News at NCH
"Prescription Drug Addiction ­ An Under-Recognized Problem" By Allen Weiss, MD, MBA, President and CEO


Prescription Drug Addiction ­ An Under-Recognized Problem

April 1, 2010 - An estimated 20% of Americans use prescription drugs for non-medical reasons. This overuse or abuse of pain medications, sedatives or stimulants can easily seduce the brain’s “reward pathways” into desiring more medications than are needed or are therapeutic.

This downward spiral occurs with excess prescribing, loose control of “controlled substances” and the perceived need of some people to be either “up or down”. Over a period of time the drugs control the person and not the other way around where the person controls the drugs.

Moods can be altered with prescription medications and, when used appropriately by responsible patients and physicians, the therapeutic effects are very beneficial. However, without supervision patients can easily be lured by prescription drugs. Desiring to be either excited or tranquil—or some other mood or behavior alteration which is aided and abetted by prescription drugs—is a common first step to the misuse of drugs and eventual addiction.

Most people start by using medications prescribed by their physicians for real, legitimate reasons. Over the past two decades, prescription drugs have been much easier to obtain, contributing to the alarming fact that almost half of all Americans takes at least one medication, while one in six takes three or more medications. From 1997 to 2007, the use of prescription medication increased 72% while the population of the United States increased only 11%, according to the Henry J. Kaiser Family Foundation.

Granted, many of these medications are for medical conditions such as high blood pressure, elevated cholesterol, or diabetes, but a significant proportion are for mood alteration, pain, sleep or attention deficit disorder. At first, the drugs are helpful but when abused—either intentionally or by accident—the medications then cause physical and emotional harm to both the patient and his/her family.

This growing problem extends across the age spectrum. According to the National Institute of Drug Abuse, prescription drug abuse occurs in more than 17% of high school seniors. Another sobering statistic is that in 2000 43% of admissions from the Emergency Room for drug overdoses were due to prescription medication.

The mechanism for this addiction is now being elucidated. Researchers have found that Valium, Ativan, Xanax, heroin, marihuana and that entire family of prescription and illegal drugs share a common pharmacological brain pathway. These chemicals boost the calming action of gamma-aminobutyric acid (GABA), a neurotransmitter normally found in the brain.

GABA’s mechanism of action boosts the effect of dopamine on the brain which stimulates the “reward” pathway making people feel better. As the brain acclimates to having excess GABA and dopamine, it responds by decreasing the amount of these substances produced intrinsically. Basically, the brain becomes dependent on outside sources for pleasure.

As someone tries to withdraw from abused prescription drugs the following symptoms are common:

• Anxiety
• Paranoia
• Changes in mood—from a sense of well being to belligerence
• Increased sensitivity to sights and sounds, including hallucinations
• Altered activity levels—ranging from excessive sleeping to manic behavior
Obviously the best “treatment” is prevention. People can also increase the amount and beneficial effects of dopamine by exercising, eating well and generally taking care of themselves.

Fortunately, there are many excellent therapies available once the problem is recognized and addressed. Recently, Hazelden an internationally recognized leader in addiction has opened a treatment center in Naples. Breaking the cycle almost always requires help and support. You, your family, friends, work colleagues and professional care givers all need to be involved.

Prescription drugs are useful and appropriate when necessary. However, dependence and abuse are increasingly common. Individuals and physicians need to be on guard as we demand and prescribe, respectively, more and more medications.


Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.