Several classes of medications that are commonly abused include opioids, central nervous system (CNS) depressants, and stimulants. Certain over-the-counter (OTC) medicines can also be abused when not taken as directed. It is important to note that many prescription drugs or OTC medications can produce dangerous health effects when taken concurrently or taken with alcohol.
Over-The-Counter (OTC) medicines, including sleep aids such as doxylamine (Unisom), antihistamines such as diphenhydramine (Benadryl) and dimenhydrinate (Gravol or Dramamine), and cough suppressants containing dextromethorphan (DXM), have been abused for their psychoactive effects.
- Opioids. Opioids are commonly prescribed to treat pain. Examples of prescription opioids include morphine (Kadian, Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), hydrocodone (Lortab, Lorcet, Vicodin), propoxyphene (Darvon), fentanyl (Duragesic), and hydromorphone (Dilaudid). Opioids work in the brain to diminish the perception of pain. Opioids also can produce a sense of euphoria by affecting pleasure centers in the brain. This is often intensified when opioids are taken by routes other than those prescribed.1 For example, OxyContin can be crushed and snorted, or injected intravenously-this can enhance the euphoric effects, while at the same time increasing the risk for serious medical consequences, such as overdose.
- CNS Depressants. CNS depressants commonly are prescribed to treat anxiety and sleep disorders because of their ability to slow normal brain function. These medications include barbiturates, such as mephobarbital (Mebaral), pentobarbital sodium (Nembutal), butalbital (Fioricet), and benzodiazepines such as diazepam (Valium), chlordiazepoxide HCl (Librium), alprazolam (Xanax), triazolam (Halcion), and others.
- Stimulants. Stimulants, including dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta), are used primarily to treat attention deficit hyperactivity disorder, attention deficit disorder, and narcolepsy. These stimulants increase the amount of certain chemicals in the brain and peripheral nervous system. This can lead to increased blood pressure and heart rate, and increased blood glucose.
Who is most vulnerable?
- Adolescents. According to the 2003 National Survey on Drug Use and Health, 9.2 percent of youth aged 12-17 had used a prescription psychotherapeutic drug for nonmedical reasons in the past year and 4.0 percent were current users. Prescription opioids are a particularly serious problem in this age group. NIDA's 2004 Monitoring the Future survey of 8th-, 10th-, and 12thgraders found that 5.0 percent of 12th-graders reported abusing OxyContin in the past year, and 9.3 percent reported abusing Vicodin, making Vicodin one of the most commonly abused prescription drugs in this population. Another troubling trend is the recent phenomena known as "pharming," where young people mix prescription medications and ingest some or all of them at once, unaware of potentially severe drug interactions.
- Elderly Adults. Although persons 65 years of age and above comprise only 13 percent of the population, they are prescribed approximately one-third of all medications in the United States. In addition, older patients are likely to be prescribed more long-term prescriptions, as well as multiple prescriptions, which could potentially result in unintentional misuse. A large percentage of older adults also use OTC medicines and dietary supplements, along with prescription medications, which could lead to dangerous results. The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. Because of high rates of comorbid illnesses among the elderly, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse or misuse can have more adverse health consequences among this age group.