Medication Misuse

Medication Misuse

Misuse of medication, including both prescription and over-the-counter medicine, occurs when someone uses it in ways that aren’t prescribed or directed. It can lead to serious, even deadly, consequences, especially when medications are taken in high doses or combined with other substances. For young people whose brains are still developing, risks can include damage to critical brain functions related to emotion, decision-making, memory, learning, attention and general mental health. For some, it can lead to addiction.

Most people who misuse prescription drugs are between the ages of 18 and 25.^[2] A national survey of high school students conducted in 2019 found that 1 in 7 students reported misusing prescription pain relievers (opioids) at least once in their lifetime.^[3]

Why medication gets misused

It’s easy to believe that prescription medication is relatively safe. A health care provider prescribes them as medicine. We often see them in ads, leading people to think they must not be especially harmful. Yet certain prescribed medications are similar to illegal drugs in their chemical makeup. If misused, they can be quite dangerous.

Common reasons for misuse include:

Curiosity, fun or social enhancement

Some young people simply want to experience the effects of “getting high” or feeling more relaxed. They might misuse medications on their own or in social settings to ease social anxiety and be alert or aroused. Friends may pressure each other into trying a pill because “you’ll like how it feels.” This experimentation with pills can be even more dangerous when combined with alcohol.

To enhance academic or athletic performance

Young people who misuse prescription stimulants may want to sharpen their attention or sustain a high level of arousal, alertness or attention. They believe drugs like Adderall will boost their academic or athletic performance. However, while stimulants may help in the short term, over time, they become less effective. A young person will need more and more of the drug to function normally. This is the definition of tolerance, which is a key symptom of addiction. Long-term use may actually lead to a decline in grades or sports performance.

To relieve mental health problems or stress

Some young people may misuse medications in an attempt to self-treat mental health issues like anxiety, depression or attention-deficit/hyperactivity disorder (ADHD) that are not adequately treated by a professional.

Numerous environmental factors shape a young person’s beliefs and attitudes. These can contribute to whether they will misuse medications and to what extent and whether they will experience negative consequences. A child’s risk increases if they have a family history of substance use or addiction, see parents or older siblings misuse medication or if there is easy access to medications in the home, at school or in the neighborhood.

Why be concerned

Certain prescription medications, especially those categorized as controlled substances by the U.S. Drug Enforcement Administration (DEA), are powerful drugs that have a risk of misuse and addiction. For example, opioid pain relievers are highly addictive and  are very similar to heroin in their chemical makeup. Therefore, the U.S. Centers for Disease Control and Prevention (CDC) strongly recommends against prescribing them for long-term treatment of chronic pain and prescribing them very rarely for short-term pain^[4].

Adolescents and young adults who use these drugs are at especially high risk of becoming addicted to them. The human brain does not fully develop until early adulthood, usually the mid- to late-twenties. During this time of rapid brain growth, exposure to drugs interferes with the brain’s development. As a result, the lifetime risk of misusing substances and developing addiction increases.

Beyond the risk of addiction, misusing prescribed medications can result in serious health consequences.

• Opioid pain relievers, like oxycodone and codeine, can cause fatigue and stomach problems. At higher doses, misuse can lead to breathing difficulties, overdose and death.
• Stimulants used to treat ADHD can lead to feelings of paranoia, high body temperature and rapid heartbeat.
• Depressants, like anti-anxiety or sleeping medications, can cause slurred speech, shallow breathing, sleepiness, confusion and lack of coordination. At higher doses, they can lead to overdose and death, especially when combined with alcohol.

Added risk of mixing prescription drugs with alcohol or other drugs

Misusing medications while also using alcohol or other drugs, whether accidentally or intentionally, can be dangerous and potentially deadly. Common effects include altered mental state, vomiting, blood pressure changes and heart damage. The combination of prescription drugs and alcohol can lead to stroke, heart attack, liver failure, internal bleeding, brain damage and other serious mental health consequences.

Potential for legal trouble

It’s illegal to use a prescription medication in any way other than how a health care provider prescribed it. The same holds for use by anyone other than the individual to whom it was prescribed. If you offer your stimulant medication (e.g., for ADHD), anti-anxiety medication or pain reliever to a friend or family member who seems to be struggling with similar problems, it’s against the law. It’s illegal, too, if you take a prescribed drug offered by a friend or family member.

To be considered misuse, one does not have to be using the drug to get high or have fun. Even use for the designated medical purpose of the drug is considered misuse if it wasn’t prescribed for the individual using the medication. While the specific legal offense depends on the type of drug misused, the nature of the activity and state-level statutes, penalties can include prison time and fines.

Intentional misuse of over-the-counter medication carries risk, too

It’s likely that your household also contains over-the-counter (OTC) medications to treat headaches, indigestion, fever, allergies, constipation and more. When used as directed, these drugs are generally safe. Intentional misuse occurs when a medication is not taken as directed. This includes taking a higher quantity than instructed or using it for a nonmedical purpose.

In addition, some teens have been drawn to social media challenges to misuse OTC medications. One such challenge to take large quantities of Benadryl resulted in at least one teen’s death, with many others hospitalized.

It’s important to help your young person understand that just because these medications can be purchased without a prescription doesn’t mean they are harmless.

Most commonly misused medications

How to protect your child

Despite what many parents believe and feel, you have tremendous influence over whether your children can access these medications and misuse them, as well as their interest in doing so. Most importantly, kids themselves say that their parents have the greatest influence over their attitudes and behaviors around substances.

Know the facts

You can help protect your children by knowing the risks and staying informed about the how, where and why young people get and misuse prescription drugs. Parents and caregivers are an essential buffer between youth and the influences that encourage them to misuse medications.

Be ready to answer your child’s questions about medications honestly and accurately and in an age-appropriate way. You want them to see you as a good and trustworthy source of information. It is better for them to come to you with questions rather than get their information from less reliable sources like friends or social media.

Have a conversation

You don’t have to sit down for the “drug talk,” but there are opportunities in even casual settings – while watching the news or a movie – where you can discuss medication misuse. This can be after dinner, before bed or on the way to or from extracurricular activities. Most importantly, be ready to listen to your child and understand their perspective.

It can help to start the conversation with open-ended questions about what they think about prescription or OTC medication. Try to avoid scare tactics or threats. Instead, explain that you genuinely care about their health. It’s helpful to have conversations frequently, and if you can, before they gain access to medications. Remember to be clear about your expectations and compassionate. To learn more about how to have an effective conversation with your child about drugs, see our guide and resources.

Set a good example

If you, a family member or anyone in your home has been prescribed potentially addictive medications, you can demonstrate proper use for your own  safety. Set a good example for your child. Make sure to take doses as prescribed and safely dispose of expired or unwanted medication. Highlight and draw attention to these actions for children so they can learn by example.

Ask questions

Medication misuse can begin with a valid prescription from a trusted health care professional. Your child may think, “If my doctor prescribed this, it must be safe.” There are obviously times when such medications are needed, helpful and should be taken. Still, it’s important to be fully aware of the risks of these medications. Learn how to minimize the chances that your child will misuse them.

Consider posing these questions to your child’s health care provider:

• Is a prescription opioid necessary to treat their pain? Would alternatives like an over-the-counter pain reliever work? For chronic pain, can we explore other treatments such as physical therapy? Are there non-medication therapies to help treat my child’s depression or anxiety disorder?
• How many pills are being prescribed and over how long a period? Is it necessary to prescribe this amount of pills?
• What are the risks of misuse of this drug?
• What are the potential interactions between this medication and other medications? Between this and alcohol or other substances they are using?
• Should my child be screened for substance use disorder before you prescribe this medication? If not, why not?
• Should they be screened for common risk factors for prescription drug misuse, including co-occurring mental health disorders such as depression or ADHD, as well as a family history of addiction or a recent trauma. If not, why not?

Signs of misuse & how to address

It’s important to be aware of any signs that your child could be misusing medication. Physical signs of misuse include dizziness, confusion, nausea, constipation, slowed breathing and slurred speech. Changes in behavior and mood include:

• Excessive mood swings or hostility
• Acting unusually energetic or lethargic
• Significant changes in sleep habits
• Poor decision-making
• Requesting early refills or claiming to have lost prescriptions in order to get them rewritten
• Seeking out prescriptions from multiple doctors
• Selling medications or prescriptions