Most drugs can be grouped into one of two main categories – prescription and over the counter medications.
Prescription-only drugs – drugs that require a prescription to buy
Over the counter (OTC) drugs – drugs that can be bought without a prescription
While many prescription drugs are safe and exhibit no potential for abuse, there are a significant amount of prescription drugs that can be addicting, even those used for legitimate medical conditions. Drugs deemed to carry the potential for abuse by the Drug Administration Agency (DEA) are called “controlled substances.” While many illegal drugs are controlled substances, some legal, prescription drugs are controlled substances as well.
All controlled substances are classified into categories called “schedules” depending on how likely they are to cause physical and/or psychological dependence. Below is a table showing the different schedules and examples of controlled substances belonging to each schedule.
Schedule Definition Examples
Schedule I Schedule I drugs have no currently accepted Heroin, LSD, marijuana
medical use and exhibit a high potential for abuse
Schedule II Schedule II drugs exhibit a high potential for abuse, Adderall, hydrocodone, oxycodone
potentially leading to severe psychological or
Schedule III Schedule III drugs exhibit a moderate potential for abuse Ketamine, Tylenol with codeine, anabolic
with a low-moderate risk for psychological or steroids
Schedule IV Schedule IV drugs exhibit a low potential for Xanax, Valium, Ativan, tramadol
abuse and low risk for psychological or
Schedule V Schedule V drugs exhibit a lower potential for abuse obitussin AC, Lyrica, Lomotil
than Schedule IV and a low risk for psychological or
It is important to note that while prescription-only controlled substances are completely legal for someone with a valid prescription to possess and take, it is illegal for anyone without a prescription to be in possession of a prescription-only controlled substance.
Some of the most common types of abused prescription drugs are listed below.
Opioids – Opioids are drugs that bind to opioid receptors in the brain. As prescription drugs, opioids are effective analgesics (painkillers) used in the management of both short-term and chronic pain. Opioids can be prescription drugs such as hydrocodone, oxycodone, morphine and fentanyl as well as illegal drugs such as heroin. Abuse of opioids is often associated with an intense high that can be incredibly addicting.
Stimulants – Stimulants are drugs that stimulate the central nervous system, increasing alertness and energy. Most prescription stimulants are used for the treatment of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). In individuals with these conditions, stimulants having a calming effect, however those who abuse the drug feel alert, hyperconfident and may engage in risky behavior while under the influence of the drug. Prescription stimulants include Adderall (dextroamphetamine salts), Ritalin (methylphenidate) and Vyvanse (lisdexamfetamine).
Depressants – Depressants are in many ways the “opposite” of stimulants in that they slow down the central nervous system and make a user feel more relaxed. Prescription depressants are often used to treat anxiety disorders as well as epilepsy. Examples of depressants includes benzodiazepines such as Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam) as well as barbiturates such as phenobarbital and butalbital. Long term use of depressants is associated with a significant risk for dependence and dangerous withdrawal symptoms such as seizures.
Steroids/Hormonal Products – Not all prescription drugs are abused because they make an individual feel high. Hormonal products such as testosterone is an example. Testosterone is a prescription-only controlled substance very similar to anabolic steroids, a dangerous class of performance-enhancing drugs used by some athletes to gain an unfair advantage.
You may hear two terms when reading about drug addiction, drug misuse and drug abuse. While similar, the differences between the two should be appreciated. Drug misuse is when a prescription drug is used for something other than its intended purpose while drug abuse is when an individual takes the drug with an intention to get high.
The fictional scenarios below illustrate examples of drug misuse vs drug abuse.
Drug Misuse – Mike was prescribed hydrocodone for pain following his wisdom teeth removal. He had some pills left over and decided to use it for a painful headache. Even though Mike has a valid prescription for hydrocodone, it was not prescribed to use for his headache. Mike engaged in prescription drug misuse.
Drug Abuse– Alex heard from a friend that hydrocodone can make him “feel high.” He knows that his grandmother had a prescription for hydrocodone and keeps it in the medicine cabinet. Alex steals some of the pills and takes them to get high. Because he did not have a prescription for hydrocodone and intentionally took them to get high, Alex has engaged in prescription drug abuse.
Overdose deaths due to prescription drug abuse is a major problem in the United States. The American Society of Addiction Medicine estimates that in 2015, 20,000 overdose deaths were due to prescription drugs.
The National Institute on Drug Abuse reports disturbing statistics regarding prescription drug abuse, particularly with teens and young adults.
Overdose deaths involving prescription opioids was nearly five times higher in 2016 than in 19991
4% of young adults aged 18-25 had abused a prescription drug within the past year
Approximately six percent of high school seniors had taken Adderall without a prescription in the past year
The signs of prescription drug abuse can vary widely depending on the individual. Many drug abusers can hide their substance abuse habit, however the side effects that a user experiences are often difficult to hide. Listed below are typical side effects of prescription drugs that may signal abuse.
Rapid weight loss
Feeling jittery / speaking fast
Irritability and moodiness
Depression and/or lack of motivation
Chronic fatigue or confusion
Regardless of whether someone is abusing a stimulant or depressant, they may show signs of drug craving if they are not able to obtain the drug. Users may also exhibit drug-seeking behavior such as deception or stealing in order to support their drug habit.
Because many who abuse prescription drugs also have a prescription for it, the following may also serve as red flags that signal abuse:
Attempting to refill prescriptions earlier than allowed
Visiting different doctors to obtain several prescriptions for the same drug, also known as “doctor shopping”
Visiting different pharmacies to obtain the drug from multiple sources
Addiction is, at its core, a disorder that significantly affects a user’s mental health. While prescription drugs are legal, it is important to keep in mind that they are no less dangerous than illegal drugs. Drug addiction is a difficult challenge to overcome, however there are many resources to help a user overcome their addiction.