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How to spot the signs of prescription medication misuse
Concerned about a friend’s medication habits? Here’s how to know if it’s becoming a problem for someone you love, or for yourself.
When you think about someone who’s addicted to or misuses prescription medications, whom do you picture? Probably not your best friend, your favorite co-worker or yourself. But the fact is, medication misuse and substance use disorders are much more common than you might think. They can happen to anyone, old or young, of any economic background or ethnicity.
“The reality is that most people with substance use disorders don’t resemble the stereotypes,” says Rannon Arch. He’s an addiction program supervisor at Hazelden Betty Ford in St. Paul, Minnesota. “They have a job, a family and an illness they don’t recognize.”
The negative stereotypes are “a reflection of the stigma associated with addiction and unfortunately keep some people from seeking help,” he says.
How common is prescription medication misuse?
It’s natural for people to assume that medications prescribed by a doctor won’t become problematic. A doctor prescribed it, after all, so there’s a sense of security that comes with that. “Unfortunately, in reality, prescription addiction is one of the more common addiction categories,” says addiction expert Adi Jaffe, PhD. He’s a psychologist and CEO of the virtual substance use recovery platform IGNTD.
He says addiction to stimulants is incredibly common. Addiction to opioids such as oxycodone, and benzodiazepines such as Xanax® and Valium® are also common. About 6% of Americans over the age of 12 misuse these medications, says Jaffe.
What’s the difference between medication misuse and substance use disorder?
Medication misuse is taking medication in a way that doesn’t follow medical or legal guidelines. That could mean:
- Repeatedly taking a higher dose than your doctor prescribed. Maybe your prescription pain medication isn’t doing the trick, so you take 2 pills instead of 1 without checking in with your doctor. (Doing this once or twice, while not safe, is not misuse.)
- Using medication prescribed to someone else for a way it’s not intended.
- Using medication differently than prescribed — for example, crushing and snorting a tablet instead of swallowing it.
- Taking medication to feel high. This can start out as casual or a one-time experimental event, but it always carries the risk of addiction.
These behaviors used to be called “drug abuse,” but experts are moving away from this language because it’s shaming and stigmatizes the person experiencing it.
Substance use disorder is what’s commonly thought of as drug addiction. A person who misuses a medication can end up with a substance use disorder. It can develop when the repeated use of medications causes health issues — such as high blood pressure or sleeplessness — or interferes with daily life and responsibilities at home, work or school.
“Misuse and addiction are not the same, nor does addiction automatically follow misuse,” explains Arch. Using or misusing medications can cause changes in the brain that lead to addiction and substance use disorders. “But a lot of underlying factors — including genetics and your family and social environment — contribute to the onset of a substance use disorder, or addiction.”
In other words, the brain you were born with and your life experiences, including the pressures and difficulties you face every day, can play a role. (Remember, you don’t have to navigate these challenges alone. Find help here.)
“Addiction is a chronic condition and much more difficult to manage than general substance use or misuse, as there is both a physical and psychological element to it,” says Arch.
According to the most recent data from the U.S. Department of Health and Human Services, nearly 15% of people age 12 and up met the criteria for needing substance use treatment in 2020. Of the people who needed treatment but didn’t seek it, 97.5% didn’t think they needed help.
“People understandably look for every possible reason to differentiate themselves from the negative stereotype,” says Arch. “But no one sets out to become addicted. Not the young person drinking their first beer or smoking their first cigarette, and not someone taking their first medication.”
What types of medications are commonly misused?
Anything can be misused that creates a sense of euphoria, relaxation or pleasure. Misuse is also a risk with medications that provide relief from physical or psychological pain. The medication may be prescribed for an ailment, but it can tip over into misuse when you’re no longer taking it as prescribed or even for the reason it was prescribed. Some commonly misused prescription medications include:
- ADHD stimulants such as methylphenidate (Concerta® and Ritalin®)
- Anti-anxiety medications, including alprazolam (Xanax) and diazepam (Valium)
- Painkillers, including codeine, oxycodone (OxyContin®) and hydrocodone
- Sleep medications such as zolpidem (Ambien®)
While these medications are risky, it’s important to remember that prescription medications aren’t inherently “bad.”
“Medications help a lot of people to thrive and have a better quality of life,” says Arch. But some medications carry a risk of addiction no matter how helpful they are, and some people are more vulnerable to that risk than others,” he says. “The reality is any substance that alters the mind, body and mood can be addictive.”
Signs of prescription medication misuse
If you’re wondering whether you or someone you know may be misusing medication, here are some early signs to watch for:
- Continuing to take a medication, even after the prescription has expired. You may have a leftover prescription of an opioid from a previous surgery, for example, and you take the pills because you want to feel better.
- Delaying stopping the medication, even after planned treatment has ended. You may no longer have a medical need to take the medication, but you continue because you’re afraid to stop or you enjoy the effect.
- Increasing the dosage without talking to your doctor and requesting early refills.
- Engaging in “seeking” behavior when your supply has run out. This can include telling your doctor you lost your medication to get a refill. Or you may go to a new doctor to have an easier time getting a fresh prescription. You may even visit the emergency room or urgent care to ask for medication.
Signs of a substance use disorder
Once a substance use disorder has started to develop, some other signs and symptoms may crop up, including:
- A disruption in basic functioning, healthy living and relationships. You may start missing work or school, or you stop going to the gym or eating nutritiously. You may struggle with your relationships or feel sick and tired a lot.
- Acting in ways that go against your values to get the medication, such as stealing or lying. You might steal a loved one’s prescription or buy the medication illegally off the street or online. And while you feel guilty about these things, you continue to do them.
- Spending money on the medication, even if it creates a financial problem for you.
- Having intense cravings for the medication or urges to use it.
- Trying to quit and being unable to do so.
- Taking the medication specifically to get high.
What can you do if medication misuse is a problem for you?
“The earlier you can start a conversation with a loved one or your care provider, the better,” says Arch. Because misuse can lead to addiction in some people, addressing misuse can nip a problem in the bud. “Addiction is a progressive disease, meaning it typically gets worse with time. It progresses from mild to moderate to severe and late stage. The earlier we recognize and address it, the better.”
If you are misusing medication
Call your doctor and ask for a screening for substance use disorder. Your doctor and specialty care providers are trained to help, not to be judgmental, says Arch. “There is nothing to be embarrassed about. We all carry some risk for substance use disorder.”
Call the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP (4357). You can ask for a referral or a list of local support groups and organizations. It’s free, confidential, open 365 days a year, and they speak both English and Spanish.
If you’re worried about a friend or family member:
- Prepare in advance for a conversation by writing down some of the things you’re concerned about, says Arch.
- Approach your loved one when they’re sober, not under the influence.
- “Talk about the effect substance use has had on whatever aspects of life they care about most — perhaps family, children and work, for example,” says Arch.
- Be compassionate and use “I” statements to describe how you feel.
- Ask how you can support them.
- “Accept that no matter how much you care about and love them, you can’t control their behavior,” says Arch.
There is an alternative if you or a loved one is struggling with prescription medication misuse or a substance use disorder, says Arch. “You can take a step in the opposite direction toward help. Good treatments are available, and many people are recovering. You are worthy of help — everyone is.”
Finally, an ounce of prevention is worth a pound of cure. If you are prescribed an addictive medication, ask if there is a non-addictive alternative. You can also ask your doctor for a plan to taper off the medication. And don’t leave medications you’re no longer using lying around. It can be a temptation for anyone, including visitors, to grab it. Safely disposing of medications is easier than you think. Learn more.
Statistics on general drug misuse and addiction: Substance Abuse and Mental Health Services Administration. "2020 National Survey of Drug Use and Health (NSDUH) Releases, Highlights"
Statistics on prescription drug misuse: National Institutes of Health / National Institute on Drug Abuse (2020). "Misuse of Prescription Drugs Research Report: What is the Scope of Prescription Drug Misuse"
Signs of prescription drug misuse:
- US National Library of Medicine/MedlinePlus (2021). "Prescription Drug Misuse"
- Mayo Clinic (n.d.). "Prescription Drug Abuse"
Substance abuse and health conditions: Public Health Reviews (2017). "Substance Use and Associated Health Conditions Throughout the Lifespan"