The epidemic of prescription drug abuse in the United States has been driven predominantly by the rise of opioid addiction. The Centers for Disease Control and Prevention (CDC) notes that, in 1999, a change in physicians’ prescribing practices with opioid analgesics led to wider use and distribution of a variety of narcotic painkillers, especially oxycodone, hydrocodone, morphine, and methadone. Unfortunately, because these drugs were used to treat more types of pain, including injury or surgery-related pain, they were given to more people, and with more people gaining access to potent narcotics, more people began to struggle with addiction to these substances. Today, per the CDC, 91 people die every day in the US due to an overdose on opioid drugs.
However, opioids are not the only substances being abused. Other central nervous system (CNS) depressants, especially benzodiazepines, barbiturates, and sedative-hypnotic drugs, are also widely abused, and prescription stimulants like Ritalin and Adderall are frequently diverted to young people. The National Institute on Drug Abuse (NIDA) found that, among those who report in several surveys that they have abused prescription drugs for nonmedical reasons in the previous year, about 12 percent meet the criteria for addiction. As many as 54 million people, ages 12 and older, have abused prescription drugs at least once in their lives, which is about 20 percent of that population. Young adults between the ages of 18 and 25 are the most likely to abuse prescription medicines for nonmedical reasons.
Prescription Drugs and Their Abuse
Nonmedical use of stimulants designed to treat attention deficit hyperactivity disorder (ADHD) among high school students, especially 12th graders, increased overall between 2012 and 2013 while prescription narcotics abuse declined. Young people tend to abuse prescription stimulants due to the misperception that they can improve academic, work, or physical performance. As a result, they are often referred to as study drugs.
Young people who begin abusing drugs are at greater risk for abusing multiple substances later in life; this is true not just for illicit drugs like marijuana, but also for prescription drugs. Women are at greater risk for prescription drug abuse, specifically, because they are more likely to seek treatment for pain or mental health conditions; therefore, they are more likely to receive opioids, benzodiazepines, muscle relaxations, or a combination of these drugs.
Older adults, especially those in middle age, are at greater risk for opioid and benzodiazepine abuse. In fact, benzodiazepine abuse, especially involving Valium and Xanax, has led to a “shadow epidemic” causing drug overdoses and deaths. The CDC found that benzodiazepines were involved in 30 percent of prescription drug overdose deaths; opioids were the only drug that caused more overdose death, being involved in 70 percent of overdose deaths. There was a lot of overlap in the two epidemics, with opioids and benzodiazepines both involved in overdose deaths in 75 percent of cases.
What Effective Treatment Looks Like
NIDA maintains a list of Principles of Effective Treatment for substance abuse, which includes prescription drug addiction. Some of these principles include:
- No single treatment works for everyone.
- Treatment must be readily available to address a variety of needs.
- Treatment must address multiple, individual needs.
Remaining in treatment for at least 90 days (three months) is crucial.
Behavioral therapy and medication in combination can help the most.
Safe detox and effective ways to manage withdrawal symptoms are extremely important as a first step to overcoming addiction. While few prescription drugs have effective pharmacological therapies, opioid drug withdrawal symptoms can be moderated with some detox medications. Currently, buprenorphine-based medications are the most popular form of medication-assisted treatment (MAT) for opioid withdrawal. Buprenorphine has been used in Europe for decades, but it was only approved for use in the US by the Food and Drug Administration (FDA) in 2002.
Tapering is an option for some other prescription drugs, like benzodiazepines, which can induce life-threatening withdrawal symptoms like seizures. Other substances, like prescription stimulants, must simply be stopped, although a doctor may be able to ease symptoms with anti-nausea or anti-anxiety medicines.
Working with a physician to develop a safe detox plan is crucial to reducing the risk of relapse. If a person has been abusing opioids, alcohol, or benzodiazepines, medical detox is necessary to ensure safety during withdrawal.
The other crucial aspect of drug treatment is evidence-based therapy. Working individually with an addiction counselor, as well as in a group setting with others in recovery, helps to change behaviors; this can create more positive long-term outcomes and ultimately helps the person to avoid relapse. Family counseling is becoming increasingly important, as addressing the negative impact of substance abuse in the family environment can create a safer atmosphere for everyone and reduce the risks of mental illness, relapse, or future substance abuse.
The leading form of therapy that appears to work for most people is Cognitive Behavioral Therapy. This type of treatment involves discussing thoughts and behaviors, and developing skills to cope with cravings, negative feelings, or lapses in the future. There are other forms of therapy, like the Matrix Model, which may work better for specific substances. This is why NIDA recommends multiple forms of treatment for different people, as underlying causes and specific drugs may respond better to different forms of counseling.
After a rehabilitation program has been successfully completed, ongoing support in the form of peer support groups, individual therapy, and complementary treatments can help one stay focused on sobriety and enjoy ongoing recovery.