by admin-blog-kh | May 13, 2025 12:16 pm
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[1]. 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.
The three classes of medicine commonly misused are opioids (pain medication), anti-depressants (anxiety and sleep disorder[4]) and stimulants (prescribed for attention deficit hyperactivity disorder).
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.
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.
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.
CNS depressants include hypnotics, sedatives and tranquilisers that slow brain activity, helping in the treatment of sleep disorders and anxiety.
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[8], 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, 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.
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[9].
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.
Stimulants, such as ritalin, adderall and dexedrine are used to treat ADHD and narcolepsy (sleep disorder).
Stimulants increase the effects of epinephrine and dopamine to increase alertness, energy and attention.
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.
Counselling is crucial in prescription drug misuse management. Once the underlying cause of misuse is identified, the patient receives counselling in the following areas:
Pharmacists must be trained to recognise prescription drug misuse. A pharmacist can recognise illegitimate prescriptions or peculiar patient patterns in the following ways:
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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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).
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.
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.
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.
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.
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.
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