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Prescription Drugs vs Illegal Drugs

Many people think that abusing prescription drugs is safer than abusing illicit drugs like heroin because the manufacturing of prescription drugs is regulated or because they are prescribed by doctors. That's true, but it doesn't mean that these drugs are safe for someone who was not prescribed the drug or when they are taken in ways other than as prescribed. 

Prescription drugs can have powerful effects in the brain and body, and they act on the same brain sites as illicit drugs. Opioid painkillers act on the same sites in the brain as heroin; prescription stimulants have effects in common with cocaine. And people sometimes take the medications in ways that can be very dangerous in both the short and long term (e.g., crushing pills and snorting or injecting the contents). Also, abusing prescription drugs is illegal—and that includes sharing prescriptions with friends.

Why Don't People Who Take Prescription Drugs for Medical Conditions Become Addicted?

On rare occasions they do, which is why a person must be under a doctor's care while taking prescription medications and sometimes when stopping their use. A doctor prescribes a medication based on an individual's need—each patient is examined for symptoms and receives a dose of medication that will treat the problem effectively and safely. Typically, prescription drugs are taken in a form (e.g., a pill) that doesn't allow for rapid absorption of the drug by the brain and at a dosage that treats the problem but doesn't overwhelm the system—both of which reduce the likelihood of addiction. 

Long-term medical use of certain prescription drugs can, however, lead to "physical dependence," because the brain and the body naturally adapt to chronic drug exposure. A person may need larger doses of the drug to achieve the same initial effects (tolerance), and when drug use is stopped, withdrawal symptoms can occur. Dependence is not the same as addiction. It is one of the many reasons why prescription drugs need to be taken and stopped under a physician's guidance. 

What About Over-the-Counter Drugs, Like Cough Medicine? Aren't They Safer Than Prescription Drugs?

Cough and cold medications are some of the most commonly abused over-the-counter (OTC) medications. Many contain an ingredient called dextromethorphan (DXM). However, to get the "high" or "dissociative" state craved by people who use drugs, large quantities are needed. At high doses, DXM causes effects similar to that of the drugs ketamine or PCP by affecting similar sites in the brain. Ketamine and PCP are considered "dissociative" drugs, which make people feel disconnected from their normal selves. They affect memory, feelings, and thoughts. DXM is similar, and its abuse can affect control over movement; cause numbness, nausea, and vomiting; and can increase heart rate and blood pressure. 

When taken as directed, OTCs are safe and effective, but high doses can cause problems. And, some OTC medications can produce dangerous health effects when taken with alcohol. It is important to understand these risks, read the bottle labels, and take OTC medications only as directed.