicidal thoughts
- Fatal catatonia and/or convulsions
Benzodiazepine withdrawal should ALWAYS – REPEAT: ALWAYS – be supervised by medical professionals. The safest way is to very gradually reduce the dosage of the medication, giving the body time to recover. However, even when it is done slowly, benzodiazepine withdrawal symptoms can be extensive and disturbing:
- Extreme anxiety, panic, and terror
- Agitation and restlessness
- Mood swings
- Poor concentration
- Memory loss
- Sleep paralysis
- Muscle spasms
- Unbearable sensitivity to light, sounds, smells, or touch
- Dilated pupils, double/blurred vision
- Nausea, copious vomiting, and uncontrollable diarrhea
- Loss of appetite
- Unhealthy weight loss
- Feelings of unreality
What Are Some Medications for Benzodiazepine Withdrawal?
Right now, there are NO medications approved specifically to treat benzodiazepine withdrawal. The ONLY way to safely quit benzos is by gradually weaning from them, under close medical monitoring. On the other hand, there are a several drugs that MUST be absolutely avoided:
- Antipsychotics (Haldol, Abilify, Seroquel, etc.) – lower the user’s seizure threshold
- Barbiturates (Seconal, Luminal, etc.) – cross-tolerant with benzodiazepines
- Caffeine (coffee, soda, tea) – worsen symptoms of withdrawal
- Alcohol (liquor, wine, beer) – even “light” drinking can mean withdrawal failure
How to Protect Yourself and Your Family from Prescription Drug Abuse Dependence on prescription drugs can happen to ANYONE, even someone taking their legitimately-prescribed medication properly, exactly as directed. This means there are several steps you must take to keep both yourself and your loved ones safe:
- EDUCATE yourself about the medications in your home—side-effects, abuse potential, etc.
- DISCUSS with your doctor any personal or family history of any substance abuse.
- TALK to your family about the hazards of prescription misuse.
- Never SHARE your prescription drugs with anyone.
- Properly STORE and regularly INVENTORY your prescriptions.
- PAY ATTENTION for any signs of prescription misuse.
- LEARN the street and slang names for prescription drugs.
- DISPOSE OF any unused or unwanted medications by participating in drug take-back days in your area.
If you or someone you care about is dependent on or addicted to any prescription drug, the best way to safely return to healthy sobriety is by getting professional help from an accredited treatment center.