PRESCRIPTIONDRUGSWhat is prescriptiondrug abuse?

A lthough most peopletake prescription med-ications responsibly,

there has been an increase inthe nonmedical use of or, asNIDA refers to it in this report,abuse1 of prescription drugs inthe United States.

What are some of the commonlyabused prescriptiondrugs?

A lthough many pre-scription drugs can beabused, there are several

classifications of medicationsthat are commonly abused.

The three classes of prescription drugs that aremost commonly abused are:

■ Opioids, which are most often prescribed to treat pain;

■ Central nervous system(CNS) depressants, whichare used to treat anxietyand sleep disorders; and

■ Stimulants, which are prescribed to treat thesleep disorder narcolepsyand attention-deficithyperactivity disorder(ADHD).

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The nonmedical use or abuse of prescription drugs is a serious andgrowing public health problem in thiscountry. The elderly are among thosemost vulnerable to prescription drugabuse or misuse because they are prescribed more medications than theiryounger counterparts. Most people takeprescription medications responsibly;however, an estimated 48 million people(ages 12 and older) have used prescrip-tion drugs for nonmedical reasons intheir lifetimes. This represents approxi-mately 20 percent of the U.S. population.

Also alarming is the fact that the2004 National Institute on Drug Abuse’s(NIDA’s) Monitoring the Future surveyof 8th-, 10th-, and 12th-graders foundthat 9.3 percent of 12th-graders reportedusing Vicodin without a prescription inthe past year, and 5.0 percent reportedusing OxyContin—making these medications among the most commonlyabused prescription drugs by adolescents.

The abuse of certain prescriptiondrugs —opioids, central nervous system(CNS) depressants, and stimulants—can alter the brain’s activity and lead to addiction. While we do not yetunderstand all of the reasons for theincreasing abuse of prescription drugs,we do know that accessibility is likely a contributing factor. In addition to the increasing number of medicinesbeing prescribed for a variety of healthproblems, some medications can beobtained easily from online pharmacies.Most of these are legitimate businessesthat provide an important service; how-ever, some online pharmacies dispensemedications without a prescription and without appropriate identity verifi-cation, allowing minors to order themedications easily over the Internet.

NIDA hopes to decrease the prevalenceof this problem by increasing awarenessand promoting additional research onprescription drug abuse. Prescriptiondrug abuse is not a new problem, butone that deserves renewed attention. Itis imperative that as a Nation we makeourselves aware of the consequencesassociated with the misuse and abuse of these medications.

Nora D.Volkow, M.D.DirectorNational Institute on Drug Abuse

U . S . D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s • N a t i o n a l I n s t i t u t e s o f H e a l t h

ResearchReportN A T I O N A L I N S T I T U T E O N D R U G A B U S E

S E R I E S

Abuseand Addiction

1 A common vocabulary has not been established in the field of prescription drug abuse.Because much of the data collected in this area focuses on nonmedical use of prescriptiondrugs, the definition of abuse used in this report does not correspond to the definition ofabuse/dependence listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Opioids—What are opioids?

Opioids are commonlyprescribed because oftheir effective analgesic,

or pain-relieving, properties.Medications that fall withinthis class—referred to as prescription narcotics—includemorphine (e.g., Kadian,Avinza), codeine, oxycodone(e.g., OxyContin, Percodan,Percocet), and related drugs.Morphine, for example, isoften used before and aftersurgical procedures to alleviatesevere pain. Codeine, on theother hand, is often prescribedfor mild pain. In addition totheir pain-relieving properties,some of these drugs—codeineand diphenoxylate (Lomotil)for example—can be used torelieve coughs and diarrhea.

How do opioids affectthe brain and body?Opioids act on the brain and body by attaching to specific proteins called opioidreceptors, which are found in the brain, spinal cord, andgastrointestinal tract. Whenthese drugs attach to certainopioid receptors, they canblock the perception of pain.Opioids can produce drowsi-ness, nausea, constipation,and, depending upon theamount of drug taken, depressrespiration. Opioid drugs

also can induce euphoria by affecting the brain regionsthat mediate what we perceiveas pleasure. This feeling isoften intensified for those who abuse opioids whenadministered by routes otherthan those recommended. Forexample, OxyContin often issnorted or injected to enhanceits euphoric effects, while atthe same time increasing therisk for serious medical consequences, such as opioidoverdose.2

What are the possibleconsequences of opioiduse and abuse?Taken as directed, opioids can be used to manage paineffectively. Many studies have shown that the properly managed, short-term medicaluse of opioid analgesic drugsis safe and rarely causesaddiction—defined as thecompulsive and uncontrollableuse of drugs despite adverse

consequences—or depend-ence, which occurs when thebody adapts to the presenceof a drug, and often results in withdrawal symptoms when that drug is reduced or stopped. Withdrawal symp-toms include restlessness,muscle and bone pain, insom-nia, diarrhea, vomiting, coldflashes with goose bumps(“cold turkey”), and involuntaryleg movements. Long-term useof opioids can lead to physicaldependence and addiction.Taking a large single dose ofan opioid could cause severerespiratory depression that canlead to death.

Is it safe to use opioid drugs with other medications?Only under a physician’ssupervision can opioids beused safely with other drugs.Typically, they should not beused with other substancesthat depress the CNS, such as

2NIDA RESEARCH REPORT SERIES

Over-the-counter (OTC) medicines, such as certain cough suppressants (including dextromethorphan); sleep aids (such

as doxylamine, an ingredient in Unisom); antihistamines (such asdiphenhydramine, found in Benadryl); and dimenhydrinates (inGravol or Dramamine) can be abused for their psychoactiveeffects. OTC medicines also can be abused when not taken asdirected. It is also important to note that OTC medications canproduce dangerous health effects when taken with alcohol.

Over-the-Counter (OTC) Medicines Can Be Abused

2 This does not apply only to opioids. Changes in routes of administration also contribute to the abuse of other prescription medications, andthis practice can lead to serious medical consequences.

alcohol, antihistamines, barbiturates, benzodiazepines,or general anesthetics, becausethese combinations increasethe risk of life-threatening respiratory depression.

CNS depressants—What are CNS depressants?

CNS depressants, sometimesreferred to as sedativesand tranquilizers, are sub-

stances that can slow normalbrain function. Because of this property, some CNSdepressants are useful in the treatment of anxiety andsleep disorders. Among themedications that are commonlyprescribed for these purposesare the following:

■ Barbiturates, such asmephobarbital (Mebaral)and pentobarbital sodium(Nembutal), are used totreat anxiety, tension, andsleep disorders.

■ Benzodiazepines, such as diazepam (Valium),chlordiazepoxide HCl(Librium), and alprazolam(Xanax), are prescribed to treat anxiety, acutestress reactions, and panicattacks. The more sedatingbenzodiazepines, such astriazolam (Halcion) andestazolam (ProSom) areprescribed for short-termtreatment of sleep dis-orders. Usually, benzodi-azepines are not prescribedfor long-term use.

How do CNS depressantsaffect the brain and body?There are numerous CNSdepressants; most act on the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA).Neurotransmitters are brainchemicals that facilitate communication between brain cells. GABA works by decreasing brain activity.Although the different classesof CNS depressants work inunique ways, it is throughtheir ability to increase GABAactivity that they produce adrowsy or calming effect thatis beneficial to those sufferingfrom anxiety or sleep disorders.

What are the possible consequences of CNSdepressant use and abuse?Despite their many beneficialeffects, barbiturates and benzodiazepines have thepotential for abuse and shouldbe used only as prescribed.During the first few days oftaking a prescribed CNSdepressant, a person usuallyfeels sleepy and uncoordinated,but as the body becomesaccustomed to the effects ofthe drug, these feelings beginto disappear. If one uses thesedrugs long term, the body will develop tolerance for thedrugs, and larger doses will be needed to achieve thesame initial effects. Continueduse can lead to physical

dependence and—when use is reduced or stopped—withdrawal. Because all CNSdepressants work by slowingthe brain’s activity, when anindividual stops taking them,the brain’s activity can reboundand race out of control, poten-tially leading to seizures andother harmful consequences.Although withdrawal frombenzodiazepines can be problematic, it is rarely lifethreatening, whereas with-drawal from prolonged use of other CNS depressants canhave life-threatening compli-cations. Therefore, someonewho is thinking about discon-tinuing CNS depressant therapyor who is suffering withdrawalfrom a CNS depressant shouldspeak with a physician or seekmedical treatment.

Is it safe to use CNSdepressants with othermedications?CNS depressants should beused in combination withother medications only undera physician’s close supervision.Typically, they should not be combined with any othermedication or substance thatcauses CNS depression,including prescription painmedicines, some OTC coldand allergy medications, andalcohol. Using CNS depressantswith these other substances—particularly alcohol—can slowboth the heart and respirationand may lead to death.

NIDA RESEARCH REPORT SERIES3

Stimulants—What are stimulants?

A s the name suggests,stimulants increase alertness, attention,

and energy, as well as elevateblood pressure and increaseheart rate and respiration.Stimulants historically wereused to treat asthma and otherrespiratory problems, obesity,neurological disorders, and avariety of other ailments. Butas their potential for abuse andaddiction became apparent, themedical use of stimulants beganto wane. Now, stimulants areprescribed for the treatment ofonly a few health conditions,including narcolepsy, ADHD,and depression that has notresponded to other treatments.

How do stimulants affectthe brain and body?Stimulants, such as dextroam-phetamine (Dexedrine andAdderall) and methylphenidate(Ritalin and Concerta), havechemical structures similar to afamily of key brain neurotrans-mitters called monoamines,which include norepinephrineand dopamine. Stimulantsenhance the effects of thesechemicals in the brain.Stimulants also increase blood pressure and heart rate, constrict blood vessels,increase blood glucose, andopen up the pathways of the respiratory system. Theincrease in dopamine is

associated with a sense ofeuphoria that can accompanythe use of these drugs.

What are the possibleconsequences of stimu-lant use and abuse?As with other drugs of abuse,it is possible for individuals tobecome dependent upon oraddicted to many stimulants.Withdrawal symptoms asso-ciated with discontinuing stimulant use include fatigue,depression, and disturbance of sleep patterns. Repeated useof some stimulants over a shortperiod can lead to feelings ofhostility or paranoia. Further,taking high doses of a stimu-lant may result in dangerously

high body temperature and an irregular heartbeat. There is also the potential for cardiovascular failure or lethal seizures.

Is it safe to use stimulantswith other medications?Stimulants should be used in combination with othermedications only under aphysician’s supervision.Patients also should be awareof the dangers associated withmixing stimulants and OTCcold medicines that containdecongestants; combiningthese substances may causeblood pressure to becomedangerously high or lead toirregular heart rhythms.

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More than 6.3 Million Americans Reported Current Use of Prescription Drugs

for Nonmedical Purposes in 2003

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health, 2004.

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TranquilizersOpioid PainRelievers

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Trends in prescription drug abuse

A lthough prescriptiondrug abuse affects many Americans, some

concerning trends can beseen among older adults,adolescents, and women.Several indicators suggest thatprescription drug abuse is onthe rise in the United States.According to the 2003 NationalSurvey on Drug Use andHealth (NSDUH), an estimated4.7 million Americans used pre-scription drugs nonmedicallyfor the first time in 2002—

■ 2.5 million used painrelievers

■ 1.2 million used tranquilizers

■ 761,000 used stimulants■ 225,000 used sedatives

Pain reliever incidenceincreased—from 573,000 initiates in 1990 to 2.5 millioninitiates in 2000—and hasremained stable through 2003.In 2002, more than half (55percent) of the new userswere females, and more thanhalf (56 percent) were ages 18 or older.

The Drug Abuse WarningNetwork (DAWN), which mon-itors medications and illicitdrugs reported in emergencydepartments (EDs) across theNation, recently found that twoof the most frequently reportedprescription medications indrug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam)

and opioid pain relievers (e.g., oxycodone, hydrocodone,morphine, methadone, andcombinations that includethese drugs). In 2002, ben-zodiazepines accounted for100,784 mentions that wereclassified as drug abuse cases,and opioid pain relieversaccounted for more than119,000 ED mentions. From1994 to 2002, ED mentions ofhydrocodone and oxycodoneincreased by 170 percent and450 percent, respectively.While ED visits attributed todrug addiction and drug-takingfor psychoactive effects havebeen increasing, intentionaloverdose visits have remainedstable since 1995.

Older adultsPersons 65 years of age andabove comprise only 13 per-cent of the population, yetaccount for approximatelyone-third of all medicationsprescribed in the United States.Older patients are more likelyto be prescribed long-term andmultiple prescriptions, whichcould lead to unintentionalmisuse.

The elderly also are at riskfor prescription drug abuse, inwhich they intentionally takemedications that are not med-ically necessary. In addition to prescription medications, a large percentage of olderadults also use OTC medicinesand dietary supplements.Because of their high rates of comorbid illnesses, changes

Past Month Use of Selected Illicit Drugs Among Youths, by Age: 2003

18%

15

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Age 14 or 15 Age 16 or 17

MarijuanaPsychotherapeuticsInhalantsHallucinogens

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health, 2004.

in drug metabolism with age,and the potential for druginteractions, prescription andOTC drug abuse and misusecan have more adverse healthconsequences among the elderly than are likely to beseen in a younger population.Elderly persons who take benzodiazepines are atincreased risk for cognitiveimpairment associated withbenzodiazepine use, leadingto possible falls (causing hipand thigh fractures), as well as vehicle accidents. However,cognitive impairment may bereversible once the drug is discontinued.

Adolescents and young adultsData from the 2003 NSDUHindicate that 4.0 percent of

youth ages 12 to 17 reportednonmedical use of prescriptionmedications in the past month.Rates of abuse were highestamong the 18–25 age group(6.0 percent). Among theyoungest group surveyed, ages12–13, a higher percentagereported using psychothera-peutics (1.8 percent) than marijuana (1.0 percent).

The NIDA Monitoring theFuture survey of 8th-, 10th-,and 12th-graders found thatthe nonmedical use of opioids,tranquilizers, sedatives/barbi-turates, and amphetamineswas unchanged between 2003and 2004. Specifically, the survey found that 5.0 percentof 12th-graders reported usingOxyContin without a prescrip-tion in the past year, and 9.3 percent reported using

Vicodin, making Vicodin oneof the most commonly abusedlicit drugs in this population.Past year, nonmedical use oftranquilizers (e.g., Valium,Xanax) in 2004 was 2.5 percentfor 8th-graders, 5.1 percent for10th-graders, and 7.3 percentfor 12th-graders. Also withinthe past year, 6.5 percent of12th-graders used sedatives/barbiturates (e.g., Amytal,Nembutal) nonmedically, and 10.0 percent usedamphetamines (e.g., Ritalin,Benzedrine).

Youth who use other drugsare more likely to abuse prescription medications.According to the 2001 NationalHousehold Survey on DrugAbuse (now the NSDUH), 63 percent of youth who hadused prescription drugs non-medically in the past year had also used marijuana in the past year, compared with17 percent of youth who hadnot used prescription drugsnonmedically in the past year.

Gender differencesStudies suggest that womenare more likely than men tobe prescribed an abusableprescription drug, particularlynarcotics and antianxietydrugs—in some cases, 55 percent more likely.

Overall, men and womenhave roughly similar rates ofnonmedical use of prescriptiondrugs. An exception is foundamong 12- to 17-year-olds. Inthis age group, young womenare more likely than youngmen to use psychotherapeutic

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Past-Year Use of Other Drugs Reported by Prescription Drug Abusers: Persons Aged 12 to 25, 2001

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Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NHSDA Report, January 16, 2003.

NIDA RESEARCH REPORT SERIES7drugs nonmedically. In addi-tion, research has shown thatwomen are at increased riskfor nonmedical use of narcoticanalgesics and tranquilizers(e.g., benzodiazepines).

Preventing and recognizing prescriptiondrug abuseThe risks for addiction to prescription drugs increasewhen the drugs are used inways other than for those prescribed. Healthcareproviders, primary care phy-sicians, and pharmacists, aswell as patients themselves, allcan play a role in identifyingand preventing prescriptiondrug abuse.

Physicians. Because about70 percent of Americans(approximately 191 millionpeople) visit their primary carephysician at least once every 2 years, these doctors are in aunique position—not only toprescribe medications, but alsoto identify prescription drugabuse when it exists, help thepatient recognize the problem,set recovery goals, and seekappropriate treatment.Screening for prescription drugabuse can be incorporatedinto routine medical visits byasking about substance abusehistory, current prescriptionand OTC use, and reasons for use. Doctors should takenote of rapid increases in theamount of medication needed,or frequent, unscheduled refillrequests. Doctors also shouldbe alert to the fact that those

addicted to prescription drugsmay engage in “doctor shop-ping”—moving from providerto provider—in an effort toobtain multiple prescriptionsfor the drug(s) they abuse.

Preventing or stopping prescription drug abuse is animportant part of patient care.However, healthcare providers

should not avoid prescribingor administering stimulants,CNS depressants, or opioidpain relievers if needed. (Seetext box on “Pain Treatmentand Addiction.”)

Pharmacists. By providingclear information on how totake a medication appropriatelyand describing possible side

It is estimated that more than 50 million Americans suffer fromchronic pain. When treating pain, healthcare providers have

long wrestled with a dilemma: How to adequately relieve apatient’s suffering, while avoiding the potential for that patient to become addicted to the pain medication.

Many healthcare providers underprescribe opioid pain relievers,such as morphine and codeine, because they overestimate thepotential for patients to become addicted. This fear of prescribingopioid pain medications is known as “opiophobia.” Althoughthese drugs carry a risk for addiction and physicians shouldwatch for signs of abuse and addiction in their patients, the likelihood of patients with chronic pain becoming addicted to opioids is low (with the exception of those with a personal or family history of drug abuse or mental illness). The risk ofbecoming addicted to prescription pain medications is also minimal in those who are treated on a short-term basis. Moreresearch is needed to better understand what other factors predispose people to addiction to prescription pain relievers, and what can be done to prevent addiction among those at risk.

Pain management for patients who have substance abuse disorders is particularly challenging, but these patients can still be treated successfully with opioid pain medications. Developingnew and effective addiction and pain medications that are lesslikely to be abused is a priority for NIDA. For example, the medication buprenorphine/naloxone (Suboxone), developed byNIDA in collaboration with the pharmaceutical industry for treat-ing opioid addiction, may provide an alternative medication forpain that has less abuse potential than other pain medications,while also having a much greater safety margin. However, furtherresearch is needed before this practice can be recommended.

Pain Treatment and Addiction

effects or drug interactions,pharmacists also can play a key role in preventing prescription drug abuse.Moreover, by monitoring prescriptions for falsificationor alterations and being awareof potential “doctor shopping,”pharmacists can be the firstline of defense in recognizingprescription drug abuse. Somepharmacies have developedhotlines to alert other phar-macies in the region when afraudulent prescription isdetected.

Patients. There are alsosteps a patient can take to en-sure that they use prescriptionmedications appropriately.Patients should always followthe prescribed directions, beaware of potential interactionswith other drugs, never stopor change a dosing regimenwithout first discussing it withtheir healthcare provider, andnever use another person’sprescription. Patients shouldinform their healthcare profes-sionals about all the prescrip-tion and OTC medicines anddietary and herbal supplementsthey are taking, in addition toa full description of their pre-senting complaint, before theyobtain any other medications.

Treating prescriptiondrug addictionYears of research have shownus that addiction to any drug(illicit or prescribed) is a braindisease that, like other chronicdiseases, can be treated effectively. No single type of

treatment is appropriate for all individuals addicted to prescription drugs. Treatmentmust take into account thetype of drug used and theneeds of the individual.Successful treatment may need to incorporate severalcomponents, including detox-ification, counseling, and insome cases, the use of phar-macological therapies. Multiplecourses of treatment may beneeded for the patient tomake a full recovery.

The two main categories of drug addiction treatmentare behavioral and pharmaco-logical. Behavioral treatmentsencourage patients to stopdrug use and teach them howto function without drugs,handle cravings, avoid drugsand situations that could leadto drug use, and handle arelapse should it occur. Whendelivered effectively, behavioral

treatments—such as individualcounseling, group or familycounseling, contingency management, and cognitive–behavioral therapies—also can help patients improvetheir personal relationshipsand their ability to function atwork and in the community.

Some addictions, such as opioid addiction, can betreated with medications.These pharmacological treat-ments counter the effects ofthe drug on the brain andbehavior, and can be used torelieve withdrawal symptoms,treat an overdose, or helpovercome drug cravings.Although a behavioral or pharmacological approachalone may be effective fortreating drug addiction,research shows that, at least in the case of opioid addic-tion, a combination of both is most effective.

8NIDA RESEARCH REPORT SERIES

Treating addiction toprescription opioidsSeveral options are availablefor effectively treating pre-scription opioid addiction.These options are drawn fromresearch regarding the treat-ment of heroin addiction, and include medications suchas naltrexone, methadone, and buprenorphine, as well as behavioral counselingapproaches.

Naltrexone is a medicationthat blocks the effects of opioids and is used to treatopioid overdose and addic-tion. Methadone is a syntheticopioid that blocks the effectsof heroin and other opioids,eliminates withdrawal symptoms, and relieves drugcraving. It has been used

successfully for more than 30 years to treat heroin addiction. The Food and DrugAdministration (FDA) approvedbuprenorphine in October2002, after more than a decadeof research supported byNIDA. Buprenorphine, whichcan be prescribed by certifiedphysicians in an office setting,is long lasting, less likely tocause respiratory depressionthan other drugs, and is welltolerated. However, moreresearch is needed to deter-mine the effectiveness of thesemedications for the treatment of prescription drug abuse.

A useful precursor to long-term treatment of opioidaddiction is detoxification.Detoxification in itself is not atreatment. Rather, its primaryobjective is to relieve with-

drawal symptoms while thepatient adjusts to being drugfree. To be effective, detoxifi-cation must precede long-termtreatment that either requirescomplete abstinence or incor-porates a medication, such asmethadone or buprenorphine,into the treatment program.

Treating addiction to CNS depressantsPatients addicted to barbitu-rates and benzodiazepinesshould not attempt to stoptaking them on their own.Withdrawal symptoms from these drugs can be problematic, and—in the caseof certain CNS depressants—potentially life-threatening.Although no research regardingthe treatment of barbiturateand benzodiazepine addictionexists, addicted patientsshould undergo medicallysupervised detoxificationbecause the treatment dosemust be gradually tapered.Inpatient or outpatient coun-seling can help the individualduring this process. Cognitive-behavioral therapy, whichfocuses on modifying thepatient’s thinking, expecta-tions, and behaviors, while atthe same time increasing skills for coping with various lifestressors, also has been usedsuccessfully to help individualsadapt to the discontinuation of benzodiazepines.

Often barbiturate and ben-zodiazepine abuse occurs inconjunction with the abuse ofanother substance or drug,

NIDA RESEARCH REPORT SERIES9

Many Physicians Have Difficulty DiscussingSubstance Abuse With Patients

Over 40% of physicians report having difficulty discussing substance abuse, including abuse of prescription drugs, with their patients. In contrast, less than 20% have difficulty discussing depression.

National Center on Addiction and Substance Abuse at Columbia University (CASA). Missed Opportunity: National Survey ofPrimary Care Physicians and Patients on Substance Abuse, New York: CASA, 2000.

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OPIOIDS■ Oxycodone (OxyContin, Percodan, Percocet)■ Propoxyphene (Darvon)■ Hydrocodone (Vicodin, Lortab, Lorcet)■ Hydromorphone (Dilaudid)■ Meperidine (Demerol)■ Diphenoxylate (Lomotil)■ Morphine (Kadian, Avinza, MS Contin)■ Codeine■ Fentanyl (Duragesic)■ Methadone

Generally prescribed for■ Postsurgical pain relief■ Management of acute or chronic pain■ Relief of cough and diarrhea

In the bodyOpioids attach to opioid receptors in the brain and spinal cord, blocking the perception of pain.

Effects of short-term use■ Alleviates pain■ Drowsiness ■ Constipation■ Depressed respiration (depending on dose)

Effects of long-term use■ Potential for physical dependence and addiction

Possible negative effects■ Severe respiratory depression or death

following a large single dose

Should not be used withOther substances that cause CNS depression, including:■ Alcohol ■ Antihistamines■ Barbiturates■ Benzodiazepines■ General anesthetics

CNS DEPRESSANTSBarbiturates■ Mephobarbital (Mebaral)■ Pentobarbital sodium (Nembutal)

Benzodiazepines■ Diazepam (Valium)■ Chlordiazepoxide hydrochloride (Librium)■ Alprazolam (Xanax)■ Triazolam (Halcion)■ Estazolam (ProSom)■ Clonazepam (Klonopin)■ Lorazepam (Ativan)

Generally prescribed for■ Anxiety■ Tension■ Panic attacks■ Acute stress reactions■ Sleep disorders■ Anesthesia (at high doses)

In the bodyCNS depressants slow brain activity through actions on the GABA system, producing a calming effect.

Effects of short-term use■ A “sleepy” and uncoordinated feeling

during the first few days; as the body becomes accustomed (tolerant) to the effects, these feelings diminish.

Effects of long-term use■ Potential for physical dependence and addiction

Possible negative effects■ Seizures following a rebound in brain

activity after reducing or discontinuing use

Should not be used withOther substances that cause CNS depression, including:■ Alcohol ■ Prescription opioid pain medicines ■ Some OTC cold and allergy medications

STIMULANTS■ Dextroamphetamine (Dexedrine and Adderall)■ Methylphenidate (Ritalin and Concerta)

Generally prescribed for■ Narcolepsy■ Attention-deficit hyperactivity disorder (ADHD) ■ Depression that does not respond to other treatment

In the bodyStimulants enhance brain activity, causing an increasein alertness, attention, and energy.

Effects of short-term use■ Elevated blood pressure■ Increased heart rate■ Increased respiration■ Suppressed appetite■ Sleep deprivation

Effects of long-term use■ Potential for physical dependence and addiction

Possible negative effects■ Dangerously high body temperature or an

irregular heartbeat after taking high doses ■ Cardiovascular failure or lethal seizures■ For some stimulants, hostility or feelings

of paranoia after taking high doses repeatedly over a short period of time

Should not be used with■ OTC decongestant medications■ Antidepressants, unless supervised by a physician■ Some asthma medications

Use and Consequences of Commonly Prescribed Medications

such as alcohol or cocaine. In these cases of polydrugabuse, the treatment approachmust address the multipleaddictions.

Treating addiction toprescription stimulantsTreatment of addiction to prescription stimulants, suchas Ritalin, is often based onbehavioral therapies that haveproven effective in treatingcocaine and methamphetamineaddiction. At this time, thereare no proven medications for the treatment of stimulantaddiction. However, NIDA issupporting a number of studieson potential medications fortreating stimulant addiction.

Depending on the patient’ssituation, the first steps intreating prescription stimulantaddiction may be tapering thedrug dosage and attempting to ease withdrawal symptoms.The detoxification processcould then be followed by oneof many behavioral therapies.Contingency management, for example, uses a systemthat enables patients to earnvouchers for drug-free urinetests. (These vouchers can be exchanged for items thatpromote healthy living.)Cognitive-behavioral therapyalso may be an effective treatment for addressing stimulant addiction. Finally,recovery support groups may be helpful in conjunctionwith behavioral therapy.

NIDA RESEARCH REPORT SERIES11GlossaryAddiction: A chronic, relapsing disease charac-terized by compulsive drug seeking and use,despite harmful consequences, and by neuro-chemical and molecular changes in the brain.

Barbiturate: A type of CNS depressant oftenprescribed to promote sleep.

Benzodiazepine: A type of CNS depressantoften prescribed to relieve anxiety. Valium andLibrium are among the most widely prescribedmedications.

Buprenorphine: Medication approved by theFDA in October 2002 for treatment of opioidaddiction.

Central nervous system (CNS): The brainand spinal cord.

CNS depressants: A class of drugs that slow CNS function (also called sedatives and tranquilizers), some of which are used to treatanxiety and sleep disorders; includes barbituratesand benzodiazepines.

Detoxification: A process that enables the body to rid itself of a drug, while at the sametime managing the individual’s symptoms of withdrawal; often the first step in a drug treatment program.

Dopamine: A neurotransmitter present inregions of the brain that regulate movement,emotion, motivation, and feelings of pleasure.

Methadone: A long-acting synthetic medicationthat is effective in treating opioid addiction.

Narcolepsy: A disorder characterized by uncontrollable episodes of deep sleep.

Norepinephrine: A neurotransmitter present in some areas of the brain and the adrenalglands; decreases smooth muscle contraction andincreases heart rate; often released in responseto low blood pressure or stress.

Opioids: Controlled drugs or narcotics mostoften prescribed for the management of pain;natural or synthetic chemicals based on opium’sactive component—morphine—that work bymimicking the actions of pain-relieving chemicalsproduced in the body.

Opiophobia: A healthcare provider’s fear thatpatients will become addicted to opioids evenwhen using them appropriately; can lead to theunderprescribing of opioids for pain management.

Physical dependence: An adaptive physiological state that can occur with regulardrug use and results in withdrawal when drug use is discontinued. (Physical dependence alone is not the same as addiction, which involves compulsive drug seeking and use, despite itsharmful consequences.)

Polydrug abuse: The abuse of two or moredrugs at the same time, such as CNS depressantsand alcohol.

Prescription drug abuse: The intentional misuse of a medication outside of the normallyaccepted standards of its use.

Prescription drug misuse: Taking a medication in a manner other than that prescribed or for a different condition than thatfor which the medication is prescribed.

Psychotherapeutics: Drugs that have an effecton the function of the brain and that often areused to treat psychiatric disorders; can includeopioids, CNS depressants, and stimulants.

Respiratory depression: Depression of respiration (breathing) that results in the reducedavailability of oxygen to vital organs.

Sedatives: Drugs that suppress anxiety and relax muscles; the National Survey on Drug Use and Health classification includes benzodiazepines, barbiturates, and other types of CNS depressants.

Stimulants: Drugs that increase or enhance the activity of monamines (such as dopamine and norepinephrine) in the brain, which leads to increased heart rate, blood pressure, and respiration; used to treat only a few disorders,such as narcolepsy and ADHD.

Tolerance: A condition in which higher doses ofa drug are required to produce the same effectsas experienced initially.

Tranquilizers: Drugs prescribed to promotesleep or reduce anxiety; this National Survey on Drug Use and Health classification includesbenzodiazepines, barbiturates, and other types of CNS depressants.

Withdrawal: A variety of symptoms that occurafter chronic use of some drugs is reduced orstopped.

12NIDA RESEARCH REPORT SERIES

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Cowan, D.R.; Wilson-Barnett, J.; Griffiths, P.; and Allan, L.G. A survey of chronic noncancerpain patients prescribed opioid analgesics.Pain Medicine 4(4):340–351, 2003.

CSAT. Substance Abuse Among Older Adults(TIP #26). DHHS Pub. No. BKD250. SAMHSA, 1997.

Fishbain, D.A.; Rosomoff, H.L.; and Rosomoff,R.S. Drug abuse, dependence and addiction in chronic pain patients. Clin J Pain8:77–85, 1992.

Helling, D.K.; Lemke, J.H.; Semla, T.P.; Wallace,R.B.; Lipson, D.P.; and Cornoni-Huntley, J.Medication use characteristics in the elderly:the Iowa 65+ Rural Health Study J AmGeriatr Soc 35(1):4–12, 1987.

Johnston, L.D.; O’Malley, P.M.; and Bachman,J.G. Monitoring the Future: National SurveyResults on Drug Use, Overview of KeyFindings 2004. Bethesda, MD, NIDA, NIH, DHHS (2005). Available at: www.monitoringthefuture.org.

Joransson, D.E.; Ryan, K.M.; Gilson, A.M.; and Dahl, J.L. Trends in medical use andabuse of opioid analgesics. JAMA283(13):1710–1714, 2000.

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Paterniti, S.; Dufouil, C.; and Alperovitch, A.Long-term benzodiazepine use and cognitivedecline in the elderly: The Epidemiology ofVascular Aging Study. J Clin Psychopharmacol22(3):285–293, 2002.

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Simoni-Wastila, L.; Ritter, G.; and Strickler, G.Gender and other factors associated with thenonmedical use of abusable prescription drugs.Subst Use Misuse 39(1):1–23, 2004.

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Access information on the NIDA Web site

■ Information on prescription drugs andother drugs of abuse

■ Selected PrescriptionDrugs with Potential for Abuse chart(www.drugabuse.gov/DrugPages/PrescripDrugsChart.html)

■ Publications and communications (including NIDA NOTES)

■ Calendar of events■ Links to NIDA

organizational units■ Funding information

(including programannouncements and deadlines)

■ International activities■ Links to related

Web sites (access to Web sites of many other organizations inthe field)

NIDA Web Siteswww.drugabuse.gov

www.steroidabuse.orgwww.clubdrugs.org

National Clearinghousefor Alcohol and DrugInformation (NCADI)

Web Site: www.health.orgPhone No.: 800-729-6686

References

NIH Publication Number 05-4881Printed July 2001, Revised August 2005

Feel free to reprint this publication.