Substance use - prescription drugs

Common types of medicines that are misused include depressants, opioids, and stimulants.

DEPRESSANTS

These medicines are also known as tranquilizers and sedatives. They are prescribed to treat anxiety and sleep problems.

Types of medicines and their street names include:

• Barbiturates, such as Amytal, Nembutal, phenobarbital, Seconal. Street names include barbs, phennies, reds, red birds, tooies, yellows, yellow jackets.
• Benzodiazepines, such as Ativan, Halcion, Klonopin Librium, Valium, Xanax. Street names include bars, benzos, blues, candy, chill pills, french fries, downers, planks, sleeping pills, totem poles, tranks, zanies, and z-bar.
• Other sleep medicines, such as Ambien, Sonata, Lunesta. Street names include A-, zombie pills.

When used to get high, they cause feelings of well-being, intense happiness, and excitement. As street drugs, depressants come in pills or capsules and are usually swallowed.

Harmful effects of depressants on the body include:

• Decreased attention span
• Impaired judgment
• Lack of coordination
• Lowered blood pressure
• Memory problems
• Slurred speech

Long-time users may have life-threatening withdrawal symptoms if they try to stop the drug abruptly.

OPIOIDS

Opioids are powerful painkillers. They are prescribed to treat pain after surgery or a dental procedure. Sometimes they are used to treat severe cough or diarrhea.

Types of opioids and their street names include:

• Codeine. There are many medicines that contain codeine as an ingredient, especially ones for cough such as Robitussin A-C and Tylenol with codeine. Street names for codeine alone include captain cody, cody, little c, and school boy. For Tylenol with codeine, street names include T1, T2, T3, T4, and dors and fours. Codeine syrup mixed with soda can have street names such as purple drank, sizzup, or Texas tea.
• Fentanyl. Drugs include Actiq, Duragesic, Onsolis, and Sublimaze. Street names include apache, china girl, china white, dance fever, friend, goodfella, jackpot, murder 8, percopop, tango and cash.
• Hydrocodone: Drugs include Lorcet, Lortab, and Vicodin. Street names include fluff, hydros, v-itamin, vic, vike, Watson-387.
• Morphine. Drugs include Avinza, Duramorph, Kadian, Ormorph, Roxanol. Street names include dreamer, first line, god's drug, M, miss emma, mister blue, monkey, morf, morpho, vitamin m, white stuff.
• Oxycodone. Drugs include Oxycontin, Percocet, Percodan, Tylox. Street names include cotton, hillbilly heroin, o.c., ox, oxy, oxycet, oxycotton, percs, pills.

When used to get high, opioids cause a person to feel relaxed and intensely happy. As street drugs, they come as powder, pills or capsules, or syrup. They can be swallowed, injected, smoked, put into the rectum, or inhaled through the nose (snorted).

Harmful effects of opioids on the body include:

• Constipation
• Dry mouth
• Confusion
• Lack of coordination
• Lowered blood pressure
• Weakness, dizziness, sleepiness

In high doses, opioid intoxication can result, which can cause breathing problems, coma, or death.

STIMULANTS

These are medicines that stimulate the brain and body. They make the messages between the brain and body move faster. As a result, the person is more alert and physically active. Stimulants such as amphetamines are prescribed to treat health problems such as obesity, narcolepsy, or attention deficit hyperactivity disorder (ADHD).

Types of stimulants and their street names include:

• Amphetamines, such as Adderall, Biphetamine, and Dexedrine. Street names include bennies, black beauties, crosses, hearts, LA turnaround, speed, truck drivers, uppers.
• Methylphenidate, such as Concerta, Metadate, Quillivant, and Ritalin. Street names include JIF, kibbles and bits, MPH, pineapple, r-ball, skippy, the smart drug, vitamin R.

When used to get high, stimulants cause a person to feel excited, very alert, and have increased energy. Some people use the medicines, especially amphetamines, to help them stay awake on the job or to study for a test. Others use them to boost their performance in sports.

As street drugs, they come as pills. They can be swallowed, injected, smoked, or inhaled through the nose (snorted).

Harmful effects of stimulants on the body include:

• Heart problems, such as fast heart rate, irregular heartbeat, increased blood pressure
• High body temperature and skin flushing
• Loss of appetite and weight loss
• Memory loss and problems thinking clearly
• Delusions and hallucinations
• Mood and emotional problems, such as aggressive or violent behavior
• Restlessness and tremors

You usually do not get addicted to prescription medicines when you take them at the right dosage to treat your health condition.

Addiction means your body and mind are dependent on the drug. You are not able to control your use of it and you need it to get through daily life.

Drug use over a period of time can lead to tolerance. Tolerance means you need more and more of the drug to get the same feeling. And if you try to stop using, your mind and body may have reactions. These are called withdrawal symptoms, and may include:

• Strong cravings for the drug
• Having mood swings from feeling depressed to agitated to anxious
• Not being able to concentrate
• Seeing or hearing things that are not there (hallucinations)
• Physical reactions may include headaches, aches and pains, increased appetite, not sleeping well
• Life-threatening symptoms in long-time users of certain drugs

Treatment begins with recognizing there is a problem. Once you decide you want to do something about your drug use, the next step is to get help and support.

Treatment programs use behavior change techniques through counseling (talk therapy). The goal is to help you understand your behaviors and why you use drugs. Involving family and friends during counseling can help support you keep you from going back to using (relapsing). Treatment programs also teach you how to better deal with situations that led you to use or to relapse in the past.

With some drug addictions, such as opioids, medicines may also be used to help reduce the effects of opioids on the brain. Other medicines may be used to lessen cravings and withdrawal symptoms.

If you have severe withdrawal symptoms, you may need to stay at a live-in treatment program. There, your health and safety can be monitored as you recover.

As you recover, focus on the following to help prevent relapse:

• Keep going to your treatment sessions.
• Find new activities and goals to replace the ones that involved drug use.
• Spend more time with family and friends you lost touch with while you were using. Consider not seeing friends who are still using.
• Exercise and eat healthy foods. Taking care of your body helps it heal from the harmful effects of drug use. You will feel better, too.
• Avoid triggers. These triggers can include the people you used drugs with. Triggers can also be places, things, or emotions that can make you want to use again.

Resources that may help you on your road to recovery include:

• LifeRing - www.lifering.org/
• National Coalition Against Prescription Drug Abuse - ncapda.org
• SMART Recovery - www.smartrecovery.org/
• Partnership for Drug-Free Kids - drugfree.org/article/medicine-abuse-project-partners/

Your workplace employee assistance program (EAP) is also a good resource.

Contact your health care provider if you or someone you know is addicted to prescription drugs and needs help stopping. Also contact your provider if you are having withdrawal symptoms that concern you.

Substance use disorder - prescription drugs; Substance abuse - prescription drugs; Drug abuse - prescription drugs; Drug use - prescription drugs; Narcotics - substance use; Opioid - substance use; Sedative - substance use; Hypnotic - substance use; Benzodiazepine - substance use; Stimulant - substance use; Barbiturate - substance use; Codeine - substance use; Oxycodone - substance use; Hydrocodone - substance use; Morphine - substance use; Fentanyl - substance use

Centers for Disease Control and Prevention website. Overdose prevention: preventing opioid overdose. www.cdc.gov/overdose-prevention/prevention/. Updated May 8, 2024. Accessed May 23, 2024.

Kowalchuk A, Reed BC. Substance use disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 50.

National Institute on Drug Abuse website. Misuse of prescription drugs research report. www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/overview. Updated June 2020. Accessed May 23, 2024.

Weiss RD, Liebschutz JM. Drug use disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 365.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.