Your Health Checkup: Medication Misuse

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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I am one of more than 131 million people in the U.S. — two thirds of all adults — who take prescription drugs. As expected, the numbers of people and number of medications are both highest for older folks and those with chronic health conditions.

Most people follow directions when taking prescription medications. However, an estimated 18 million (more than six percent of those aged 12 or older) have misused such medications at least once in 2017 by taking the medicine in a dose or manner not prescribed, taking someone else’s drug, or taking the medicine for its euphoric effect, i.e., to get high. About 2 million have misused pain relievers, more than one million have misused stimulants, one-and-a-half million have abused tranquilizers, and more than a quarter million have misused sedatives for the first time.

Those are troubling statistics since misuse of common prescription drugs can have disastrous consequences. Misuse has increased in the last fifteen years — more recently since COVID-19 — as reflected by increased emergency room visits, increased admissions for prescription drug use disorders, and overdose deaths. Nearly 50,000 people died from opioid overdoses in 2019, even more in 2020 (see below).

In addition to the horrible loss of life, the economic burden of opioid overdoses approaches $80 billion annually.

What are the categories of drugs that are commonly abused?

Antianxiety medications and sedatives

Drugs used commonly to treat anxiety or induce sleep include benzodiazepines (e.g. Xanax, Librium, Valium), barbiturates (e.g. phenobarbital, secobarbital), and nonbenzodiazepine sedatives like zolpidem (e.g. Ambien), and eszopiclone (e.g. Lunesta). Their actions differ, but each drug can lead to dependency and tolerance that result in symptoms when the drug is stopped. They each can cause substance abuse, including memory loss, decreased attention, bad judgment, and emotional swings. Concomitant alcohol consumption can intensify these effects. Sudden withdrawal can be dangerous, depending on the drug and dose, and should be done gradually, often with health care supervision.

Stimulants

Used to treat attention deficit hyperactivity disorder and sleepiness, these drugs include dextroamphetamine (e.g., Dexedrine), dextroamphetamine/amphetamine (e.g., Adderall), and methylphenidate (e.g., Ritalin or Concerta). They can cause euphoria and elevate blood pressure, heart rate, and blood sugar. High doses can dangerously increase body temperature and cause heart rhythm problems. Misusing stimulants is often associated with misusing other drugs.

Opioids

These are potentially dangerous drugs, in large part because of ease of addiction, and are generally considered the “bad guys” in this list. The Centers for Disease Control indicated that during this pandemic, U.S. opioid overdose deaths have increased, with more than 81,000 in the 12 months ending May 2020, the highest number of overdose deaths ever recorded in a 12-month period. Synthetic opioids (primarily fentanyl manufactured illicitly) appear to be the primary cause of the increases in overdose deaths. A book by Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty (Doubleday 2021), provides a superb accounting of the origin and creation of the opioid crisis.

Anabolic steroids

These synthetic drugs, variations of the male hormone testosterone, are used for muscle building and to increase male sex characteristics (e.g., Anadrol, Anavar). Anabolic steroids are prescribed by health care workers to treat delayed puberty and to build up muscle in patients with atrophy from problems like AIDS or cancer, and can be taken orally, injected, or applied to the skin in creams or gels. The drugs are often misused by young male bodybuilders. Long term complications can be severe and result in kidney failure, liver damage, blood clots, high blood pressure, high cholesterol, heart attacks, paranoid behavior, and other problems.

Advice

The above list is just a sampling of drugs commonly misused or abused by the U.S. population. As a practicing physician for over 50 years, my philosophy has been to give the right drug to the right patient for the right indication at the lowest effective dose and for the shortest time needed. Patients would do well to follow that advice and adhere to the directions given by their health care worker.

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