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In the 1970s, parents worried that their longhaired, bell-bottomed teenagers were getting drunk or smoking marijuana. Today, dangers also come in the form of prescription medicines -- from opioid pain relievers such as OxyContin to ADHD drugs such as Ritalin.
Prescription drug abuse appears to be on the rise in this country. Wilson Compton, MD, director of the division of epidemiology services and prevention research at the National Institute on Drug Abuse (NIDA), says the reasons aren't clear.
But he suspects that increasing numbers of prescriptions written for certain drugs, such as ADHD medications, afford greater opportunity. "A certain portion of those will be diverted for abuse purposes," he says.
Compton also says that in the current environment it seems almost normal to pop pills. "All of the advertising for pills may play a role in our willingness to try them."
Roughly 6.3 million Americans report that they're currently using prescription drugs for nonmedical reasons, according to the U.S. Department of Health and Human Services.
Prescription drug abuse knows no age. The elderly are vulnerable because they're more likely to take many medications, often long term. Also, women may be as much as 55% more likely as men to be prescribed drugs that can be abused, such as narcotics and tranquilizers; therefore, their risk is greater, according to the NIDA.
Teens and Prescription Drug Abuse
Abuse is most common among young people, Compton says. "Prescription drug abuse -- like most drug abuse -- tends to peak in the teens and 20s," he tells WebMD.
Almost one in five teens -- roughly 4.5 million -- has tried getting high with prescription drugs (typically with pain relievers such as Vicodin or OxyContin, or stimulants, such as Ritalin and Adderall). That's according to a recent national study on teen abuse of prescription and over-the-counter drugs by the nonprofit Partnership for a Drug-Free America.
The study also found that teens' abuse of prescription and over-the-counter medicines is equal to or higher than abuse of drugs such as cocaine and crack, Ecstasy, methamphetamine, and heroin.
Some teens say that prescription medicines are much safer to abuse than illegal drugs. But just because prescription drugs aren't cooked up in someone's garage doesn't mean that they're safe. According to Compton, the main risk for many drugs is addiction.
"As people try these substances, some of them will find that they really like them," he says. "They take more of them and they continue to take them, even when they no longer want to. And that's the hallmark of addiction. It creeps up on people in very subtle and unexpected ways. No one starts out taking a drug, saying, 'I want to be an addict.'"
Besides addiction, prescription drug abuse can bring on a host of health problems, such as irregular heartbeats, seizures, hostility, and paranoia -- even infections with HIV or other agents if someone dissolves and injects pills to get a quick high. Overdoses can be fatal. To combat the potential for abuse, some drug companies have marketed newer, timed-release versions that are harder to misuse.
It's important to remember that most people can reap benefits from prescription drugs without problems. But a minority will run into trouble. "Using these substances outside of a doctor's prescription is already a red flag and a warning," Compton says.
Which drugs are commonly abused? Who's most susceptible? How could they be endangering their health? Here's the rundown.
Stimulants
These drugs, which include Ritalin, Concerta, and Adderall, are often prescribed for attention deficit hyperactivity disorder (ADHD). By enhancing brain activity, stimulants increase one's attention, alertness, and energy.
Typically, high school and college students abuse these drugs for different reasons, "both for what I consider typical drug abuse reasons, for its intoxicating or inebriating qualities, to feel good or feel high," Compton says. "But they're also taking it as a performance-enhancing substance to increase their ability to stay up late and to work and concentrate."
Not only are these older students abusing stimulants, so are junior high students, Compton adds. The rates are much higher in high school and college, he says. "But even in the younger group, we see significant abuse."
According to the NIDA, health risks include: addiction and elevated blood pressure, heart rate, and respiration. In high doses, stimulants can cause irregular heartbeats and dangerously high body temperature, heart failure, or deadly seizures. Some stimulants can also cause hostility or paranoia.
Opioid Pain Relievers
These potent medications are prescribed for acute or chronic pain, as well as to relieve pain after surgery. They work by blocking pain perception.
Among the opioids, OxyContin, Vicodin, and Percodan are the most commonly abused, Compton says, although other types in this category are also misused.
"OxyContin is very concerning because it's an extremely powerful opioid agent. It's a fantastic medication for people with serious pain. It's just lifesaving for many people," Compton says. But when it's abused, it can have a heroin-like effect.
Teens who abuse opioids tend not to be "drug-na?," he adds. "They're using other substances as well -- marijuana, alcohol, tobacco." Opioids tend not to be the first substance they try. But adults who are prescribed these painkillers for a legitimate reason, such as serious pain, can also become addicted.
The most dangerous medical risk is severe respiratory depression or death if someone takes a large single dose of an opioid. But other problems can occur, too. "They're very sedating," Compton says. "So accidents would be a real risk as well, driving or even around the house -- falling down, hitting your head, cutting yourself accidentally."
Sedatives and Tranquilizers
Sedatives are also called central nervous system depressants because they work by slowing brain activity and creating a calming effect. They're often prescribed for anxiety, panic attacks, and sleep disorders.
Commonly abused sedatives include Valium and Xanax.
People of all ages may abuse sedatives and tranquilizers, but again, the problem is mostly concentrated in youth and young adults, Compton says.
The drugs can be addictive. These drugs slow brain function, and as a result, a person who stops taking them can have a rebound in brain activity that leads to seizures.
Erectile Dysfunction Drugs
Some men are abusing erectile dysfunction (ED) medications, such as Viagra, Cialis, and Levitra, as recreational drugs to enhance sexual performance. "It's taken by men who don't need it," says Craig Comiter, MD, associate professor of surgery (urology) at the University of Arizona. Often, they mix the medications with other drugs, such as methamphetamine or Ecstasy. "Those drugs do change judgment," Comiter says.
Perhaps that explains why one study found that men who use Viagra while having sex with other men engaged in unprotected sex up to six times more often than nonusers.
As a result, those who abuse ED drugs may dramatically increase their risk of sexually transmitted diseases and HIV infection. Comiter adds that among men who abuse ED drugs, there have also been anecdotal reports of severe nosebleeds that require hospitalization.
Drugs to Enhance Athletic Performance
Some people abuse anabolic steroids, synthetic versions of the male hormone testosterone, to improve athletic performance and physical appearance. According to the NIDA, most of these steroids are smuggled from abroad, made in covert labs, or illegally diverted from U.S. pharmacies. They can be taken by mouth or injected.
In the U.S., steroids are a prescription drug that doctors use to treat various conditions, such as delayed puberty or muscle wasting from AIDS.
Who's most likely to abuse steroids? Mostly young males, although the problem is growing among young females. Many are athletes, but not all. "There's a huge population of kids who just want to look good," says Robert Dimeff, MD, primary care director of sports health at The Cleveland Clinic. "They're really trying to get this aesthetic look of being big, lean, muscular individuals."
Steroid Side Effects
Steroid abuse can lead to liver tumors and cancer, jaundice, high blood pressure, increases in "bad" LDL cholesterol, and other problems. In men, steroids can cause shrinking of the testicles and breast development. In women, they can cause masculinization of the body. In adolescents, steroids can halt growth prematurely.
What concerns Dimeff more than physical problems are the potential effects on behavior. "In males, the testosterone tends to make them more aggressive and violent, and it increases libido." Hence, the term "roid rage."
If adolescents have a personal or family history of psychiatric problems, steroid abuse makes them especially vulnerable to behavioral or emotional problems, he adds. Such a psychiatric history would include alcohol or drug addiction, violent or criminal behavior, and bipolar disorder, among others, Dimeff says. "That's what I worry about the most. You give them something intense, and you can put them over the edge."
Some athletes may also abuse erythropoietin (a drug that doctors use to treat anemia, also known as Epogen and Procrit) to boost production of red blood cells. Athletes hope that the increased numbers of red blood cells will deliver more oxygen to muscles and improve endurance. Erythropoietin abuse can alter the body's regulation of red blood cell production. Once the drug is stopped, the number of red blood cells may drop suddenly.
Human growth hormone can be abused, too. The brain produces growth hormone to help the body control growth. But growth hormone also comes in drug form to help children grow if their own bodies don't make enough of the hormone. Sometimes athletes abuse growth hormone in an attempt to build muscle and strength while reducing body fat. But long-term abuse carries risks, such as increases in blood fat levels, diabetes, and heart enlargement that may end in heart failure.
Published May 22, 2006.
SOURCES: Wilson Compton, MD, director, Division of Epidemiology Services and Prevention Research, National Institute on Drug Abuse. Craig Comiter, MD, associate professor of surgery (urology), University of Arizona. Robert DiMeff, MD, primary care director, sports health, The Cleveland Clinic. Partnership for a Drug-Free America: "Partnership Attitude Tracking Study (PATS) 2005." National Institute on Drug Abuse: "Some Commonly Prescribed Medications: Use and Consequences." National Institute on Drug Abuse: "InfoFacts: Steroids (Anabolic-Androgenic)." National Institute on Drug Abuse: "Trends in Prescription Drug Abuse." WebMD Medical News: "Viagra Abuse Linked to Risky Sexual Behavior." U.S. Dept. of Health and Human Services: "National Survey on Drug Use and Health, 2004." Merck Manual of Medical Information, 2003; pp 648.