Author: Claudia M. Elsig, MD

The words, drug addiction, tend to conjure a murky world of crime, desperate people, and illegal substances. We immediately associate addictive drugs with narcotics like marijuana, cocaine, amphetamines, or heroin.

Drug addiction, however, crosses the socioeconomic divide, and there are many high-functioning addicts, including those in the upper echelons of society. And it’s not just illegal drugs people fall victim to. 

Lurking in many home medicine cabinets are legal prescription drugs that are also highly addictive and have the potential for misuse. Prescription drug abuse is an epidemic affecting millions.

The silent epidemic

Misuse of prescription drugs is widespread and is prevalent across all socioeconomic groups. It’s not new – Marilyn Monroe, Elvis Presley, and Judy Garland all indulged in prescription drug use, with fatal results.¹

Many celebrities in recent decades have been open about their prescription drug addiction – in the 1980s, Jamie Lee Curtis became addicted to prescription painkillers after a cosmetic procedure. 

Eminem’s album, Recovery, details his addiction to prescription drugs.

The late Matthew Perry became addicted to painkillers after a jet-ski accident. Before his death, Perry received treatment for addictions to alcohol, Amphetamines, and Methadone. 

Prince and Michael Jackson are other prominent celebrities known to have struggled with prescription drug addictions that contributed to their deaths. 

Research shows recurring epidemics of pharmaceutical drug abuse in America over the past century.² Another study found the prevalence of prescription drug abuse escalated rapidly in the U.S., beginning in the late 1990s, and that opioids are the most commonly abused type of prescription drug.³

Now, according to America’s Center for Disease Control and Prevention, it has reached ‘epidemic’ proportions, with deaths from prescription drugs, particularly opioid analgesics, on a par with automobile accidents.² 

Earlier this year, the Economist reported that America’s ten-year-old fentanyl epidemic is still getting worse despite the government spending record levels to slow its growth.⁴

Previously, it was thought that the prescription drug epidemic was limited to the United States. Still, another study shows that the epidemic extends well beyond the U.S. There is a high rate of prescription pain reliever abuse in the E.U., with nonmedical prescription drug use in Europe highest in the UK, Spain, and Sweden.⁵

From medical use to abuse: how do people become addicted?

Prescription medications are used to treat legitimate mental and physical complaints. Doctors typically prescribe drugs like codeine, morphine, and methadone to treat conditions such as chronic pain, sleep disorders, anxiety disorders, and ADHD.

Unfortunately, these medications are highly addictive; for example, consider opiates like codeine or morphine. These drugs block pain, but this also results in a dopamine surge. Dopamine is the body’s chemical messenger that helps us feel pleasure. It is commonly referred to as the ‘feel good’ chemical.

Increasing tolerance to medication can cause a person to increase its quantity and frequency, and as addiction kicks in, people are more likely to take greater risks with their health to pursue that ‘feel good’ place. This scenario is commonly known as chasing the dragon.

Some responsibility lies with the physicians prescribing these drugs; it is up to them to monitor, limit the longevity of use, and educate people on the dangers. However, a person can quickly become addicted, even after one course, and most of these drugs can be sourced easily online. 

Who is susceptible to addiction?

Anyone who is prescribed medication, especially certain types of prescription drugs, can become addicted to them. Addiction does not discriminate and can affect people of all ages, intelligence, and backgrounds. The false perception that it only affects specific demographics can set the path for addiction without a person at first realising it. There is the idea that ‘addiction couldn’t happen to me.’

Most people start taking prescription medications without any awareness of the dangers and do so under the guidance of their doctor. Taking prescription medications for a short time and at the prescribed times and doses does not generally lead to addiction. Still, addiction is complex, and there are many risk factors to consider.

Even without these risk factors, taking regular medication over a long period can affect self-control and the ability to make good decisions. The longer a person is on prescription drugs, depending on the drug type, there is a higher chance they could become addicted to them.

The factors that can make a person at higher risk include:

• Existing mental health conditions, like bipolar disorder, anxiety, ADHD, or depression
• A high I.Q.
• Experiencing stress, isolation, or failed relationships
• Genetic predisposition – born into dependency (children of people with an addiction)
• Sensitivity to stimulants and alcohol

Studies show that mental and sexual health risk factors are associated with an increased likelihood of nonmedical prescription drug use.⁴

What types of prescription drugs are addictive?

The most commonly abused prescription drugs are prescription painkillers, prescription sedatives, and stimulant medications.

Prescription painkillers – the facts about opioids

Opioids are a class of drugs prescribed by doctors to relieve persistent, moderate, or severe pain. They are often given following surgery or after injury/physical trauma, and also for pain management in health conditions such as cancer. 

These medicines travel through the blood to the brain, attaching to receptors and blocking pain messages. By association, this also leads to feelings of pleasure, which is why they can become addictive. Fentanyl, similar to morphine but about 100 times more potent, is now abused at epidemic levels in the United States.²

Common opioids include codeine, hydrocodone (Vicodin®), oxycodone (OxyContin®, Roxybond®), morphine (Duramorph®, MS Contin®), and fentanyl (Actiq® and Fentora®). These are just some examples; there are many others.

Most opioids are made from the poppy plant or chemical substances in a laboratory.

Prescription sedatives – the facts about benzodiazepines

Benzodiazepines are a type of sedative medication, such as sleeping pills and minor tranquillisers. They are used to help people with anxiety, panic disorder, and insomnia as they slow down the activity of the nervous system and brain, reducing anxiety, relaxing muscles, and helping people sleep better. 

Benzodiazepines work by stimulating the release of the chemical gamma-aminobutyric acid (GABA). GABA is a neurotransmitter that makes the nervous system less active. They make people feel sleepy and hypnotic, but can have dangerous and deadly effects when misused.

Common benzodiazepines include Alprazolam (Xanax®), Diazepam (Diastat®, Valium®, Valtoco®) and Temazepan (Restoril®).

Prescription painkillers – the facts about stimulants

Other groups of drugs with addiction concerns are stimulants. These are generally prescribed to treat ADHD, narcolepsy, and obesity.

Stimulants are used to increase alertness, attention, and energy. They increase the levels of dopamine and norepinephrine in the brain. Norepinephrine is the hormone and chemical messenger that sends signals to constrict blood vessels, increasing blood flow and making the heart pump faster. Low levels of norepinephrine are evident in people with ADHD.

Common stimulants are Methylphenidate (Ritalin®), Dextroamphetamine (Dexedrine®), Amphetamine, and dextroamphetamine (Adderall®).

The psychological and physical toll of addiction to prescription medication

Addiction is more than physical dependency; it is a profound psychological and emotional struggle. What starts with an ordinary act of taking prescribed medication to help with a condition and manage pain, as recommended by and prescribed by a physician, can quickly become an uncontrollable compulsive need.

The psychological toll is huge, creating a cycle of shame, hopelessness, and emotional pain. People will often cover up the addiction, driving untreated psychological issues deeper. 

Prescription drug misuse can also exacerbate existing disorders and even induce new ones. Those caught up in the whirlwind of prescription drug addiction can experience mood swings, anxiety, depression, and suicidal thoughts.

There are also a whole host of unpleasant physical side effects.

The side effects of prescription opioids

• Increased tolerance – a need to take more to get the same pain relief
• Increased pain sensitivity
• Confusion
• Depression
• Dizziness
• Tiredness
• Nausea and vomiting
• A dry mouth
• Constipation
• Itchy skin
• Sweating

The side effects of prescription benzodiazepines (sleeping pills and minor tranquillisers)

• Drowsiness
• Light-headedness
• Confusion
• Dizziness
• Slurred speech
• Memory problems
• Muscle weakness
• Nausea
• Dry mouth
• Blurred vision

The side effects of prescription stimulant medications

• Decreased appetite – eating problems
• Anxiety
• Mood changes
• Paranoia
• Jitteriness
• Sleep problems – insomnia
• Tics
• Nausea
• Headaches
• Sweating
• Palpitations
• Shortness of breath
• Tachycardia
• Arrhythmias
• Pruritus

How to break the habit

When a person becomes physically dependent on any drug, it can be a difficult habit to break, and stopping suddenly will most likely cause withdrawal symptoms. The best way to break free from a prescription drug addiction is to seek qualified help and manage any withdrawal under a physician’s supervision. The drug can be withdrawn slowly, and dosage reduced over a set period. This slow and steady approach will prevent severe withdrawal symptoms.

If a person has developed strong addictive behaviours, supportive counselling or psychotherapy will be necessary to break the habit, understand behaviours that led to the addiction, and prevent relapse.

Getting help for prescription drug addiction at CALDA

CALDA Clinic is an award-winning addiction recovery and mental health rehabilitation private centre, treating high-profile UHNWIs one client at a time. CALDA recognises that addiction has nothing to do with weakness of character or lack of discipline but is instead a severe mental illness.

The CALDA technique de-emphasises reliance on prescription drugs, replacing them where possible with carefully managed micronutrients. The therapeutic programme involves six to eight hours per day, seven days per week, under the supervision of a personal lifestyle and diet coach, and includes intensive psychotherapy.

Please contact us to find out more and to schedule a private initial conversation with CALDA’s Medical Director, Dr Claudia M. Elsig.

Resources/references

1. Bukszpan, D. 28 Jun 2011. Celebrities Who Abused Prescription Drugs. cnbc.com [Accessed online 16 May 2024].
2. Herzberg D, et al. Mar 2016. Recurring Epidemics of Pharmaceutical Drug Abuse in America: Time for an All-Drug Strategy. Am J Public Health. 2016 Mar;106(3).
3. McHugh RK, Nielsen S, & Weiss RD. 28 Aug 2014. Prescription drug abuse: from epidemiology to public policy. J Subst Abuse Treat. 2015 Jan;48(1):1-7.
4. The Economist. 29 Feb 2024. America’s ten-year-old fentanyl epidemic is still getting worse. [Accessed online 17 May 2024]
5. Novak SP, et al. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry 16, 274 (2016). 
6. Klobucista, C & Ferragamo, M. 22 Dec 2023. Fentanyl and the U.S. Opioid Epidemic. Council on Foreign Relations. [Accessed online 16 May 2024].