percent for CNS depressants to 422,000 visits. Of the latter, 85 percent involved benzodiazepines (e.g., Xanax®). ED visits related to use of zolpidem (Ambien®), a popular prescribed non-benzodiazepine sleep aid, rose from roughly 13,000 in 2004 to 30,000 in 2011. More than half of ED visits for nonmedical use of prescrip- tion drugs involved multiple drugs. Analy- sis of hospital inpatient data also revealed a 72 percent increase in hospitalizations related to opioid use over the decade from 2002 to 2012, including increases in seri- ous infection associated with intravenous drug administration. Inpatient costs for these hospitalizations quadrupled over the same time period.
Is it safe to use prescription drugs in com- bination with other medications? The safety of using prescription drugs in combination with other substances depends on a number of factors including the types of medications, dosages, other substance use (e.g., alcohol), and indi- vidual patient health factors. Patients should talk with their health care provider about whether they can safely use their prescription drugs with other substances, including prescription and over-the- counter (OTC) medications as well as al- cohol, tobacco, and illicit drugs. Specifi- cally, drugs that slow down breathing rate, such as opioids, alcohol, antihistamines, prescription central nervous system de- pressants (including barbiturates and benzodiazepines), or general anesthetics, should not be taken together because these combinations increase the risk of life- threatening respiratory depression. Stimu- lants should also not be used with other medications unless recommended by a physician. Patients should be aware of the dangers associated with mixing stimulants and OTC cold medicines that contain decongestants, as combining these sub- stances may cause blood pressure to be- come dangerously high or lead to irregular heart rhythms.
WHICH CLASSES OF PRESCRIPTION DRUGS ARE COMMONLY MISUSED?
Opiods
What are opioids? Opioids are medi- cations that act on opioid receptors in both the spinal cord and brain to reduce the intensity of pain-signal perception. They also affect brain areas that control emo-
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tion, which can further diminish the effects of painful stimuli. They have been used for centuries to treat pain, cough, and diar- rhea. The most common modern use of opioids is to treat acute pain. However, since the 1990s, they have been increas- ingly used to treat chronic pain, despite sparse evidence for their effectiveness when used long term. Indeed, some pa- tients experience a worsening of their pain or increased sensitivity to pain as a result of treatment with opioids, a phenomenon known as hyperalgesia. Importantly, in addition to relieving pain, opioids also activate reward regions in the brain caus- ing the euphoria—or high—that underlies the potential for misuse and addiction. Chemically, these medications are very similar to heroin, which was originally synthesized from morphine as a pharma- ceutical in the late 19th century. These properties confer an increased risk of ad- diction and overdose even in patients who take their medication as prescribed. Prescription opioid medications in-
clude:
hydrocodone (e.g., Vicodin®), oxycodone (e.g., OxyContin®, Perco- cet®),
oxymorphone (e.g., Opana®), morphine (e.g., Kadian®, Avinza®), codeine, fentanyl, and others.
Hydrocodone products are the most commonly prescribed in the United States for a variety of indications, including den- tal- and injury-related pain. Oxycodone and oxymorphone are also prescribed for moderate to severe pain relief. Morphine is often used before and after surgical procedures to alleviate severe pain, and codeine is typically prescribed for milder pain. In addition to their pain-relieving
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