Prescription Drug Misuse: Risks, Patterns, and Prevention

Introduction

Prescription drug misuse — the use of prescription medications in ways other than prescribed, or by someone other than the person for whom they were prescribed — is a major public health problem. According to SAMHSA, approximately 16.3 million Americans aged 12 and older misused prescription drugs in 2021. Prescription drug misuse is the second most common form of illicit drug use in the United States, after cannabis, and is associated with significant addiction, overdose, and other health consequences.

Key Definitions

Prescription drug misuse: Using a prescription medication in a way other than prescribed — including taking more than prescribed, taking someone else's medication, taking for a different reason than prescribed, or taking to get high.

Diversion: The transfer of prescription medications from the person for whom they were prescribed to another person. A major source of prescription drugs for misuse.

Doctor shopping: Visiting multiple healthcare providers to obtain multiple prescriptions for the same medication. A pattern associated with prescription drug misuse.

Prescription drug monitoring programs (PDMPs): State-run electronic databases that track prescriptions for controlled substances. Used to identify patterns of misuse and diversion.

Stimulant misuse: Misuse of prescription stimulants (Adderall, Ritalin) — particularly common among college students for academic performance enhancement.

Most Commonly Misused Prescription Medications

Opioid pain relievers: Opioids — including oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), and morphine — are the most commonly misused prescription drugs and the most dangerous. Prescription opioid misuse was the primary driver of the first wave of the opioid epidemic. Approximately 9.7 million Americans misused prescription opioids in 2021.

Benzodiazepines and other CNS depressants: Benzodiazepines (Xanax, Valium, Klonopin) and other CNS depressants (sleep medications including zolpidem) are commonly misused for their sedating and anxiolytic effects. Benzodiazepine misuse is particularly dangerous in combination with opioids, dramatically increasing overdose risk.

Prescription stimulants: Stimulants prescribed for ADHD — including amphetamine (Adderall) and methylphenidate (Ritalin) — are commonly misused, particularly among college students seeking academic performance enhancement. Stimulant misuse is associated with cardiovascular risks, psychiatric effects, and addiction.

Gabapentinoids: Gabapentin (Neurontin) and pregabalin (Lyrica) — medications used for nerve pain, seizures, and anxiety — are increasingly misused, particularly in combination with opioids. They enhance opioid effects and increase overdose risk.

Risk Factors for Prescription Drug Misuse

Research has identified several risk factors for prescription drug misuse:

History of substance use disorders: People with a history of addiction are at significantly elevated risk for prescription drug misuse. This is an important consideration when prescribing controlled substances.

Mental health disorders: Depression, anxiety, PTSD, and ADHD are associated with elevated rates of prescription drug misuse, often reflecting self-medication of undertreated symptoms.

Age: Young adults (18-25) have the highest rates of prescription drug misuse. Adolescents are also at elevated risk, particularly for stimulant misuse.

Access: Having prescription medications in the home — or having family members or friends with prescriptions — increases access and risk. Many people who misuse prescription drugs obtain them from family members or friends.

Chronic pain: People with chronic pain who are prescribed opioids are at elevated risk for developing opioid use disorder, particularly with long-term use at high doses.

Health Consequences

Opioid misuse: Prescription opioid misuse is associated with overdose, addiction, and transition to heroin and illicit fentanyl use. Many people who develop opioid use disorder began with prescription opioids.

Benzodiazepine misuse: Benzodiazepine misuse is associated with dependence, cognitive impairment, falls, and overdose (particularly in combination with opioids).

Stimulant misuse: Prescription stimulant misuse is associated with cardiovascular risks (increased heart rate and blood pressure), psychiatric effects (anxiety, paranoia, psychosis), sleep disruption, and addiction.

Gabapentinoid misuse: Gabapentinoid misuse is associated with sedation, respiratory depression (particularly in combination with opioids), and dependence.

Prevention Strategies

Prescriber education: Educating prescribers about the risks of prescription drug misuse and evidence-based prescribing practices — including risk assessment, informed consent, and monitoring — is essential for prevention.

Prescription drug monitoring programs (PDMPs): PDMPs allow prescribers to check a patient's prescription history before prescribing controlled substances, identifying patterns of misuse and diversion. Research has found that PDMP use is associated with reduced opioid prescribing and reduced opioid-related mortality.

Safe storage and disposal: Proper storage of prescription medications — in locked containers, out of reach of children and adolescents — reduces diversion. Unused medications should be disposed of through drug take-back programs or by mixing with an undesirable substance (coffee grounds, dirt) and discarding in household trash.

Patient education: Patients should be educated about the risks of prescription drug misuse, the importance of taking medications only as prescribed, and the dangers of sharing medications.

Treatment

Treatment for prescription drug misuse depends on the specific medication involved:

Prescription opioid use disorder: Treated with MAT (buprenorphine, methadone, or naltrexone) combined with behavioral therapies — the same approach used for heroin use disorder.

Prescription benzodiazepine use disorder: Treated with medically supervised tapering, ideally using a long-acting benzodiazepine, combined with behavioral therapies addressing the underlying anxiety or insomnia.

Prescription stimulant use disorder: Treated with behavioral therapies (CBT, contingency management) — no FDA-approved medications are available.

Frequently Asked Questions

Is taking someone else's prescription medication illegal?
Yes. Using a prescription medication that was not prescribed to you is illegal under federal law and the laws of all states. It is also dangerous — medications are prescribed based on individual medical history, and taking someone else's medication can cause serious harm.

Can I become addicted to a medication prescribed by my doctor?
Yes. Physical dependence can develop with many prescribed medications, including opioids and benzodiazepines, even when taken as prescribed. Addiction — characterized by compulsive use and loss of control — can also develop, particularly with long-term use at high doses. This does not mean that these medications should not be prescribed, but that they should be used with appropriate caution and monitoring.

What should I do with unused prescription medications?
Unused medications should be disposed of through drug take-back programs (many pharmacies and law enforcement agencies offer these) or by mixing with an undesirable substance and discarding in household trash. Do not flush medications down the toilet unless the label specifically instructs you to do so.

Key Takeaways

• Prescription drug misuse affects approximately 16.3 million Americans and is the second most common form of illicit drug use.
• The most commonly misused prescription drugs are opioids, benzodiazepines, stimulants, and gabapentinoids.
• Risk factors include history of substance use disorders, mental health disorders, young age, and access to prescription medications.
• Prevention strategies include prescriber education, PDMPs, safe storage and disposal, and patient education.
• Treatment depends on the specific medication involved and follows the same evidence-based approaches used for other substance use disorders.

Additional Resources

Related articles on Sobriety Navigator: Opioid Use Disorder, Benzodiazepine Dependence, Adolescent Brain Development and Addiction, Medication-Assisted Treatment.