Prescription drug abuse involves using prescription medication in a way that differs from the prescribing healthcare provider's instructions. Also referred to as prescription drug misuse, this can range from taking a friend’s pain reliever for back pain to crushing and injecting pills to achieve a high. This type of abuse may become habitual and compulsive, even in the face of harmful consequences. 

A growing concern, prescription drug abuse can impact people of all ages, including adolescents. The most frequently misused prescription medications include opioid pain relievers, anti-anxiety medications, sedatives, and stimulants. 

Recognizing and addressing prescription drug abuse early on can help prevent it from progressing into an addiction. 

Symptoms 
The signs and symptoms vary depending on the specific medication involved. Prescription drugs most commonly misused due to their mind-altering effects include: 

• Opioids for pain relief, such as oxycodone-containing medications (Oxycontin, Percocet) and hydrocodone-containing drugs (Norco) 
• Anti-anxiety medications, sedatives, and hypnotics for treating anxiety and sleep disorders, such as alprazolam (Xanax), diazepam (Valium), and zolpidem (Ambien) 
• Stimulants for managing ADHD and sleep disorders, such as methylphenidate (Ritalin, Concerta), dextroamphetamine-amphetamine (Adderall XR, Mydayis), and dextroamphetamine (Dexedrine) 

Understanding Opioids and Their Risks 

Opioids are a wide-ranging class of medications used to relieve pain by interacting with receptors in the brain. Some opioids are derived from the opium poppy plant—such as morphine (Duramorph, MS Contin, and others)—while others are synthetically produced in laboratories, like fentanyl (Actiq, Fentora). Common examples also include codeine, hydrocodone (Vicodin), and oxycodone (OxyContin, Roxybond), among others. 

These medications enter the bloodstream and bind to opioid receptors in the brain, which helps block pain signals and can enhance feelings of pleasure. 

When Opioids Become Dangerous 

The same properties that make opioids effective for pain management also make them potentially harmful. 

In small doses, opioids may cause drowsiness. However, larger amounts can dangerously slow your breathing and heart rate—sometimes with fatal consequences. Additionally, the euphoric "high" that opioids can produce may lead to repeated use, increasing the risk of dependence and addiction. Addiction occurs when the brain and behavior are so strongly influenced by the drug that you lose control over its use. 

To minimize your risk of harmful side effects, it’s important to follow your healthcare provider’s directions closely and take opioids exactly as prescribed. Always inform your doctor about any other medications or supplements you're taking. Have an open discussion with your doctor about the benefits and potential risks of opioid treatment, and consider alternative pain management options if you're concerned about the possibility of addiction.  

Symptoms by drug type: 

Opioids 

• Constipation 
• Nausea 
• Euphoria 
• Slowed breathing 
• Drowsiness 
• Confusion 
• Impaired coordination 
• Tolerance (needing higher doses) 
• Increased pain sensitivity at higher doses 

Anti-anxiety medications and sedatives 

• Drowsiness 
• Confusion 
• Unsteady gait 
• Slurred speech 
• Difficulty concentrating 
• Dizziness 
• Memory problems 
• Slowed breathing 

Stimulants 

• Heightened alertness 
• Euphoria 
• Irregular heart rate 
• Elevated blood pressure 
• Increased body temperature 
• Suppressed appetite 
• Insomnia 
• Agitation 
• Anxiety 
• Paranoia 

Additional warning signs 

• Forging, stealing, or selling prescriptions 
• Taking more than the prescribed dose 
• Mood swings or hostility 
• Sleeping more or less than usual 
• Poor decision-making 
• Unusually high energy or sedation 
• Repeatedly requesting early refills or reporting lost prescriptions 
• Seeking prescriptions from multiple providers  

When to See a Doctor 
If you suspect a problem with prescription drug use, speak with a healthcare provider. While it may feel uncomfortable to bring up, remember that medical professionals are there to help, not judge. Addressing the issue early can prevent it from escalating into addiction or causing more serious harm. 

Causes 
Both teenagers and adults may misuse prescription medications for various reasons: 

• To experience pleasure or get high 
• To feel relaxed or relieve stress 
• To alleviate pain 
• To suppress appetite 
• To boost alertness 
• Out of curiosity about the drug’s effects 
• To avoid withdrawal symptoms 
• Due to peer pressure or social influences 
• To enhance focus or performance at school or work  

Risk Factors 
Some individuals worry about becoming dependent on medications prescribed for legitimate health issues, such as painkillers after surgery. Following your healthcare provider’s instructions can help lower this risk. 

Prescription drug abuse is most prevalent among teens and young adults. 

Risk factors include: 

• A history of substance abuse, including alcohol or tobacco 
• Family background of substance misuse 
• Preexisting mental health conditions 
• Peer influence or environments where drugs are accessible 
• Availability of prescription medications at home 
• Lack of awareness about the dangers of misuse 

Older Adults 
Older adults are also increasingly affected, especially when prescription medications are combined with alcohol. Multiple health conditions and medications increase the risk of misuse and addiction in this age group. 

Complications 
Misusing prescription drugs can result in a range of serious problems. These drugs are particularly hazardous — and potentially fatal — when used in excessive amounts, combined with other prescriptions or over-the-counter drugs, or taken with alcohol or illicit substances. 

Medical Consequences 

• Opioids: May lead to slowed or stopped breathing, coma, or death from overdose. 
• Anti-anxiety medications and sedatives: Can cause memory issues, low blood pressure, and respiratory depression. Sudden discontinuation may trigger withdrawal symptoms, including seizures. 
• Stimulants: Can elevate body temperature, cause cardiovascular issues, seizures, tremors, hallucinations, aggression, and paranoia. 

Physical Dependence vs. Addiction 
Many prescription drugs impact the brain’s reward system, which can lead to both dependence and addiction. 

• Physical dependence: Also known as tolerance, it develops when the body adapts to long-term drug use, requiring higher doses to achieve the same effect. Withdrawal symptoms may occur if the drug is reduced or stopped suddenly. 
• Addiction: Involves compulsive drug-seeking behavior and continued use despite adverse consequences, often accompanied by physical dependence. 

Additional Consequences 

• Increased likelihood of engaging in risky behavior 
• Use of illicit or recreational drugs 
• Criminal activity 
• Involvement in car accidents 
• Decline in academic or job performance 
• Strained personal relationships  

Prevention 
Even individuals who need medications for valid medical conditions can be at risk for misuse. If you’re prescribed a potentially habit-forming drug, consider these strategies: 

• Ensure proper diagnosis and treatment: Share all current medications, supplements, and substance use with your healthcare provider. Ask if alternatives with lower addiction risks are available. 
• Maintain regular communication: Meet with your provider to evaluate whether the drug is effective and the dosage is appropriate. 
• Follow instructions closely: Only take your medicine as directed. Don’t adjust dosages without consulting your provider, even if the medicine doesn’t seem to work. 
• Understand your medication: Learn what effects to expect and check for interactions with other substances. 
• Avoid using others’ prescriptions: What works for one person may not be safe or effective for another. 
• Be cautious with online pharmacies: Only use reputable sources. Some online sellers provide counterfeit or dangerous medications. 

Preventing Teen Prescription Drug Abuse 
Prescription medications are among the most misused substances by teenagers. Steps to help prevent misuse include: 

• Educate your teen: Explain that prescription drugs, especially when not prescribed to them or when combined with other substances, can be dangerous. 
• Set firm rules: Make it clear that sharing or taking someone else’s medicine is unacceptable. 
• Address alcohol risks: Discuss the dangers of mixing alcohol with prescription drugs. 
• Secure medications: Track quantities and keep prescriptions in a locked cabinet. 
• Monitor online activity: Ensure your teen isn’t purchasing drugs from unverified websites. 
• Dispose of medications properly: Don’t keep expired or unused medicines. Follow disposal instructions on the label or consult a pharmacist. 

Treatment 

Treatment for prescription drug abuse varies depending on the specific drug involved and your individual needs. However, counseling is typically a central part of the process. Treatment may also include withdrawal (detoxification), addiction medication, and recovery support services. 

Counseling 

Individual, group, or family counseling from a licensed alcohol and drug counselor or another addiction specialist can provide essential support. Counseling can help you: 

• Identify contributing factors to your prescription drug abuse, such as underlying mental health or relationship issues 
• Develop skills to resist cravings, avoid drug misuse, and prevent relapse 
• Learn ways to build and maintain healthy relationships 
• Discover healthy, drug-free activities to engage in 
• Understand steps to take in the event of a relapse 

Withdrawal 

Depending on the type and duration of drug use, detoxification may be a necessary part of treatment. Because withdrawal can be risky, it should always be managed by a healthcare provider. 

• Opioid Withdrawal: Tapering the dosage gradually is the typical approach. Medications such as clonidine (Catapres), primarily used for high blood pressure, can help alleviate withdrawal symptoms. In the U.S., healthcare providers may prescribe medications like buprenorphine, buprenorphine-naloxone (Suboxone), or methadone under strict regulations to ease symptoms. Monthly injectable options, such as naltrexone (Vivitrol) or buprenorphine (Sublocade), can help maintain opioid abstinence during recovery. 
• Withdrawal from Anti-Anxiety Medications and Sedatives: Long-term use of sedatives or anti-anxiety drugs usually requires a slow, gradual taper over weeks. This allows your body to adjust safely to lower doses before stopping completely. Additional medications may be needed to stabilize mood, assist with tapering, or manage anxiety. Close monitoring by a healthcare provider is essential. 
• Stimulant Withdrawal: Currently, the U.S. Food and Drug Administration has not approved specific medications for stimulant withdrawal. Treatment typically involves tapering off the drug and managing symptoms such as fatigue, insomnia, and depression. 

Helping Yourself 

You may feel embarrassed to seek help or worry about how your loved ones will react. However, those who care about you will likely respect your courage and honesty in taking this step. Pesach Tikvah’s Addiction Counseling program, Hearts and Minds, is an excellent place to start.  

Helping a Loved One 

Talking to a loved one about prescription drug abuse can be difficult. You may face denial or anger, and fear damaging your relationship. 

Be patient and compassionate. Express your care and encourage honesty about their drug use. Offer support for getting help. When concerns come from someone they trust, the person may be more open to change. If the situation doesn't improve, a more structured approach may be needed. 

Intervention 

Supporting someone struggling with drug abuse or other harmful behaviors can be very challenging. Often, individuals are in denial or unwilling to seek help. They may not see the impact their behavior has on themselves or others. An intervention can be a turning point. 

An intervention involves a planned meeting with the individual, family, friends, and others who care about them. Seeking guidance from an intervention professional, addiction specialist, psychologist, or counselor can help you organize an effective intervention. 

This is your opportunity to address the issue, share concerns, and encourage the person to accept treatment. Think of an intervention as a proactive step to help a loved one change course before the situation worsens.