Last year, numerous news stories detailed that Kim Kardashian allegedly misused a diabetes drug for weight loss ahead of her Met Gala appearance wearing Marilyn Monroe’s iconic dress. Following this (and other influencers praising anti-diabetic drugs for enhancing weight loss), these drugs were suddenly in high demand, leaving a shortage for those who really needed it to manage their diabetes. With this in mind, we collaborated with Dr Samantha Miller (MB CHB) to share insight into the topic of misusing prescription drugs, as well as discussing the issue of microdosing. Read on to find out more…

packs of pills

Misusing Prescription Drugs

Prescription drug misuse is the use of any prescribed medication other than the dose and regime recommended by a healthcare professional. This usually means taking a higher dose than prescribed or using the drug more often. However, it also refers to taking a smaller amount than prescribed, for example, microdosing.

Prescription drug misuse also refers to using a drug for something other than its intended purpose, for example utilizing opiate analgesia for anxiolytic and sedative effects rather than pain relief. It can also mean taking a prescription drug prescribed to someone else, even if it’s for a valid medical condition. Last but not least, prescription drug misuse also refers to the non-medical use of drugs to feel euphoric.

Opioids, stimulant medications, sedatives, hypnotic drugs, and muscle relaxants are among the most commonly misused prescription drugs. These prescriptions could be habit-forming, especially if someone has a history of addictive behaviours like smoking or alcohol use.

Misusing Prescription Stimulants

Common prescription stimulants include methylphenidate (e.g., Ritalin) and amphetamines (e.g., Adderall). These drugs are prescribed to treat conditions such as attention deficit hyperactivity disorder (ADHD) and narcolepsy.

Some people take these medications as “study drugs”, to improve cognitive performance (academic or work performance) or to gain a competitive edge at work or school. Older adults may misuse prescription stimulants to improve concentration and memory. As well as to improve cognitive performance, they may also be used to remain awake for extended periods, to enhance athletic performance. Appetite suppression is a common side effect of prescription stimulants, so prescription stimulant drugs may also be misused for weight loss.

Common symptoms of someone misusing prescription stimulants might include: increased alertness; increased body temperature; increased blood pressure; irregular heartbeat; reduced appetite; insomnia; restlessness; weakness and muscle aches; anxiety, agitation, paranoia. Misuse can lead to many health problems, including seizures and hallucinations.

Misusing Prescription Opioids

Opioids make people feel relaxed and euphoric. Some people use them for non-medical reasons, such as the euphoric effects (to feel good and get “high”). Others misuse prescription pain pills to manage chronic pain or stressful situations, or to self-treat conditions such as anxiety and depression. People who have developed a prescription opioid addiction may take the drug to avoid withdrawal symptoms. Common symptoms of someone misusing prescription opioids might include: poor reflexes; constipation; confusion; nausea and sickness; slowed breathing; drowsiness and tiredness; hyperalgesia (increased sensitivity to pain) with high doses. Slowed or stopped breathing can lead to hypoxia (lack of oxygen) in the brain, which can cause permanent brain.

Misusing Prescription Depressants

Prescription depressants reduce central nervous system activity, such as benzodiazepines (e.g., Valium, Xanax), sleeping pills, and muscle relaxants. These drugs are prescribed to treat conditions such as anxiety, sleep disorders, and epilepsy. People often misuse prescription depressants to self-medicate, e.g., for anxiety or depression, for pain relief, for their calming effects, or to manage sleep.

Common symptoms of someone misusing prescription depressants might include: confusion and memory-recall issues; difficulty concentrating and memory problems; drowsiness and tiredness; dizziness; slurred speech; slowed breathing. As above, slowed or stopped breathing can lead to hypoxia (lack of oxygen) in the brain, which can cause permanent brain damage or coma. Overdose and death are also risks of misusing prescription depressants.

Misusing Prescription Sedatives, Hypnotics, and Tranquilizers

Prescription sedatives include benzodiazepines (e.g., Valium, Xanax), sleeping pills, some antidepressants, and some antihistamines. These drugs reduce central nervous system activity and are used to treat conditions such as anxiety, sleep disorders, mental health conditions, and allergies. People often misuse prescription sedatives to self-medicate e.g., anxiety or depression, for pain relief, for relaxation, or to manage sleep.

Hypnotics and tranquilisers are also often abused by people who struggle with anxiety or insomnia. Abruptly stopping sedatives, hypnotics, tranquilizers, and anti-anxiety medicines can lead to seizures and withdrawal symptoms.

Misusing Other Prescription Drugs

Some medicines used to manage diabetes, such as Metformin, sulphonylureas, and insulin can also be misused. These anti-diabetic drugs are usually misused to enhance weight loss. Other drugs that can be misused include medications used to treat thyroid disorders (e.g., levothyroxine), medicines used to facilitate weight loss (e.g., Orlistat and Naltrexone), and steroids.

Risks, and Prescription Drug Addiction

Side effects of prescription drug misuse depend on the drug being misused, however, can include low blood pressure, slowed breathing, heart problems, seizures, hallucinations, memory problems. It can include worsening of long-term health conditions, drug dependence, overdose, and addiction.

Prescription drug addiction is a substance use disorder characterized by an individual utilizing a prescribed drug for reasons other than its intended purpose and becoming physically or psychologically dependent on it. It can include medicines prescribed to the individual or medications prescribed to someone else.

Most prescription drug addictions occur with drugs that cause pleasurable, relaxing, energizing, or euphoric effects. These include stimulants, sedatives, anti-anxiety medications, and pain medications. Early signs and symptoms of prescription drug addiction can be challenging to spot; however, there are often noticeable behavioural changes, such as becoming more withdrawn and secretive or changing who they spend time with. Other patterns, such as sleep, may also change. A person may start to neglect social, educational, or work commitments and have unexpected periods of absence or trouble holding down a job. If a prescription drug habit is creating a financial burden, signs of not spending money on other things or finding other sources of income, e.g., selling personal possessions or crime, may become apparent.

Physical signs of prescription drug addiction depend on the substance or substances the person is using; however can include mood swings, including aggression or violent outbursts, paranoia, appearing agitated, quick/jerky movements, and weight loss. A person may exhibit physical neglect, e.g., poor dental and personal hygiene, as their habit takes over their life and becomes an addiction.

Microdosing

As mentioned earlier, microdosing involves taking a tiny drug dose much smaller than would usually be required to produce the expected effect. The most common drugs used in microdose quantities are psychoactive and hallucinogenic drugs such as LSD, psilocybin (found in “magic mushrooms”), and cannabis.

There are various reasons why people might decide to microdose drugs (illegal or prescription). These include improving mood, reducing symptoms of social anxiety or depression, increasing focus or cognitive ability, relieving pain, and heightening spiritual awareness and mindfulness. Microdosing involves tiny amounts of active substances, making the user less likely to experience side effects or feel intoxicated. In addition, the quantity used is small, so there are financial benefits to microdosing over consuming larger doses.

Risks

No drug is entirely “safe,” even if used in microdose quantities. Using illicit drugs at any dose is not recommended and carries risks of intoxication, overdose, dependence, and addiction. Some illicit drugs are associated with long-term health implications such as cardiovascular disease, organ damage, and mental health problems. The use of illicit drugs can also be associated with low educational achievement, legal issues, financial difficulty, and social problems.

Microdosing prescription drugs is also not recommended, as these drugs are specifically designed to be taken at specific doses, and the safety, efficacy, and side effect profile of alternative dosing regimens have not been tested. You should always only take drugs prescribed for you and adhere to the dosing regimen. Taking more or less than the specified amount may lead to serious health problems. Consuming smaller quantities may mean the therapeutic effect of a drug is lessened, monitoring becomes difficult, and toxicity may become more likely. You should always take the dose you have been prescribed and adhere to any monitoring requirements advised by your healthcare professional.

Also, illicit drugs are unregulated and may contain varying amounts of active substance and may contain other substances which can cause undesirable effects. This makes it challenging to know the quantity consumed and makes it very difficult to regulate. Taking any amount of illicit drugs can result in serious and long-term health problems, including cardiovascular disease, organ damage, addiction, and mental health conditions. Taking illicit drugs can lead to dependency and addiction, which increases the risks of poor mental health, financial difficulty, and social problems. Possession of illicit drugs is illegal in most locations, and therefore there is a risk of prosecution, fines, and even imprisonment. Any illicit drug use increases the risk of social isolation, relationship problems, unemployment, and homelessness, particularly where a person’s habit impacts their financial situation significantly.

Help and Advice

Withdrawal

People who have developed a prescription drug addiction may experience withdrawal symptoms and severe cravings if they abruptly stop using the drug or reduce the dose. Withdrawal symptoms include both physical and psychological effects. They can begin within a few hours of the last dose. The withdrawal symptoms associated with commonly abused prescription drugs are as follows:

  • CNS depressant withdrawal symptoms: Seizures; agitation; anxiety; insomnia; hallucinations; increased heart rate; increased blood pressure; sweating
  • Opioid pain pill withdrawal symptoms: Sleeping problems; muscle and bone pain; vomiting; diarrhoea; cold flashes; uncontrolled leg movements
  • Prescription stimulant withdrawal symptoms: Depression; sleep problems; fatigue

Other Considerations

It is also worth noting that any medication can have adverse reactions with other drugs, including alcohol and caffeine. For example, mixing opioids and alcohol result in slower disposal of these substances from the body and higher toxicity. Drugs that slow down breathing, such as opioids, alcohol, and CNS depressants, should not be taken together. Prescription stimulant medications should not be mixed with over-the-counter cold medicines that contain decongestants.

Therefore, it is always recommended to inform the prescribing doctor about any other drugs, supplements, alcohol, or illicit substances you are using. This can prevent dangerous interactions between prescription medications and other substances.

At-Risk Groups

Studies show that younger patients with depression, illicit drug use, and chronic pain are at risk of prescription drug abuse and addiction. Another group of people at high risk of prescription drug addiction are those with chronic medical conditions, such as severe, longstanding pain. Prescription drug abuse and addiction is reported in up to 45% of patients with chronic pain by some researchers.

Older adults are often on multiple medications for a variety of medical conditions. Also, due to problems with memory or dementia, elderly people can mix up medications, resulting in an unintentional misuse of prescription drugs. On the other hand, some elderly people may intentionally misuse prescription medicines to self-treat unpleasant symptoms.

Recovery and Support

The best way to prevent prescription drug addiction is only to take drugs prescribed to you as they have been advised. Medications should not be used for longer than is necessary and should be used at the lowest effective dose.

If you are worried about potential prescription drug addiction, it is important to speak with your prescriber to discuss alternative regimes, reducing the frequency of dispensing your medications or stopping the medication altogether. It is essential to seek professional help as soon as possible if prescription drug addiction is suspected.

If you have been prescribed a commonly abused prescription drug, you can reduce your risk of prescription drug addiction by:

  • Following your doctor’s directions carefully concerning the dose and method of use
  • Telling your doctor about all your other prescription medicines, over-the-counter medicines, and herbal supplements, as well as any illegal drugs or alcohol use
  • Checking with your doctor regularly to report symptoms and make changes in dose
  • Never using another person’s prescription medication, even if they have very similar symptoms
  • Never ordering prescription medications from unauthorized sources, since the drugs could be counterfeit and may cause you harm
  • Asking your doctor about long-term risks (including addiction) for any prescribed medication
  • Taking “drug holidays” or skipping days (with doctor’s approval) to avoid tolerance and dependence

Full and successful recovery requires a multi-pronged approach, with detoxification, counselling, and medications. Detox will flush out the prescription drugs from your body. Counselling will help you change unhealthy drug-seeking behaviours. Medications will help relieve withdrawal symptoms and reverse the effects of the misused drugs on your brain and body. For more information, visit our prescription drug hotline page.

*Information provided by Dr Sarah Miller in February 2023

References

  • Alcohol and drug foundation (2023). Drug Facts: Cannabis. https://adf.org.au/drug-facts/cannabis/
  • Alcohol and drug foundation (2022). Drug Facts: Psilocybin (magic mushrooms). https://adf.org.au/drug-facts/psilocybin/
  • National Institute on Drug Abuse (2021). What Are the Signs of Having a Problem With Drugs? Available at: https://teens.drugabuse.gov/blog/post/what-are-signs-having-problem-drugs
  • Centers for Disease Control and Prevention (2021). Recovery is Possible: Treatment for Opioid Addiction. Available at: https://www.cdc.gov/drugoverdose/featured-topics/treatment-recovery.html
  • Substance Abuse and Mental Health Services Administration. Opioid Treatment Program Directory. Available at: https://dpt2.samhsa.gov/treatment/directory.aspx

Last updated: March 8, 2023