Prescription Medication – How misuse can ruin your health
Introduction
Prescription medications are medicines that an individual can obtain from a pharmacy only with the written instructions of a qualified healthcare professional. They are intended for use by the individual for whom the medication has been prescribed.
Certain medications are available only by prescription owing to their administration mode (e.g. injection), associated risks, and misuse concerns. When prescription medicines are used for their intended purpose and at the right time and dosage, they are useful for treating illnesses; however, any misuse can have serious medical consequences, such as overdose deaths, hospital admissions and medical emergencies.
Prescription drugs are misused for recreation, sleep improvement, stress relief, anxiety and depression. The commonly misused drugs have psychotropic characteristics (the drug primarily affects the central nervous system (CNS) and the behaviours it controls (attention, concentration, judgment, emotion and learning). Other drugs that are misused are laxatives and cough medicines.
Forms of misuse
- Taking medication that was prescribed for someone else
- Taking medication via a different route; crushing the medicine pills and snorting or injecting them
- Taking higher doses than prescribed
- Using the medicine to feel euphoria
- More frequent consumption than the required dosage per day
- Combining medications without consulting the healthcare provider
- Continuing the medication beyond the prescribed duration
Who is at risk of prescription medication misuse?
- People who are in their early teens or 20s
- Those with a family history of substance abuse
- Those with problems, such as poverty, unemployment and family problems
- Have a crime history, including driving under influence
- Depression and anxiety
- History of physical and sexual abuse
- Poor academic performance
Types of prescription medication often misused
The three classes of medicine commonly misused are opioids (pain medication), anti-depressants (anxiety and sleep disorder) and stimulants (prescribed for attention deficit hyperactivity disorder).
Opioids
Opioids are a class of drugs that have been used for centuries to treat pain, diarrhoea and cough; in modern times, it is used for acute pain before or after surgery or dental procedures and cough. Common prescription opioid drugs include oxycodone, hydrocodone, morphine, codeine and fentanyl. When opioid drugs are taken under the strict instructions of the doctor, pain is effectively managed and does not lead to addiction.
Mechanism of action
Opioids reduce pain by activating the opioid receptors in the brain. Opioids also affect the areas of the brain that control emotion, diminishing the effect of pain.
Side effects of opioids at clinically recommended levels:
- Drowsiness
- Relaxation
- Nausea
- Vomiting
- Constipation
- Decreased appetite
- Dry mouth
- Difficulty breathing
- Elevated body temperature
Opioid misuse can lead to tolerance (the original dose does not provide relief; therefore, increased amounts are taken), dependence (physical discomfort if the drug is not taken) or addiction (compulsive use of the drug). Thus, it is possible to develop substance use disorder with opioids, increasing the risk of overdose.
Opioids also cause euphoria by activating the reward regions in the brain, properties which increase the risk of misuse and substance use disorder. Opioids trigger endorphin release, which gives a powerful feeling of pleasure and a sense of well-being. However, when the effect wears off, you want those feelings back and crave the drug, which is how opioid misuse begins.
If you do not get those pleasurable feelings back, you experience withdrawal symptoms, such as increased pain, anxiety, diarrhoea, restlessness, lack of sleep and goosebumps. Due to the risk of opioid misuse, doctors do not raise the dose or renew the prescription, leading people to obtain it via illegal means or use the street drug heroin. Heroin is laced with the powerful opioid fentanyl or contaminants, which can be fatal.
Effects of opioid misuse:
- Decreased consciousness
- Decreased heart rate
- Shallow breathing; opioids interact with the brain stem (controls breathing), and an overdose of opioids can suppress breathing and cause suffocation. A single large opioid dose can cause respiratory depression (slow breathing) or respiratory arrest (stopped breathing), which can be life-threatening. When opioids are taken with sedatives and alcohol, the respiratory depression risk increases.
- Cyanosis (lips and nails turn blue due to low oxygen levels)
- Seizures
- Muscle spasms
- Pinpoint pupils (abnormally small pupils)
CNS depressants
CNS depressants include hypnotics, sedatives and tranquilisers that slow brain activity, helping in the treatment of sleep disorders and anxiety.
Mechanism of action of CNS depressants
CNS depressants increase the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). The increase in GABA signalling increases the inhibition of brain activity. This leads to drowsiness and a calming effect, which is beneficial for those affected by sleep problems and anxiety.
When you first start taking CNS depressants, you may feel excessively sleepy and uncoordinated as the body gets accustomed to the medicine. When CNS depressants are taken under the strict advice of the psychiatrist or neurologist, it has the potential to improve the quality of life. Once the body adjusts and develops tolerance the side effects disappear. Prolonged usage may require large doses to achieve the same therapeutic effect, which can lead to dependence.
The most common CNS depressants prescribed include the following:
Benzodiazepines
Benzodiazepines, such as clonazepam are clinically used to treat insomnia and seizure disorders. Estazolam and triazolam are strong sedating benzodiazepines used to treat short-term sleep disorders. Long-term use of benzodiazepines is not recommended as it leads to tolerance, dependence and addiction.
Side effects of benzodiazepines at clinically recommended levels:
- Difficulty in remembering things
- Daytime drowsiness
- Allergic reactions
- Urinary incontinence due to night-time sedation
Effects of benzodiazepine misuse:
- Memory loss
- Blackouts
- Risky sexual behaviour
- Violent, criminal behaviour
- Thrombophlebitis (formation of blood clots)
- Rhabdomyolysis (muscle tissue breakdown releases myoglobin in the blood, which can damage kidneys)
- Tissue necrosis
- Pulmonary micro-embolism (blood clots block the blood vessels in the lungs)
- Withdrawal seizures are commonly observed when administered via inhalation
Non-benzodiazepine sleep-inducing agents
Non-benzodiazepine sleep-inducing agents, such as zaleplon, eszopiclone and zolpidem have fewer side effects and reduced risk of dependence. However, these drugs are misused to produce an extra-calming effect. These medications should not be used for more than a week or at higher than prescribed dose without consulting the family doctor.
Side effects of non-benzodiazepine sleep-inducing agents at clinically recommended doses
- Drowsiness
- Dizziness
- Headache
- Diarrhoea
- Unpleasant taste
- Fatigue
Effects of non-benzodiazepine sleep-inducing agent misuse
- Mild euphoria
- Visual distortions
- Perceptual changes
- Hallucinations
- Decreased anxiety
Barbiturates
Barbiturates, such as phenobarbital, mephobarbital and pentobarbital sodium are clinically used to treat anxiety, epilepsy or used as an anaesthetic. These drugs are misused for a feeling of happiness and relaxation.
Side effects of barbiturates at clinically recommended levels
- Headache
- Drowsiness
- Depression
- Constipation
- Digestive problems
- Dizziness
Effects of barbiturate misuse
- Poor coordination and concentration
- Low blood pressure
- Slurred speech and confusion
- Shallow breathing and low pulse
- Fatigue
- Impaired judgment and memory
- Coma and death
- Combining barbiturates with alcohol or anti-histamines can be fatal. Recreational users of barbiturates exhibit anger, anxiety, irritability, nervousness, paranoia, suicidal tendencies and hostility and also fight with family members.
Stimulants
Stimulants, such as ritalin, adderall and dexedrine are used to treat ADHD and narcolepsy (sleep disorder).
Mechanism of action of stimulants
Stimulants increase the effects of epinephrine and dopamine to increase alertness, energy and attention.
Side effects of stimulants at clinically recommended levels
- Increased blood pressure and heart rate
- Elevated body temperature
- Decreased appetite and sleep
Effects of stimulant misuse
- Irregular heartbeat
- Very high body temperature
- Psychosis
- Feeling of paranoia
- Risk of seizures
- Cardiovascular failure
Due to an increase in the number of stimulant prescriptions, they have become readily available, increasing the risk of misuse. Misuse of stimulants can make people addicted to it, and withdrawal symptoms include disturbed sleep, depression and fatigue.
Stimulants are cognitive enhancers; they increase motivation, alertness, learning and memory. Thus, it has been frequently used for non-medical purposes, such as by school students to improve academic performance, professionals to increase productivity and the elderly to offset cognitive decline. Non-medical stimulant misuse also raises the question of ethical practice where people with access and willingness to use stimulants have a competitive edge over others, giving the impression of a culture that one must consume drugs to stay competitive.
Treatment
Counselling is crucial in prescription drug misuse management. Once the underlying cause of misuse is identified, the patient receives counselling in the following areas:
- Learn strategies to cope with craving
- Invest in activities that are not associated with drugs
- Learn coping strategies if relapse occurs or in situations that prompt them to start drug misuse
- Educate the patient and their families on the risks of prescription misuse and the benefits of ceasing these habits
- Provide reassurance that withdrawal symptoms will be temporary
Prevention of prescription misuse
Role of patients
- Provide a complete medical history and the exact reason for the visit so that the doctor can understand your problem and prescribe the appropriate medication
- Understand the dose and duration of the medication and the risks involved. Be aware of the effects, especially during the first few days when the body is getting accustomed to the medicine.
- Clarify your doubts about the medicine from your family doctor.
- If there is a family history of addiction, it must be mentioned to the doctor as you may be vulnerable to drug addiction.
- Mention any history of alcohol and tobacco use
- Do not increase, decrease or discontinue the medication without consulting your doctor.
- Never use any other person’s prescription even if you have the same ailment.
Role of physician
- The physician must be able to recognise misuse patterns, such as taking pills for minor issues, forging prescriptions, requesting renewal of prescriptions, procuring medicine using old prescriptions, exaggerating symptoms, declining physical examination, claiming to have lost the prescription or pressurising or threatening behaviour to obtain a prescription.
- Mental health disorders such as depression and anxiety must be treated effectively so that the patient does not self-medicate
- The dose and duration of the medication and the risks of continued use must be clearly explained to the patient.
Role of pharmacist
Pharmacists must be trained to recognise prescription drug misuse. A pharmacist can recognise illegitimate prescriptions or peculiar patient patterns in the following ways:
- Pattern of prescriptions significantly varies from other doctors in the same field (e.g. large doses)
- Simultaneous prescription of antagonistic drugs (e.g. benzodiazepines and amphetamines prescribed at the same time can give a sense of euphoria)
- Patient visits the pharmacy frequently
- Patient brings multiple prescriptions for the same medicine from different doctors
- Evidence of a forged prescription (e.g. improper directions/quantities/no abbreviations/unusually legible handwriting/apparent deletions)
- Unusually well-informed about prescription narcotics
- Fakes lost/stolen prescription
Solutions
- Ensure the prescriptions are valid and for the intended use.
- Educating patients on the safe use, storage and disposal of medications.
- Awareness of the dangers of misuse must be discussed with the patient.
- Pharmacists must regularly monitor the sale and distribution of medicine capable of being misused
- Once drug misuse has been identified, the doctor withdraws the drug according to methods appropriate for the drug. He can offer alternatives by prescribing a less hazardous drug regimen or non-pharmacological interventions, such as physical/relaxation therapy or psychotherapy. The doctor must advise the patients experiencing some discomfort to avoid drug dependence.
Conclusion
Prescription medication misuse refers to taking prescription drugs in ways other than that prescribed by the doctor. People are misusing prescription drugs for improving sleep, relieving stress, recreation and managing anxiety and depression. This can have disastrous consequences, such as overdose deaths.
Commonly misused drugs are opioids, CNS depressants and stimulants, and the effects include seizures, shallow breathing, hallucinations, paranoia, cardiovascular failure, memory loss and confusion. This emphasises the fact that increased awareness is required to highlight the harmful effects of misusing these drugs. It is the responsibility of individuals, pharmacists and doctors to raise awareness on responsible use of these drugs and be vigilant of individuals who seek to obtain these drugs via illegal means.
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Frequently Asked Questions
What is considered misuse of prescription drugs?
Misuse of prescription drugs includes taking medication not prescribed to you, consuming higher doses than prescribed, using it to feel high or euphoric, or altering the form of intake (e.g. crushing pills to snort or inject).
What are the side effects of misusing prescription opioids?
Misusing opioids can lead to shallow breathing, decreased heart rate, pinpoint pupils, unconsciousness, and even fatal overdose. Long-term misuse may result in dependence, addiction, and withdrawal symptoms.
Can prescription drug misuse cause addiction?
Yes, repeated misuse of prescription medications like opioids, CNS depressants, and stimulants can lead to physical dependence and addiction, also known as substance use disorder.
What are the warning signs of prescription drug abuse?
Common signs include requesting early refills, visiting multiple doctors for the same medication (doctor shopping), taking higher doses than prescribed, and experiencing mood swings, confusion, or drowsiness.
How can I safely dispose of unused prescription medication?
Unused medicines should be returned to a pharmacy take-back programme or disposed of according to local medical waste guidelines. Do not flush them down the toilet unless specified.
What is the difference between dependence and addiction?
Dependence means your body needs the drug to function normally and may show withdrawal symptoms without it. Addiction involves compulsive drug use despite harmful consequences, often including psychological craving.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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