The widespread use of OxyContin in the late 1990s fueled the first wave of the opioid crisis, according to the popular narrative. The makers of this oxycodone medication were able to aggressively market the drug to such a degree that doctors prescribed it to patients with common ailments like backaches and knee pain. In effect, the drug acquired a wider base of users, reaping billions of dollars in revenue in the process.
Purdue Pharma, the makers of OxyContin, was fined hundreds of millions of dollars for misrepresenting the effects of the drug, but not before enacting an unforeseen level of its carnage on patients and recreational users. Many of them used the drugs to treat their pain only to get hooked. Some graduated to heroin, and others succumbed to a fatal overdose.
We are about 20 years removed from the epidemic’s first wave. Still, OxyContin and other oxycodone medications and illicit opiates continue to enact a deleterious toll on users, claiming an estimated 130 lives a day.
The potency and overdose potential make OxyContin one of the most addictive prescription medications around. But they are not the only commonly prescribed drug that poses a high risk of addiction.
Hydrocodone and benzodiazepine medications are also among the 10 deadliest drugs in America, according to the U.S. Centers for Disease Control and Prevention (CDC). In essence, opioids, benzos, and stimulants are the most addictive and abused prescription medications.
Millions of people flock to these medications to treat common maladies such as chronic pain, anxiety, sleep disorders, and attention-deficit/hyperactivity disorder (ADHD).
Because doctors prescribe them, many believe these medications are inherently safe and do not have abuse potential. But that cannot be further from the truth. These drugs and others can be as relentlessly addictive and dangerous as notorious illicit drugs like cocaine and heroin.
These Are the Most Addictive Prescription Drugs
When the CDC released its list of the most common drugs found in overdose deaths in 2016, it included popular benzodiazepines such as alprazolam (Valium) and diazepam (Xanax), along with oxycodone products. Many of these cases involved polysubstance abuse where the medication was taken with alcohol or another substance. Nevertheless, benzos are used to treat a variety of conditions, including anxiety, seizures, muscle spasms, alcohol withdrawal, and panic attacks.
They work by impacting gamma-Aminobutyric acid (GABA), a neurotransmitter in the brain that is responsible for calming the nervous system. These medications are usually not recommended for long-term use due to their addiction potential.
Yet, when benzos are abused, they can produce feelings of sedation and even euphoria. They can impair motor function, memory, and thinking. They can also induce drowsiness, depression, and respiratory depression.
Popular brand name benzodiazepine medications include Klonopin (clonazepam), Ativan (lorazepam), Halcion (triazolam), and Librium (chlordiazepoxide).
Prescription opioids comprised four of the 10 deadliest medications on the CDC list: oxycodone, morphine, methadone, and hydrocodone. That’s not to mention illicit opioids fentanyl and heroin, the two deadliest drugs on the list.
What makes prescription opioids so addictive is the way they affect the brain’s reward centers. They bind to the opioid receptors in the brain and body, effectively blocking pain signals and impacting the areas of the brain that control emotions.
This minimizes a user’s ability to feel pain. Opioids are typically prescribed to people who have mild, moderate, or even acute episodes of pain that occur from injury and surgical procedures. In addition to its pain-relieving attributes, opioids can produce euphoric effects, the strongest of which can mimic those of heroin.
OxyContin remains one of the most widely known of these types of medications, but others that fall into the opioid class include Percocet (oxycodone), Vicodin (hydrocodone), Lortab (hydrocodone), Kadian (morphine), and Avinza (morphine).
Stimulants are used to boost energy, attention, and alertness. They also increase heart rate, blood pressure, and respiration and are used to treat a variety of conditions, including ADHD, asthma, respiratory, and neurological disorders.
Medications such as these work by increasing the activity of dopamine and norepinephrine, brain chemicals that govern rewarding behaviors and blood and heart rate function, respectively.
Stimulants can produce a euphoric rush in users where they will experience increased blood pressure, blood flow, heart rate, and blood sugar. But what makes them so dangerous are their ability to, at increased doses, produce high body temperatures, seizures, irregular heartbeat, and even heart failure.
Notable stimulants that carry a high potential for abuse include Ritalin (methylphenidate), Desoxyn (methamphetamine), and Adderall (amphetamine).
How These Drugs Are Federally Classified
A good yardstick for determining which drugs are the most or least addictive is the U.S. Drug Enforcement Administration (DEA) scheduling chart for controlled substances. This schedule federally classifies drugs into five distinct categories or schedules, from substances with the highest to those with the lowest abuse potential.
Schedule I substances occupy the top tier of the most addictive drugs and have no accepted medical use. They are of the illicit variety such as heroin, lysergic acid diethylamide (LSD), marijuana, and methylenedioxymethamphetamine (ecstasy).
Opioid medications like OxyContin, Percocet, morphine, and codeine are considered Schedule II substances, meaning they “have a high potential for abuse which may lead to psychological or physical dependence.”
Also included in this category are Schedule II drugs, which include popular prescription stimulants like Ritalin (methylphenidate), Desoxyn (methamphetamine), and Adderall (amphetamine).
The Least Addictive Drugs
The drugs that carry the lowest abuse potential, Schedule V, contain limited amounts of narcotic substances. The drugs under this classification include prescription opiates and opioids that have limited amounts of codeine (less than 200 milligrams per 100 milliliters), ethylmorphine (less than 100 milligrams per 100 milliliters), and opium (less than 100 milligrams per 100 milliliters). The stimulant drug pyrovalerone also falls under the Schedule V category.
All Prescription Medications Can Be Abused
All prescriptions have abuse potential. Schedule IV drugs have a low potential for abuse compared to substances such as ketamine, anabolic steroids, and suboxone are still among the most addictive substances available by prescription. Those include benzodiazepine drugs (Xanax, Klonopin, Valium, Restoril, and Ativan).
Alternatives to Opioids
The quest for sustainable pain relief is part of what has driven the opioid epidemic, the deadliest drug crisis in American history. Though opioid prescriptions have leveled off since peaking in 2012 at 282 million, they remain widely prescribed and used. What’s more, 80 percent of people who use heroin first misused prescription opioid medication, according to the National Institute on Drug Abuse (NIDA).
In response to the utter devastation of the opioid epidemic, more doctors are directing their patients to alternative treatments for chronic pain. Recommended natural pain remedies include massage, acupuncture, meditation, and cognitive behavioral therapy (CBT).
These alternative medications are being recommended over opioids: acetaminophen (the over-the-counter variety), nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen and aspirin), and antidepressants (serotonin and norepinephrine reuptake inhibitors).
Alternatives to Benzos
Benzodiazepines are being prescribed less and less for insomnia because of their side effects. Doctors are prescribing a class of drugs thought to be safer than benzos called non-benzodiazepine hypnotics. They include name-brand drugs such as Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone).
Selective serotonin reuptake inhibitors (SSRIs) like Zoloft (sertraline) are replacing benzos to treat anxiety and panic disorders. According to Harvard Medical School, SSRIs can relieve depression and anxiety while possessing a decreased risk of dependence and abuse. Other drugs thought to be safer than benzos include BuSpar (buspirone) for anxiety and Ramelteon and Benadryl (diphenhydramine) for insomnia.
Drug-free Options for Anxiety/Insomnia
The following drug-free alternatives are thought to help relieve insomnia and anxiety. They include yoga, exercise, breath training, psychotherapy, and muscle relaxation training. CBT is also considered to be an effective treatment option for insomnia and anxiety.
Alternatives to ADHD Meds
Several drug-free treatment options are thought to help abate ADHD symptoms. Those include taking omega-3 supplements since children with ADHD tend to have lower levels of fatty acid in their blood.
People also have sought out neurofeedback and working memory training as possible alternatives as well. The former is a process where the brain is trained to produce certain waves that lower ADHD symptoms. The latter involves computer training to help people with ADHD concentrate, control their behaviors, and improve their ability to problem solve.