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Drug Classifications: Prescription Drugs

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There are various types of prescription drugs available on the market, each belonging to a specific drug class. This article serves as a guide to the different classifications of prescription drugs available.

Prescription drugs have a variety of therapeutic uses, including pain management, anxiety reduction, sleep initiation, and management of attention-deficit/hyperactivity disorder (ADHD) symptoms. Although beneficial when taken exactly as prescribed, these drugs have varying potentials for misuse, abuse, and addiction. Read on to learn about the use and abuse of opioids, benzodiazepines, non-benzodiazepine sedatives, and stimulants.

Therapeutic Use

There are several categories of prescription drugs. Below are 4 commonly prescribed classes of drugs that each have distinct abuse potential:1-6

  • Opioids: Opioids can be used to treat severe pain after surgery or injury, pain associated with advanced cancer, and some chronic pain conditions. Some examples of prescription opioids include OxyContin, Vicodin, Percocet, fentanyl, codeine, and morphine.
  • Benzodiazepines: Benzodiazepines depress or inhibit certain central nervous system (CNS) processes and are prescribed to treat anxiety, panic attacks, seizures and, less commonly, insomnia. They are also used for the management of alcohol withdrawal symptoms. Xanax, Ativan, Klonopin, Valium, and Restoril are commonly used benzodiazepines.
  • Non-Benzodiazepine Sedatives: Non-benzodiazepine sedatives are also used to manage insomnia as well. Some examples of these prescription medications are Ambien, Sonata, and Lunesta.
  • Stimulants: Stimulants are often prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and sometimes depression that has been unresponsive to other medications. Some examples of prescribed stimulants are Adderall, Ritalin, and Concerta.

Prescription Drug Abuse

Prescription drugs can be helpful for people struggling with a variety of physical and mental health issues; however, many people abuse them for their desirable effects. For example:2,3,5,7

  • Opioids have a high potential for abuse, as they can elicit a rewarding, euphoric sensation.
  • Benzodiazepines also create pleasurable and calming feelings. They are often abused along with other substances, such as cocaine and alcohol. For example, benzodiazepines relieve side effects associated with cocaine use, such as agitation and irritability. They are also combined with alcohol to amplify its intoxicating effects.
  • Non-benzodiazepine sedatives, such as Ambien, can produce feelings of relaxation and well-being when abused.
  • Stimulant medications increase alertness, attention, energy, and can help you stay awake. These medications therefore are often abused by students as study aids.

Are Prescription Drugs Safe to Abuse?

The misuse and abuse of prescription drugs is a major problem in the United States. It is estimated that approximately 54 million Americans have misused prescription medications at least once in their lifetime.8 Misuse of these medications includes taking higher doses than prescribed, taking more frequent doses than directed, taking someone else’s prescription medication, or simply taking them to get high.9

It is a common misconception that misusing prescription drugs is safe due to them being legal and prescribed by physicians.8 However, they are not meant to be used in any way other than directed by a doctor. When people abuse prescription drugs, the risk of experiencing adverse consequences increases greatly.

Potential Dangers

Abusing prescription medications carries dangers that are similar to those of using illicit drugs. Some of the dangers associated with these drugs are as follows:15

  • Opioids:11
    • Drowsiness
    • Slurred speech
    • Attention and memory problems
    • Nausea and vomiting
    • Severe constipation
    • Respiratory depression
    • Overdose (which includes signs like slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and even death)
  • Benzodiazepines:3
    • Paranoia
    • Hallucinations
    • Aggression
    • Delirium
    • Slurred speech
    • Slowed reaction time
    • Impaired coordination
    • Restlessness
  • Non-benzodiazepines sedatives:4,16
    • Incoordination
    • Impaired cognition
    • Increased risk of falls
    • Hallucinations
    • Exacerbation of depression or suicidal ideation
    • Complex sleep related behaviors (e.g., somnambulism, “sleep driving”)
  • Stimulants:5,6
    • Increased blood pressure, heart rate, and breathing rate
    • Elevated body temperature
    • Irregular heartbeat
    • Cardiac arrest
    • Stroke
    • Malnutrition
    • Seizures
    • Hostility
    • Paranoia
    • Hallucinations

Where to Find Help

Chronic prescription drug abuse can also lead to physical dependence and addiction. Once physical dependence develops, you may need to continue using the drug to avoid experiencing withdrawal symptoms. This can create a problematic cycle of substance abuse consisting of many attempts to quit followed by a relapse to relieve the unwanted symptoms, which may ultimately lead to an addiction. Addiction is characterized by compulsive and uncontrollable use despite significant impairment and distress in many aspects of a user’s life.

If you are struggling with an addiction to prescription drugs, help is available to you in the form of detox and substance abuse treatment programs.

Detoxification is the process by which the body eliminates the last traces of any harmful substances.14 Effective detox programs often employ medical care to prevent or address complications, psychiatric support, and follow-up addiction treatment planning. That being said, detox protocol can differ depending on the prescription drug that you’re addicted to.

In the case of opioids, detox treatment may consist of:17,17

  • Medication assisted treatment (MAT): Methadone and Suboxone are two medications that can alleviate withdrawal symptoms and decrease cravings. They are often used to manage withdrawal but can also be used as maintenance treatment to reduce the risk of relapse.
  • 24-hour care: Substance Abuse and Mental Health Services Administration (SAMHSA) recommends 24-hour detox treatment for opioid dependence due to the painful withdrawal symptoms and possible complications that may arise.

SAMHSA stresses the importance of receiving 24-hour care in the form of hospital or inpatient detox for withdrawal from sedatives due to the risk of life-threatening seizures. You should only seek outpatient detox once you’ve been evaluated by a medical professional who has confirmed you have little to no risk of experiencing a complicated withdrawal. There is no replacement medication used to manage withdrawal from benzodiazepines or non-benzodiazepine sedatives. Typically, physicians create a gradual tapering schedule in which the patient slowly weans off of the sedative they were already taking.18 If the sedative is short-acting, the detox team may switch the patient to a longer-acting sedative, such as clonazepam (Klonopin) or chlorodiazepoxide.18 This detox process may take weeks or even months, depending on the designated tapering plan.18

Stimulant withdrawal syndrome is not typically fatal, although profound depression can lead to suicidal thoughts and attempts. Although around-the-clock detox support isn’t typically necessary, it’s still important to get evaluated by a doctor or mental health professional before choosing the level of care that is right for you. There are no FDA-approved medications for the management of stimulant withdrawal but some may help treat some symptoms. Patients struggling with insomnia may receive Benadryl, trazodone, or Vistaril to help them sleep. Some researchers are investigating the efficacy of Modafinil, which is prescribed to treat narcolepsy and has stimulant properties, and Remeron, an antidepressant, in managing stimulant withdrawal but further research needs to be conducted.18

It is important to be aware that although detox programs can keep you safe while your body adjusts to the absence of the abused drug, they tend to be short-term programs that last for a few days to a couple weeks, depending on the drug and the program’s tapering schedule. Longer-term substance abuse treatment programs that address the underlying issues linked to substance abuse will likely be necessary for successful recovery.

Drug addiction treatment programs typically include group and/or individual therapy sessions that can help support you in building healthy coping skills to maintain sobriety and avoid relapse. There are a variety of substance abuse treatment settings, such as:

  • Inpatient: Inpatient treatment programs require that you stay at the treatment location for the duration of the program, which can last anywhere from 30 to 90 days, or longer, if necessary. During your stay, you will have the opportunity to engage in a variety of services including individual therapy, group counseling, family therapy, peer support meetings, and healthy social activities.
  • Outpatient: Outpatient treatment programs provide you with the freedom to continue working, attending school, and fulfilling home obligations while recovering from addiction. These programs include attending scheduled group or individual sessions led by chemical dependency counselors. During these sessions, you will learn about drug use and its consequences, as well as identify and cope with triggers that lead to use. There may also be a peer support component to outpatient settings.
  • Holistic: Holistic approaches include healing the whole person, including mind, body, emotions, and spirit, and finding balance within all of these areas. These programs often integrate holistic approaches and traditional approaches, such as psychotherapy, to help you obtain and maintain sobriety.
  • Luxury: Luxury programs combine upscale amenities, such as gourmet meals, massage therapy, and spa treatments, with traditional treatment modalities, such as individual and group therapy, to increase comfort throughout the recovery process.
  • Executive: These programs specialize in meeting the needs of high-powered business executives who wish to continue working while recovering from an addiction. Amenities include high-speed internet, private work rooms, and private phone access.
  • Population-specific: Population-specific treatment programs provide treatment to a certain group of people, such as male-only programs, female-only programs, or programs specifically for teens. These programs may help you connect with others who have had similar experiences, as well as increase your comfort within the program.

Even after you have completed a detox and substance abuse treatment program, it is important to continue your care by participating in therapy sessions and building a solid foundation of coping skills. Ongoing support in the form of aftercare can help to reduce the risk of relapse.

Sources

  1. National Institutes of Health. (2011). Opioids and Chronic Pain.
  2. National Institute on Drug Abuse. Opioids.
  3. Drug Enforcement Administration. (2013). Benzodiazepines: (Street Names: Benzos, Downers, Nerve Pills, Tranks).
  4. Diem, S. J., Ewing, S. K., Stone, K. L., Ancoli-Israel, S., Redline, S., Ensrud, K. E., and the Osteoporotic Fractures in Men (MrOS) Study Group. (2014). Use of Non-Benzodiazepine Sedative Hypnotics and Risk of Falls in Older MenJournal of Gerontology & Geriatric Research3(3), 158.
  5. National Institute on Drug Abuse. (2016). Misuse of Prescription Drugs: What Are Stimulants?
  6. National Institute on Drug Abuse. (2014). Stimulant ADHD Medications: Methylphenidate and Amphetamines.
  7. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  8. National Institute on Drug Abuse. (2016). Misuse of Prescription Drugs: What Is the Scope of Prescription Drug Misuse?
  9. National Institute on Drug Abuse. (2016). Misuse of Prescription Drugs: Summary.
  10. National Institute on Drug Abuse for Teens. (2017). Prescription Drugs.
  11. Substance Abuse and Mental Health Services Administration. (2016). Opioids.
  12. Hajak, G., M?ller, W.E., Wittchen, H.U., Pittrow, D., and Kirch, W. (2003). Abuse and Dependence Potential for the Non-Benzodiazepine Hypnotics Zolpidem and Zopiclone: A Review of Case Reports and Epidemiological Data. Addiction, 98, 1371–1378. 
  13. Substance Abuse and Mental Health Services Administration. (2016). Stimulants.
  14. National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
  15. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  16. Food and Drug Administration. (2008). Ambien.
  17. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
  18. SAMHSA. (2015). Detoxification and Substance Abuse Treatment: A Treatment
    Improvement Protocol TIP 45
    .

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