5. Diazepam* (Valium)
6. Clonazepam* (Klonopin)
7. Lorazepam* (Ativan)
8. Codeine
9. D-propoxyphene (Darvon)
10. Methamphetamine
11. Misc. benzodiazepines*
12. PCP
13. Hydrocodone (Tussionex)
14. Amphetamine
15. Hashish
16. Chlordiazepoxide* (Librium)
17. Oxycodone
18. Temazepam* (Restoril)
19. LSD
20. Methadone
The drugs most likely to be abused are painkillers (especially opioids and narcotic analgesics), sedatives, tranquilizers, and stimulants. Of the top 10 prescribed drugs in the United States, 3 are narcotic painkillers. We obviously have a huge problem in the United States with addiction to narcotic painkillers. Shouldn’t somebody at the FDA, our government watchdog agency that we pay for with our taxes, be taking a hint from this statistic and taking some action?
Painkillers
Addiction to painkilling drugs is not the same as the use of these drugs by people with cancer or other illnesses who take them for legitimate pain. If anything, legitimate pain is undertreated in the United States because of the stigma and fear of drug addiction. This type of pain is what the drugs are made for in the first place, and they should be used accordingly. Nobody should have to suffer pain unnecessarily. There is no gain or heroism in this type of preventable suffering.
Painkillers with Potential for Abuse
* * *
If you have a legitimate need for painkilling drugs and have to take them for more than a week or two, you will eventually have to go through physical withdrawal from them. If this is done very gradually, it doesn’t need to be traumatic or painful. The people who get in trouble with these drugs are those who deny that they’re physically dependent on them. This denial is generally the strongest indicator that they’ve become physically and emotionally dependent.
For most abusers, the first introduction to painkillers is after surgery, a broken bone, a back injury, or treatment for headaches. If the drugs are taken for more than a week or two, physical dependence will begin and withdrawing from the drug becomes increasingly difficult as each day passes. Every time the person tries to stop taking the drug, the discomfort of withdrawal becomes confused with the original pain. Complicating the picture even more, the painkiller will dull emotional pain long after the physical pain has worn off. People will convince themselves, their families, and their physicians that the physical pain is still present, but it is really the withdrawal symptoms and emotional pain that are being treated.
Stimulants
Stimulant drugs prescribed under the guise of antidepressants or appetite suppressants are the next most commonly abused prescription drugs. These are sold on the street as uppers; most of the so-called legitimate drugs are variations of the street drug called speed or methamphetamine. These drugs create a false sense of confidence and energy, speed up the metabolism, increase the heart rate, and raise blood pressure. They can also cause irritability. Typically the abuser of these drugs is a woman who goes to her physician for anxiety, depression, or some other emotional problem. If she is overweight, lethargic, depressed, or diagnosed with adult attention deficit/hyperactivity disorder (AADHD), there’s a good chance that a stimulant will be prescribed.
Abuse of stimulants is common in college students and young adults who want to achieve in school or at work. It’s all too easy to get some Adderall or Ritalin from unethical Internet pharmacies, relatives, or friends. Both physical and psychological addiction is a common outcome. While the abuser may be amazed at his or her ability to go without sleep, read boring books, pay attention in class, and keep up with homework or work assignments, he or she may not know that these drugs can be damaging to the heart, brain, and nervous system.
What goes up must come down, and withdrawing from stimulant drugs can be extremely difficult, with severe rebound depression and weight gain.
Stimulants with Potential for Abuse
Amphetamines
Antidepressants
Caffeine
Dexedrine (dextroamphetamine)
Diethylpropion
Mazindol
Methamphetamines
Methylphenidate (Ritalin)
Phenmetrazine
Phenylpropanolamine (nonprescription, i.e., Dexatrim, Acutrim)
Stimulants such as Ritalin (methylpheni-date), Adderall (d-amphetamine), Desoxyn (methamphetamine), and Focalin (dexmethylphenidate HCl) are being prescribed left and right to treat so-called ADHD in children. If some of the names of these medications sound like street drugs to you, you’re not mistaken—many are identical to highly addictive street drugs. No long-term studies on the safety of these drugs for the developing nervous systems of young people have been completed, and evidence of their effectiveness at improving a child’s ability to learn or enjoy life is virtually nonexistent. There is strong anecdotal evidence that treatment with Ritalin can cause disfiguring tics—in fact, such strong evidence that in the small print of the prescribing information, doctors are warned not to prescribe the drug to children who have a family history of Tourette’s syndrome, a disorder that includes tics.
In our “pill for every ill” culture, children are being taught to take drugs instead of learning to ride out the normal ups and downs of life. What will the long-term effects be on the growing, changing, evolving brain chemistry of a child? We don’t know, and we may never know. What we do know is that antidepressants are no substitute for love, affection, a supportive and communicative family atmosphere, a good diet, and exercise.
Benzodiazepines
The benzodiazepines are a class of drugs widely used to treat anxiety, depression related to anxiety, and insomnia, and are generally used as tranquilizers. Most nonbarbiturate sleeping pills are benzodiazepines. There are other sedatives and tranquilizers not in this class, all of which are addictive, but for the most part they have been replaced by the benzodiazepines. You can pretty much assume that if you’re taking a drug for anxiety; to ease tension, nervousness, or stress; or to help you sleep, it has the potential for abuse. The barbiturates are another story, which will be covered next.
During the 1970s, hundreds of thousands of women became hooked on the trendy antianxiety drug Valium, which is a benzodiazepine. Their physicians reassured them that the drug wasn’t addictive, because the medical literature claimed it was only habit-forming in some people who were “prone to addiction.” Physicians also reassured women that the drug created a physical dependence only if it was taken in very high doses for a long period of time. Nothing could be further from the truth, but this ignorance sold millions of dollars worth of drugs to unsuspecting women who thought they were temporarily being helped through a hard time.
Possible Withdrawal Symptoms from Antianxiety Drugs
Let’s talk about the phrase “prone to addiction.” Although some people do tend to more easily become addicted than others, nearly any human being who is going through a hard time physically, emotionally, mentally, or spiritually is prone to addiction. It is human nature to try to correct an imbalance in the body or the psyche, and if a drug gives the illusion that balance has been achieved, it has the potential for abuse. When the physician in the white coat, that authority figure whom we have been trained not to question, tells us the pill will be good for us and solve our problem, few have the wherewithal to say, “No thanks.”
Drug addiction can begin as innocently as taking something to help you sleep or to help you through a difficult time in your life. Insomnia is a very common symptom of stress and anxiety. Physicians tend to regard the benzodiazepines as harmless temporary aids for people who are stressed, anxious, and not sleeping, but they are in fact quite addictive, interact dangerously with alcohol and many other drugs, and have lists of side effects as long as your arm. Please don’t ever be fooled into thinking these are benign, harmless drugs. There may be a time in your life when you
need to take them for some reason, but be vigilant and be aware that you will go through withdrawal when you stop taking them.
Antianxiety Drugs with Potential for Abuse
Alprazolam (Xanax)
Chlorazepate (Tranxene)
Chlordiazepoxide (Librium, Mitran)
Clonazepam (Klonopin)
Diazepam (Valium, Zetran, Dizac)
Flurazepam (Dalmane)
Halazepam (Paxipam)
Lorazepam (Ativan)
Meprobamate (not a benzodiazepine) (Equanil, Miltown)
Oxazepam (Serax)
Prazepam
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)
All of the so-called antianxiety drugs have the potential for abuse. When the short-acting benzodiazepines such as lorazepam (Ativan) came out, they were applauded for their diminished potential for abuse. Experience has shown us that the short-acting versions did, in fact, create physical dependence and withdrawal symptoms—right away, instead of over time.
Barbiturates
The barbiturates are a class of drugs widely acknowledged to be addictive but still occasionally prescribed. They were much more widely prescribed before the benzodiazepines came along. Their withdrawal symptoms can be severe enough to be fatal, and they deplete folic acid, a nutrient important for heart health and preventing birth defects. At this point, virtually no good reason exists for taking a barbiturate drug, though they are still prescribed, on occasion, for insomnia or as anticonvulsants. Some of the names of the barbiturates are phenobarbital (Solfoton, Bellergal), mephobarbital (Mebaral), amobarbital (Amytal), butabarbital (Butisol), secobarbital (Seconal), and pentobarbital (Nembutal).
Antidepressants
If you are prescribed an antidepressant, you are likely to get a selective serotonin reuptake inhibitor (SSRI) such as Prozac, Paxil, or Zoloft, or a serotonin/norepinephrine reuptake inhibitor (SNRI) such as Celexa or Effexor. These uppers raise levels of the feel-good brain chemicals serotonin and norepinephrine. They give some users increased energy and almost always create a sense of emotional detachment that makes coping with life’s stresses a little easier.
When taken by mouth, SSRIs and SNRIs can take days to weeks to kick in, so they aren’t often used by people who are looking to get high. Young people have been known, however, to grind the pills and snort them, which does produce a quick high. Only in recent years have these medications become affordable, since some have lost their patent protection and are no longer more costly than street drugs.
Those who end up with an addiction to these medications are usually those who are initially prescribed the drug for mild anxiety or depression, or even just to get them through a life stress or period of mourning. They take the medicine for a period of time, and when they try to stop, they may find themselves in the throes of terrifying, severe withdrawal.
Some people who take SSRI or SNRI drugs begin to escalate dosage on their own or with a doctor’s help when the old dose stops working—which is not an unusual circumstance. Others engage in a practice known as “chipping,” where they begin taking extra, unprescribed doses, often late in the day or in the early evening to rev up their energy or boost their spirits.
As might be expected, drug manufacturers claim that these drugs are not addictive, but hundreds of thousands of people who have had to withdraw from them might disagree. According to Dr. Joseph Glenmullen, a Harvard Medical School professor of psychiatry and author of Prozac Backlash (Simon & Schuster, 2000) and The Antidepressant Solution (Simon & Schuster, 2006), these drugs do meet the relevant criteria for addiction: the need for escalating doses, debilitating withdrawal, and cravings for the drug after stopping. These issues are far more common than the drugmakers would like to admit.
The long-term side effects of these medications can include visual hallucinations, sensations like electric shocks to the brain, nausea, dizziness, and anxiety. We have no idea what the long-term effect is of fiddling around with the brain chemistry this way, and there is mounting evidence that these drugs may be causing permanent changes in the brain. One in every 10 Americans has taken one of the SSRIs or SNRIs at some point. Many continue to use them for years on end, convinced that they have some sort of “biochemical imbalance” that requires the medication—a theory that has never been proven nor even given any significant scientific weight. When they stop taking it, they mistake withdrawal symptoms for a relapse into depression or anxiety and think they can’t be without the drug. This is a form of addiction.
I Don’t Know How to Heal You, So Take This Drug
Ironically, the prescription drugs most likely to be abused are those most likely to be prescribed when your physician doesn’t know how to treat your problem.
For example, conventional medicine is notoriously unable to help back pain. If you go to your physician with back pain, chances are you’ll be given painkilling drugs or undergo surgery, neither of which will heal the back. But since your physician doesn’t know what else to do and you are in terrible pain, he or she will keep prescribing the drugs for you. Every year thousands of people become hooked on painkillers that they first took for back pain. (If you have chronic back pain, we recommend that you read the book Healing Back Pain by John Sarno, M.D., Warner Books, 1991, before you do anything else.)
Chronic headaches are another source of pain that conventional medicine is often unable to heal effectively. The medical solution tends to be a potent painkiller when the cause is usually a hormonal imbalance, a food sensitivity, or chronic stress and tension.
Women who visit a physician’s office complaining of nervousness, lethargy, or depression are likely to be prescribed drugs. However, a conscientious physician will rule out physical causes such as nutritional deficiencies or hormone imbalances before pulling out the prescription pad. If no physical problem presents itself, a woman will likely benefit far more from a referral to a good counselor than she will from antidepressants or antianxiety drugs.
When your physician prescribes a drug for an illness he or she doesn’t know how to treat, try an alternative health care professional such as a naturopathic doctor, an acupuncturist, or a chiropractor.
When Are You Addicted?
If your physician prescribed it, the drug must be OK, right? When your physician prescribes drugs for a real medical need, such as for pain after surgery, that’s a legitimate use. But if you’re still taking the drug every day six weeks, six months, or six years later, you have a problem.
In spite of their extensive training in prescribing drugs, physicians are ill equipped to recognize the symptoms of drug addiction and even less well equipped to help a patient withdraw from drugs. Your physician is just as afraid of the stigma of having a drug-addicted patient as you are of being one. It’s much easier to write you another prescription than to take the time and trouble to help you through drug withdrawal—a painful, complicated, and emotionally wrenching process. To help you withdraw from a drug, find a different physician from the one who has been prescribing you drugs. Beware of physicians who insist that addictive drugs won’t hurt you; that’s their own form of denial, and it’s no help to you.
Keep in mind that two of the primary symptoms of addiction (versus a purely physical dependence) are (1) denial that there is a problem and (2) repeated attempts to stop taking the drug, followed by a relapse. One of the requirements for getting unhooked from a drug is having the personal honesty to admit there is a problem and the courage to follow through and take action.
In our culture of instant gratification, we tend to forget that qualities such as contentedness, inner calm, inner peace, and emotional balance are won through the accumulation of wisdom, experience, and introspection. The truth is that the vast majority of people prescribed a benzodiazepine, an antidepressant, or some other type of drug that affects the mind and emotions simply need some help making it over a rough spot in their lives. They need a sympathetic ear, somebody who will listen objectively an
d caringly.
The distinctions made by drug manufacturers and the medical profession between drugs that are “habit forming” and those that are “addictive” are strictly academic and seem to have been created largely to justify prescribing dangerous drugs. If you are hooked on a drug, the difference between one that is addictive and one that is habit forming is academic. Our definition of an addictive drug is one that creates a dependence that falls outside of a legitimate medical need. If you have been using a drug for so long that you find you can’t stop, you are addicted, regardless of what the drug is.
Guidelines for Safe Use of Medications
Patients are rarely given enough information about how to safely and effectively use their medication to avoid addiction. Here are some guidelines.
1. If you have abused any type of drug in the past, including alcohol, or even if you haven’t abused drugs but you know you have an addictive personality, tell your physician and your pharmacist and ask directly if the prescribed drug is likely to cause you a problem.
2. Ask your M.D. and your pharmacist if the drug you are being prescribed is addictive or habit forming, or if it could create a dependence. If the answer is yes, ask for detailed information, such as:
• Does this drug create a physical dependence?
• How long does it take to create a physical dependence on this drug?
• Will I have to go through physical withdrawal when I stop taking this drug? (If the answer is yes, ask your M.D. how he or she plans to help you do that.)
• Is there a drug I could take that is not addictive?
3. Ask your M.D. or pharmacist to explain precisely how you should take your medicine. Be sure the following information is on the container:
• How often to take it
• Whether it should be taken with or without food
• What it is for—for example, pain or indigestion
Prescription Alternatives Page 4