Over $44 billion prescription and over-the-counter (OTC) drugs are produced each year in the USA (Statistical Abstracts 1991).  Although most people use these medications properly, a significant number do not. They might take them without a doctor’s prescription, use more than prescribed, or take them for reasons other than prescribed.

The National Institute on Drug Abuse (NIDA) Household survey showed that over 24 million people over the age of 12 reported having used one or more psychoactive drugs (sedatives, stimulants and analgesics, both prescribed and OTC) for non-medical purposes at some time in their lives. Stimulants and analgesics were the most widely used drug of abuse that fit this category.  Psychoactive drugs are abused because they directly affect the brain and the central nervous system (CNS), producing the desired effects. 

The elderly are at the greatest risk for misuse of medications because they often use many different types of medications to treat one or more illnesses.  Though this group comprises approximately 11 percent of the population, they consume one third of the prescription drugs sold each year.

STIMULANTS

Amphetamines and caffeine are stimulants used primarily to delay the onset of mental and physical fatigue and to treat problems such as hyperactivity in children.  Students studying long hours for exams, athletes who feel the drugs will improve their performance, and workers who want to stay awake on the job often use stimulants.

These drug compounds are often found in diet pills, which, if used improperly, can lead to anorexia nervosa. Anorexia nervosa is a pathological loss of appetite thought to be psychological in origin that is manifested in extreme dieting and excessive thinness.  Caffeine is also found in many beverages, pain medications and allergy and cold remedies.  Unusually high does or excessive use of stimulants over long periods of time can lead to anxiety, hallucinations, severe depression or physical and psychological dependence. For a strong stimulant such as caffeine in coffee and cola drinks, stimulants are an intimate part of our lives.

ANALGESICS

Some of most widely used analgesics, available in both prescription and OTC forms, include:

• Aspirin The most common form of analgesic used to treat fever, arthritis, and pain; possible side effects can include nausea, heartburn or the development of bleeding ulcers.  Aspirin should be taken with plenty of water or food to prevent stomach upset.  Reye’s syndrome (characterized by vomiting, swelling of the brain and liver can lead to death) may develop if aspirin is given to children with the flu or chicken pox. People with liver damage should avoid using aspirin.

• Acetaminophen (Tylenol) is used to treat aches, pains and fevers and is generally free from side affects.  Large doses or overuse of this drug may cause rashes, fevers or changes in blood composition.  People with kidney of liver problems should consult a doctor before using acetaminophen.

• Ibuprofen (Motrin, Advil, Nuprin) is used relieve pain associated with arthritis, menstrual cramping and discomfort, fever and muscles strains.  Possible side effects might include upset stomach, dizziness, drowsiness, headache or ringing in the ears.  Over use of this drug may lead to confusion, tingling in hands and feet and vomiting.

• Narcotic Analgesics These are prescription medications such as Oxycontin, Vicodin, Lortab, Opana, Codeine, Dilaudid, Darvocet, Percodan and Percocet.  They are widely used non-medically for their psychoactive effects and may be they most abused prescription medications.  They should never be used in combination with alcohol or sedatives.  Excessive use can cause respiratory arrest, shock, cardiac arrest, hallucinations, lack of coordination and rapid heartbeat.

ANTI-DEPRESSANTS

These are prescription medications used to treat depression, a disease affecting about 20 million Americans.  Some of the original drugs in this group were Nardil, Tofranil and Elavil. Although not technically an antidepressant, lithium, which is used to treat manic depression, is often included in this group.  The side effects of prolonged and excessive use of these drugs are excessive urination or thirst, diarrhea, vomiting, drowsiness, dizziness or muscle weakness.  Some newer antidepressants that have shown great promise in treating this disease are Wellbutrin, Prozac, and Zoloft.  The incidences of side effects with these newer antidepressants seem to be less than with the previously used medications.

SEDATIVE-HYPNOTICS AND TRANQUILIZERS

Benzodiazephines are the most widely prescribed tranquilizers and sleep-inducing medications.  They are also the most abused by the public.  Drugs used to treat anxiety and tension are Valium, Xanax, Ativan and Tranxene. Drugs used for sleeping are Dalmane, Resotril, and Halcion.  Possible side effects include drowsiness, lightheadedness, and poor coordination.  When the elderly use sleep–inducing Benzodiazephines, the possibility of “morning after hangover syndrome” is great.  Overuse of these drugs can lead to sleeplessness, respiratory difficulties, coma and even death.

BARBITURATES are less commonly prescribed medications used to treat anxiety and insomnia.  If improperly used, these drugs can cause an individual to feel depressed or experience respiratory difficulties.  Some examples are Phenobarbital, Seconal and Nembutal.  Non-barbiturates include Doriden, Placidyl and Chloral Hydrate. 

COUGH AND COLD PREPARATIONS  Colds are caused by viruses and typically last 7 to 10 days.  Most cold preparations are designed to treat specific cold symptoms and provide temporary relief from discomfort.  These medicines often contain pain relievers, decongestants, antihistamines and cough and suppressants.  Caution should be used when taking them, as they often cause drowsiness or excitability.  Most widely used cold remedies include the following:

• Antihistamines And Decongestants These medications are typically used to relieve itchy, watery eyes and to reduce congestion due to allergies, colds and flu.  They can also cause excitability or drowsiness.  Activities such as driving that require mental alertness should be avoided when taking these drugs.  OTC preparations containing antihistamines are often taken in excessive quantities to produce a high such as that experienced when abusing narcotics and sedatives.

• Antitussives and Expectorants Antitussives are cough suppressants used to treat painful, persistent coughs.  Expectorants are used to help clear mucous from the respiratory system.  Both medications may contain alcohol and some may contain narcotics, such as codeine to relieve pain and induce sleep.  Some may be addictive.  Young people may abuse these medications for the effects derived from alcohol use, as the alcohol content in some OTC preparations may be as high as 40 percent.

• Laxatives are among the most widely misused and abused OTC medications.  This is particularly true among the elderly and is due to misunderstanding of normal bowel function.  Use of laxatives should be restricted to short-term use for constipation, since chronic use leads to dependency.  This is primarily true of saline-type (Magnesium Citrate, Fleet Enema), stimulant-type (Ex-lax, Dulcolax), lubricants (Mineral Oil) and stool softeners (Colacs).  The last two types are useful with those who should not strain during defecation, such as heart patients, but may rapidly cause a laxative-dependent condition.  Laxative Abuse Syndrome (LAS) may lead to fluid and electrolyte imbalances as well as vitamin and mineral deficiencies.  The following guidelines when using laxatives are useful and may prevent their abuse: proper dietary fiber intake, adequate fluid intake and proper exercise.  Laxative users should remember that these drugs are only a temporary measure and should restrict intake to a one-week period unless specifically advised otherwise by their physician.

These medications should not be taken beyond the recommended number of days or in greater doses than indicated on the label or by a doctor.  Taking these medications for prolonged periods of time may cover up other illnesses or health problems.  A doctor should be notified in case of continued problems or new symptoms.

MISUSE AND DEPENDENCE

Misuse of prescription and OTC drugs can often lead to psychological and physical dependence.  People may use increased amounts to insure a sense of well being to treat unrelated illnesses or health problems or for nonmedical purposes.

Many medications contain alcohol and narcotics such as codeine, which can be addictive and life threatening.  Use of alcohol, a depressant, with some prescription and OTC drugs may inhibit or increase the drug’s effectiveness as well as cause depression, drowsiness, confusion and loss of coordination.  Combining OTC drugs with some prescription drugs can cause the same, or more harmful, types of reactions. 

PREVENTING DRUG MISUSE

Both prescription and OTC medications can be very helpful in the treatment of health problems and injuries.  The following are some points to remember about taking medication properly and preventing medication misuse, harmful reactions or drug interactions:

• Ask your doctor to read the OTC label information about the effects and/or side effects of drugs you take

• Take medications according to recommended dose and length of time

• Notify your doctor of any reactions to medications

• Dispose of any leftover prescription medications following the treatment of your illness or injury after checking with your doctor

• Inform your doctor of all medications you are currently taking, the dosages, and any allergies you may have to medications

• Do not use medications (prescription or OTC) to treat unrelated illnesses, pains, or injuries

• Discuss any special precautions you may need to take with use of medications.  As if there are any problems with combining them with certain foods, alcohol, or other prescription or OTC medicines

• If you are pregnant, always consult your doctor before taking any type of prescription or OTC medication

• Never share your prescription medication

• If you are unsure of the effects of a medication, ask your doctor or pharmacist to explain them