Prescription for Drug Addiction

Prescription Addiction

By Vicki Salemi

Sure, various medications can alleviate pain, help with focus or combat insomnia, to name a few, but with such rewards also come the risks of addiction. Which begs the question: Is the prescription worth the addiction?


Darvon

"Every drug is a double-edged sword, and there is no magic bullet," says Ernest Dole, PharmD and member of the American Society of Health-System Pharmacists. Darvon is a narcotic pain reliever that triggers the opiate system in the brain through its main ingredient, propoxyphene, which helps to ease light to moderate pain. The drug has been prescribed for over 50 years to ease pain. However, a panel recommended in January that the FDA ban Darvon due to risks such as suicide and addiction.

Darvocet

There's no specific ingredient to this painkiller that makes it addictive; rather the environment, genetics and the way the body's reward system operates may cause dependency. However, similar to Darvon, the ingredient propoxyphene activates the body's natural opiate receptors to give the feeling of reward. "People have a difficult time detoxing from these medications due to the psychological and physical prolonged withdrawal," says Morteza Khaleghi, Ph.D., executive director and founder of Creative Care, Inc. "Because it is usually prescribed by a physician, people are under a misperception that these drugs are not addictive. The reason that these drugs are considered addictive is because of the tolerance build up, which requires the need for more."


Gabapentin and Pregabalin

As for alternatives to Darvon or Darvocet, Dr. Dole recommends Gabapentin or Pregabalin, which are typically prescribed to control epileptic fits but can also be prescribed for joint or inflammation pain, particularly in patients with fybromyalgia. "If someone is having burning or stabbing pain, these two [drugs] might be alternatives because they specifically address the issue and decrease pain signals. They can be less addicting because they treat pain without involving the reward centers," he says. The primary side effect is drowsiness.



Oxycontin

This painkiller is often administered to patients after surgery, but often patients may feel it help resolve psychological issues such as social anxiety. "Oxycontin is a powerful painkiller," says Michael Schiesser, MD, an addiction medicine specialist. "And just like watering a plant causes it to grow roots, repeated exposure to Oxycontin causes major dopamine release and eventually causes the brain's opiate system to expand. Once the opiate system has expanded, people must continue to increase their dosage in order for the drug to produce the same effect." Dr. Schiesser recommends finding pain control alternatives, in addition to identifying and treating any underlying depression or anxiety.

Tylenol 3

Another alternative to the potent Oxycontin is Tylenol 3, which combines Tylenol and codeine. Margaret E. Gnegy, Ph.D. and professor of pharmacology at the University of Michigan Medical School notes that while codeine has addicting properties, it's known to be less so than other drugs, partially because it offers slower, steadier relief. "Generally the faster it gets into the brain, the more addictive it is."


Cymbalta and Effexor

Anti-depressants like Cymbalta and Effexor may be effective painkillers but these selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) also have a high risk of addiction. Dr. Schiesser notes, "In order for the brain to make a note of which experiences are positive for repeating later -- sex, food, cocaine -- the brain will release large amounts of a chemical called dopamine to help a person remember to come back for more." Dr. Dole adds, "It doesn't mean they shouldn't be used but they should be used in a controlled environment with a provider."

Tricyclics

First used in the 1950s to treat depression, tricyclic anti-depressants (TCAs) maintained a dominant fixture in the treatment of depressive symptoms until newer drugs appeared in the 1980s. Recently, TCAs are used to treat neuropathy, or chronic pain in the nervous system. "They're less addicting painkillers," says Dr. Dole. They are also known for being prescribed to treat ADHD, headaches, anxiety, insomnia, smoking cessation and bulimia.


Adderall

When it comes to Adderall, simply stated it's an amphetamine. As a whole brain stimulant, Adderall produces dopamine. "Dopamine is the reinforcing chemical, just like seeing an exciting performance, climbing a mountain on a clear day or going to the beach at age four," says Dr. Schiesser. Whenever dopamine is released, the typical human reaction is to duplicate or reinforce the experience, says Dr. Schiess. When strong enough, this desire can result in addiction, especially for people who do not suffer from attention deficit disorder.



Ritalin

Also known as an upper, similar to Adderall, Ritalin is primarily used for attention deficit disorder. "Usually the people that have ADD don't get addicted to their medication, but their friends may end up taking it for addictive purposes," explains Dr. Gnegy. Remember to keep prescription medication away from children and teens so they don't misuse them or accidentally overdose.