Prescription Pain and Other Medications
Part 1 of 3
Prescription medications such as pain relievers, tranquilizers, stimulants, and sedatives are very useful treatment tools but sometimes people do not take them as directed and may become addicted. Pain relievers make surgery possible, and enable many individuals with chronic pain to lead productive lives. Most people who take prescription medications use them responsibly. However, the inappropriate or nonmedical use of prescription medications is a serious public health concern. Nonmedical use of prescription medications like opioids, central nervous system (CNS) depressants, and stimulants can lead to abuse and addiction, characterized by compulsive drug seeking and use.
Patients, healthcare professionals, and pharmacists all have roles in preventing misuse and addiction to prescription medications. For example, when a doctor prescribes a pain relief medication, CNS depressant, or stimulant, the patient should follow the directions for use carefully, learn what effects the medication could have, and determine any potential interactions with other medications. The patient should read all information provided by the pharmacist. Physicians and other healthcare providers should screen for any type of substance abuse during routine history-taking, with questions about which prescriptions and over-thecounter medicines the patient is taking and why. Over time, providers should note any rapid increases in the amount of a medication neededâwhich may indicate the development of toleranceâor frequent requests for refills before the quantity prescribed should have been used.
Commonly Abused Prescription Medications
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 deficit/hyperactivity disorder.
Opioids are commonly prescribed because of their effective analgesic, or pain relieving, properties. Many studies have shown that properly managed medical use of opioid analgesic compounds is safe and rarely causes addiction, which is defined as compulsive, often uncontrollable use. Taken exactly as prescribed, opioids can be used to manage pain effectively.
Among the compounds that fall within this classâsometimes referred to as narcoticsâare morphine, codeine, and related medications. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContinâan oral, controlled release form of the drug); propoxyphene (Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of side effects. In addition to their effective pain relieving properties, some of these medications can be used to relieve severe diarrhea (Lomotil, for example, which is diphenoxylate) or severe coughs (codeine).
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 physicianâs 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 lifeâthreatening respiratory depression.
Chronic use of opioids can result in tolerance to the medications so that higher doses must be taken to obtain the same initial effects. Long-term use also can lead to physical dependenceâthe body adapts to the presence of the substance and withdrawal symptoms occur if use is reduced abruptly.Individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision, but also should be medically supervised when stopping use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (âcold turkeyâ), and involuntary leg movements.
Individuals who become addicted to prescription medications can be treated. Options for effectively treating addiction to prescription opioids are drawn from research on treating heroin addiction. Some pharmacological examples of available treatments follow:
Methadone, a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms and relieves craving. It has been used for over 30 years to successfully treat people addicted to opioids.
Naltrexone is a long-acting opioid blocker often used with highly motivated individuals in treatment programs promoting complete abstinence. Naltrexone also is used to prevent relapse.
Buprenorphine, another synthetic opioid, is a recent addition to the arsenal of medications for treating addiction to heroin and other opiates.
Naloxone counteracts the effects of opioids and is used to treat overdoses.
National Institute on Drug Abuse (NIDA)
National Institutes of Health (NIH)
U.S. Department of Health & Human Services
For more information on addiction to prescription medications, visit http://www.drugabuse.gov/drugpages/prescription.html.