The long- and shortterm. prescription drug abuse, including addiction Mini-course #3
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1 The long- and shortterm risks of prescription drug abuse, including addiction Mini-course #3
2 Introduction Approximately 60 percent of teens believe that prescription drugs are safer to abuse than illicit drugs, especially if taken for only a short time. But there are many risks associated with taking prescription drugs without the direction or supervision of a medical practitioner. The risks of prescription drug abuse can be divided into short- and long-term risks. This course will help you identify the risks associated with prescription drug abuse. After completing this course, you will be able to: Identify and define the short-term risks of prescription drug abuse Identify and define the long-term risks of prescription drug abuse Persuasively communicate the risks to others as a first step towards prevention 2
3 Prescription drugs A prescription drug is a drug that can only be legally obtained from a pharmacy with a prescription from a registered medical practitioner. A medical practitioner is someone who has extensive medical training and is licensed to practice medicine, such as a doctor, physician assistant, dentist, or nurse practitioner. Not all prescription drugs are abused by youth. Some drugs such as blood pressure medication, antibiotic, and insulin are rarely abused. Other drugs, such as painkillers, stimulants, and depressants are commonly diverted and abused. Indeed, many types of commonly abused painkillers, stimulants, and depressants are strictly controlled and monitored according to state and federal law. The use of these drugs carry a large risk of abuse and addiction. 3
4 Prescription drug abuse and diversion defined Prescription drug abuse is the use of prescription drugs in ways other than the intended (prescribed) purpose. This can include: Taking prescription drugs without a prescription (for example, from another person s prescription) Taking prescription drugs in an amount different than prescribed (for example, skipping doses or double up on doses) Taking prescription drugs in a different method than prescribed (for example, crushing and snorting) The major source of prescription drugs for youth drug abuse is drug diversion. Drug diversion includes giving, sharing, or selling prescription drugs from one s own prescription and sharing or selling prescription drugs that have been obtained from another source. 4
5 The effect of prescription drugs on the brain Controlled prescription painkillers, stimulants, and depressants work by changing the chemistry of the brain. Generally, medical practitioners prescribe these prescription drugs to improve brain functioning in people with certain conditions. For example, painkillers are prescribed to people with chronic pain, stimulants are prescribed to people with ADHD, and depressants are prescribed to people with anxiety. In these cases, prescription drugs can be very beneficial and can improve the quality of life when taken as prescribed. Abusing an prescription drug changes the brain chemistry in a dangerous way that interferes with the proper functioning of the brain. In these cases, prescription drugs can be addictive and deadly. 5
6 Risks of short-term prescription drug abuse Due to the effect of prescription painkillers, stimulants, and depressants on the brain, even short-term prescription drug abuse has risks. Short-term drug abuse is defined at the abuse of a drug one or more times for a period of time. Even with just one to two incidents of prescription drug abuse, a person runs the risk of short term consequences, such as an increased chance of drug dependence, an increased likelihood of engaging in high-risk behaviors, and physical repercussions. 6
7 Even short-term abuse of an prescription drug can lead to drug dependence. Drug dependence means that a person needs the drug to physically function normally. In these cases, stopping use of the drug abruptly leads to withdrawal symptoms. Withdrawal symptoms include physical and psychological reactions such as vomiting, cold flashes, and depression. Drug dependence Drug abuse can lead to drug dependence and drug addiction. Children that abuse prescription drugs are at a greater risk of drug dependence than their peers. In addition, short-term drug abuse puts youth at risk of drug dependence later in life. If drug abuse is started before the age of 16, there is a higher risk of drug-dependence at a later age. Increased dependence on drugs leads to more abuse and a greater risk for addiction. 7
8 Increased high risk behaviors Prescription drug abuse, can change brain chemistry, which may alter cognitive-skills like decision-making, especially while under the influence. The effect of prescription drugs on the brain and its function may cause youth to make poor choices. For example, youth that abuse prescription drugs are more likely to engage in other high-risk behaviors, such as using other illicit drugs, cigarette smoking, and binge drinking. The relationship between prescription abuse and other drug use is particularly strong. In fact, teens that abuse prescription drugs are 21 times more likely to use cocaine, 12 times more likely to use heroin, five times more likely to use marijuana, and two times more likely to use alcohol. Other risky behaviors include sexual activity and accidents. Teens who abuse prescription drugs are at greater risk for other physical injuries, since even small doses of painkillers and depressants can impact motor skills and cognitive ability. 8
9 Health risks In addition to the increased possibility of drug dependence and high-risk behaviors, short-term drug abuse carries the risk of numerous physical complications. The user may experience many physical symptoms, after as little as one incident of abuse. These symptoms* vary for the different categories of prescription drugs (painkillers, stimulants, and depressants). For example, someone who takes a large quantity of an opioid painkiller may experience decreased respiratory and heart rates, which can sometimes lead to death. The negative health consequences of prescription drug abuse can be magnified when prescription drugs are taking in combination with each other and other substances. We discuss drug interactions on the next page. *For details about the physical symptoms associated with prescription drug abuse see Mini-course #2: Warning signs and symptoms of prescription drug abuse and frequently diverted/abused drugs. 9
10 Health risks drug interactions A drug interaction is the interaction between a drug and another substance, which can occur when drugs are taken with: Other drugs (prescription or OTC) Alcohol Certain foods Other substances A drug interaction can increase or decrease the effect of the drug and the side-effects of the drug. Prescription drugs labels and informational sheets list possible drug interactions and warnings to avoid specific prescription drugs, OTC drugs, and alcohol when taking that drug. Both doctors and pharmacists emphasize the importance of these warnings. But people abusing prescription drugs don t have access to these warnings and safeguards. 10
11 Drug interactions Drug interactions may necessitate hospitalization due to negative side-effects, increase the possibility of overdose, and even cause death. For example, drug interactions with painkillers may cause the user to stop breathing, drug interactions with stimulants may cause the user to experience increased heart rate and breathing, and drug interactions with depressants may cause the user to experience slowed heart rate and breathing. The possibility of a drug-drug interaction increases with the number of drugs a person takes. If a youth takes unknown pills, or pills without prescription information, there is a high risk of drug-drug interactions and little awareness of the risk 11
12 Drug interactions prescription drugs and alcohol Mixing drugs with alcohol can cause dangerous interactions. The combination of painkillers and alcohol may lead to slowed or difficulty breathing, increase risk of overdose, and death. The combination of stimulants and alcohol produces a masking effect. This means that the stimulant masks the effects of the alcohol on the body. A person can be highly intoxicated, but will not feel the effects of the alcohol due to the effect of the stimulant. This may lead a person to continue drinking since the effects of the alcohol aren t felt. Excessive alcohol consumption can lead risky behavior, alcohol poisoning, and death. Mixing depressants with alcohol multiplies the effects of both substances. This causes the central nervous system to rapidly slow down. Heart rate and breathing can slow so much that both can stop, leading to death. 12
13 Health effects of prescription drugs and alcohol Mixing prescription drugs and alcohol increases the risk for liver damage and failure. The liver has the job of processing many substances, including alcohol, prescription drugs, and acetaminophen, but it can only handle so much. Exceeding the recommended amount of any drug or alcohol overburdens the liver and puts a person at risk of liver damage. For example, many controlled prescription drugs, particularly painkillers, include acetaminophen as an ingredient, such as Vicodin, which is an opioid plus acetaminophen. Alone, acetaminophen is available over-thecounter (OTC) and is commonly used to reduce fever and relieve mild to moderate pain. The Food and Drug Administration (FDA) has limited the amount of acetaminophen in a dose of medication to 325 mg because of the association with liver damage in high doses. Consider an example where a teen is abusing Vicodin at a party. He takes double the recommended dosage of Vicodin. This is an excessive amount of acetaminophen for the liver to process and could result in liver damage or failure. Then the teen consumes multiple drinks. The liver has to process the acetaminophen and the alcohol, overloading the liver and increasing the risk of liver damage and failure even more. 13
14 Risks of long-term drug abuse Long-term drug abuse is defined as the habitual use of prescription drugs over the course of weeks, months, and even years. Long-term drug abuse may lead to many problems including addiction. Teens can and do experience addiction. For example, one-third of teens admitted for drug-abuse treatment in 2006 were admitted for addiction to prescription drugs. 14
15 What is addiction? Addiction is the physical and psychological dependence on a substance. Addiction is characterized by three criteria: Compulsive use and drug seeking the person continues to use the substance despite negative health and social consequences. Tolerance the effect of the drug is reduced and the person has to increase the amount of the drug to experience the desired effect. Withdrawal the person experiences physical and psychological symptoms when he or she stops using an addictive drug. The withdrawal symptoms differ among prescription painkillers, stimulants, and depressants, but all are very unpleasant. For example, withdrawal symptoms for painkillers include muscle and bone pain, vomiting, and cold flashes. 15
16 The withdrawal symptoms of prescription painkillers include: Insomnia Muscle and bone pain Vomiting Restlessness Diarrhea Involuntary leg movements Cold flashes Withdrawal symptoms The withdrawal symptoms of prescription stimulants include: Depression Insomnia Sleepiness Apathy Seizures Drug craving The withdrawal symptoms of prescription depressants include: Seizures Depression Insomnia Confusion Anxiety Tremors Weakness Vomiting 16
17 Know the risks Being aware of the risks of prescription drug abuse and understanding all of the complications of prescription drug abuse will enable you to persuasively communicate the risks to others as a first step towards prevention. Parents for more information on ways to talk to your child about prescription drug abuse see Mini-course #4 (parents): Talking about prescription drug abuse with your child and for ways to prevent drug diversion in your home see Mini-course #5 (parents): Taking steps to prevent diversion in your home. Providers for more information about prescription drug abuse prevention see Mini-course #4 (providers): Medical management plans and disciplinary policies in your school. 17
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