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Updated 20 February 2013

Over-the-counter and prescription drug abuse

Over-the-counter and prescription medication abuse can lead to serious addiction and withdrawal symptoms.

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Over-the-counter (OTC) drugs such as painkillers and cough mixtures can be bought anywhere by anyone. They come in tablet form, in capsule form, in syrup form and in powder form.

No questions are asked by anyone and people who are addicted to OTC drugs can buy them in vast quantities from the same pharmacy or supermarket. Painkillers and cough mixtures that contain codeine, and to a lesser extent alcohol, seem to be the most commonly abused OTC medications, along with some of the appetite suppressants which contain stimulants. OTC medicines are usually cheap and this makes them doubly attractive.

Prescription drugs are generally a little more difficult to procure, as addicts need doctor’s prescriptions in order to get these. Some addicts have been known to use two or more doctors and pharmacists to feed their addictions, resorting to the devious behaviour which is characteristic of using drug addicts generally. Prescription drugs come in many different forms – usually tablets or capsules.

They are usually prescribed initially legitimately for existing medical conditions. Very often people overdose on prescribed medication and sometimes continue taking it after the condition for which it was prescribed is cleared. Sometimes the initial condition gets worse as a result of the drug abuse and people use increasingly large doses.

For example, the benzodiazepines (sleeping pills and tranquillisers) have rebound effects and after a while the user will experience the very symptoms of anxiety for which they were originally taken.

The most commonly abused prescription drugs are painkillers, sedatives or sleeping tablets and stimulants. The combination painkillers that contain paracetamol, codeine and caffeine seem to be very popular amongst people who abuse analgesics (painkillers).

Effects of medication abuse
Initially, medication serves a purpose, but it is in its continued or excessive use that problems arise. There are so many different types of medication that get abused that they cannot all be mentioned here.

One of the most famous is the date-rape drug Rohypnol that gets sold on the black market for large sums of money. This is available on prescription as a sleeping tablet, although in some countries its use is being legally restricted. However, there are many similar tranquillisers and sleeping pills that are abused widely, with serious consequences for the abuser and significant others.

Addiction to any substance means that some natural bodily function is suppressed or hampered. For instance, if something is taken which stimulates serotonin production, the body gradually loses its ability to produce serotonin without the stimulus of this drug. If laxatives are taken over a long period of time, the body’s ability to evacuate the bowels decreases without the help of a laxative. With tranquillisers the brain’s ability to produce its own relaxing chemicals becomes retarded.

Long-term addiction to any form of medication, whether over-the-counter or prescription drugs, can lead to liver and kidney damage, and in some cases heart and blood pressure problems. There are many other unpleasant side effects depending on which medication is abused.

Withdrawal symptoms
These can vary tremendously from vague irritability and a slight headache, to withdrawal from prescription medication such as Pethidene (an opiate like heroin and codeine) for which one has to be under medical care. From certain substances, the withdrawal can be every bit as traumatic as withdrawal from street drugs such as heroin. In fact, the withdrawal process from sleeping pills and tranquillisers (the benzodiazepines) is the most difficult out of all the drugs, and must be medically managed.

Anything with codeine in it or a benzodiazepine will have significant physical withdrawal symptoms.

Someone who takes a painkiller at breakfast, in case they might get a headache and two every night in order to sleep, is most probably using the medication to mask other non-physical problems. The denial that their medication abuse is problematic, is typical of all people who have a substance abuse problem, however small.

Most people do not want to admit that there is some underlying psychological cause to their addiction or that they are addicted at all. For them, the term ‘drug addict’ conjures up an image of someone injecting heroin in a public toilet, not of an old lady taking six painkillers a day.

Headaches are the most frequent symptom of withdrawal – even from substances such as caffeine. Ironically, frequent use of painkillers actually causes headaches, although it is not clear why. However, there is a long list of other withdrawal symptoms from analgesics and benzodiazepines, including disorientation, constipation or diarrhoea, hot and cold sweats, irritability and raised blood pressure.

Analgesics with codeine
Analgesics (painkillers) with codeine are often abused because of the pleasant, sleepy feeling that the medications elicit. Like morphine, codeine is derived from opium. People often use analgesics with codeine to relieve symptoms such as depression and anxiety.

When used in accordance with the warnings on the pack and your doctor's instructions, codeine should pose no risk. Taking too much codeine, however, or taking the medication over too long a period, may result in addiction and serious side effects including constipation, nausea, seizures and difficulty breathing.

Taking medications containing codeine along with other medications or alcohol can be very dangerous. If you are taking codeine, please consult with your doctor about what medications can safely be used with it.

Benzodiazepines
Benzodiazepines are a group of drugs acting on the central nervous system and is most often prescribed for the treatment of anxiety and amnesia. Valium may be the best known of the benzodiazepines. Many people become addicted to benzodiazepines.

Taking too large a dose or taking these drugs for too long may result in side effects like amnesia, irritability, confusion and increased aggression.

The danger with this group of drugs is that they are highly addictive and may cause severe withdrawal symptoms. These withdrawal symptoms may include anxiety, breathing difficulties, heart palpitations, memory problems, depression and ringing in the ears.

Appetite suppressants/stimulants
Stimulants are a class of drugs that increase brain activity – leading to an increase in alertness and attention, and mild feelings of euphoria due to increased dopamine or serotonin levels.

Stimulants are prescribed for narcolepsy, depression, ADHD and for short periods as an appetite suppressant. In the past, stimulants were prescribed for a much wider set of conditions, but an increased awareness of side effects and the potential for abuse has lead to stimulants being prescribed much less frequently.

Taking doses that are too high may lead to paranoia, feelings of hostility, seizures and an increase in cardiovascular risk. In addition, there is a risk of both physical and psychological addiction. The most commonly abused illegal stimulants such as crack-cocaine and crystal methamphetamine can cause serious cognitive difficulties and even permanent brain damage.

Reviewed by Peter Powis, Stepping Stones Addiction Centre, September 2008

 
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