The hidden battle of prescription medication dependency

When we are prescribed medicines, they typically come with a white leaflet that details the various side effects that can be associated with using the drugs. These are often listed from common to rare. The leaflet may include a list of contraindications and other instructions for use, as well as who to contact if you are concerned about the effects of the drug.

This means that we’re well versed in the concept of prescription medicines having potential side effects. What we are perhaps less cognisant of is the addiction potential of these medications. When we think of addiction and rehab, we may think of Class A drugs like heroin, cocaine and methamphetamine. Behind these illegal substances lies the shadow of prescription medications, substances prescribed every day by clinicians that can ultimately lead to the development of addiction.

But how does this kind of addiction form? How do prescription drug addiction side effects manifest? How can the use of regulated medicines develop into dependency, and what support is offered to help people recover?

Prescription drug addiction: The statistics

Each year, the Office for National Statistics publishes a report on levels of Drug Misuse in England and Wales for the previous 12 months. Strikingly, this report includes few mentions of prescription medications. A separate report on dependency-forming medicines was first published in 2022.

The main medications associated with dependency are:

• benzodiazepines
• z drugs (sleeping tablets), opioids
• antidepressants
• gabapentinoids

Between 2017 and 2018, 11.5 million adults were prescribed one or more of these medicines. At 26%, that is over a quarter of England’s adult population.

This means that:

• 17% of the adult population were prescribed antidepressants (7.3 million)
• 13% were prescribed opioids (5.6 million)
• 3% were prescribed gabapentinoids (1.5 million)
• 3% were prescribed benzodiazepines (1.4 million)
• 2% were prescribed z drugs (1 million)

This data suggests that women are 1.5 times more likely to be prescribed these types of drugs than men. Rates of prescription also ‘generally increase with age.’

The Faculty of Pain Medicine states that ‘deaths have largely mirrored prescribing levels,’ noting that ‘in recent years there have been some significant increase in rates of death per prescription.’

Why do people become dependent on prescription meds?

Dependency can develop for a range of reasons. Some of the key factors include:

• Dosage escalation
• Prolonged use
• Mental health

Dosage escalation

A dose escalation is where the amount of a drug you use slowly increases. Clinicians use this to restrict risky side effects, including mitigating overdose risk. However, there is a relationship between increasing dosage and growing tolerance. Doctors may need to increase your dosage so you continue to feel the effects of the drug you are using.

But whilst this can help manage symptoms, it does heighten the risk of dependency developing. As drug addiction is defined as a chronic disorder ‘characterised by compulsive seeking and escalated intake of drugs,’ dosage escalation can easily lead to dependency on prescription medications.

Prolonged use

A report on dependence and withdrawal reports that ‘more people are taking prescription medications for longer.’ In a survey, it was found that many patients accessed specific types of prescription medication on a continual basis. Around 50% of the patients surveyed had been using their prescription medicines for 12 months or more.

The study found a high number of people who had been using their prescription medicines for at least three years, from April 2015 to March 2018. In this period

• 930,000 people used antidepressants for the duration of this period
• 540,000 people used opioids
• 160,000 people used benzodiazepines
• 1000,000 people used z drugs

This is concerning following the clinical guidelines that benzodiazepines, for example, should not be prescribed for longer than 4 weeks.

Mental health impact

Addiction and mental health have a complicated relationship. Rather than having a linear causal relationship, mental health and addiction are intertwined or even embedded in one another. In some cases, such as in the use of antidepressants, poor mental health can lead to the need for prescription medication. However, withdrawals or other associated side effects of the antidepressants can work to unbalance mood.

Other people may find that their reason for needing prescription meds – such as opioids – causes them distress. For example, being in a great deal of chronic pain can lead people to become depressed. This means that the initial use of opioids could lead to an improvement in mood as well as a management of pain. However, long-term usage of analgesics can also affect psychological wellbeing over time.

If you are prescribed these specific types of medications, you likely have a diagnosis – or symptoms of – some mental health condition. If you become addicted to the prescription medication you are using, then you could develop what is known as a dual diagnosis. This means that you could be dealing with multiple mental health conditions – and or an addiction – at the same time.

Prescription drug addiction: Symptoms and effects

There are a range of symptoms that can signal prescription drug addiction. Just like with other conditions, some people may be more successful at obscuring their addiction symptoms than others. However, the following symptoms are typically experienced by individuals dealing with addiction.

Psychological Symptoms:

• Anxiety
• Depression
• Unpredictable changes in mood
• Low threshold for irritation
• Quick to anger
• Appearing disoriented
• Blurry thinking
• Impaired memory
• Feeling paranoid
• Worsening of preexisting mental health conditions

Physical Symptoms:

• Developing a tolerance to medications
• Cravings
• Difficulty regulating body temperature
• Irregular heartbeat
• Headaches
• Frequent constipation
• Appearing lethargic
• Moving slower than usual
• Dramatic change in appetite
• Dramatic change in sleeping patterns
• Changes to speech (speaking slower than usual or slurring words)
• Reduced balance, coordination and special awareness
• Withdrawal symptoms

Behavioural Symptoms:

• Needing to replace prescriptions faster than expected
• Seeing multiple clinicians to obtain more prescriptions
• Purchasing prescription medications online
• Accessing prescriptions through illicit channels
• Lower attendance and performance at work or school
• Asking others to obtain prescription medications for you
• Asking others to share prescription medications with you
• Lying about intentions and activities around medicines
• Becoming socially withdrawn
• Paying less attention to selfcare (washing, eating, and maintaining your living space)
• Writing your own prescriptions

Withdrawing from prescription medications

If you are dependent on prescription medications, you may begin to experience withdrawals. These can be unpleasant symptoms such as tiredness, anxiety, paranoia, low mood and headaches. During withdrawal, you may find that you feel generally unwell for a period of time.

How do I know it’s an addiction?

If you are unsure if you or a loved one are dealing with an addiction to prescription medications, then you can answer the following questions included in the CAGE-AID questionnaire:

1. In the last year, have you felt that you have used prescription drugs more than you should?
2. Have you felt like you should cut down on your use of prescription drugs?
3. Do you feel upset or defensive when others comment on your use of prescription drugs?
4. Have you ever used prescription medication to help get you through the day? (outside of their typical use)

If you answer yes to one or more of these questions, it is likely that you are dealing with an addiction to prescription drugs.

Treatment for prescription drug addiction

Dependency on prescription meds may seem less visible than issues with other substances. But that does not mean that help for prescription drug addiction does not exist. Three key areas of rehabilitation can be applied to prescription drug addiction treatment:

1. medical interventions
2. therapy
3. support groups

Medical Interventions can come in several forms. They can include having your medication use monitored and more regularly controlled, or they could include the use of pharmacological support. These are known as maintenance treatments. They can be used to help you manage difficult withdrawal symptoms whilst you are moving towards prescription drug addiction recovery. Perhaps the most infamous form of this kind of support is methadone maintenance treatment, which is used to treat opioid addiction.

Therapy is a broad term for a plethora of support options. In an addiction context, therapy can refer to 1-1 talking therapy, family, group, and even holistic therapies such as yoga.

Support Groups can be an invaluable tool in the addiction recovery process. Often, support groups help individuals in recovery to control feelings of guilt, shame, loneliness and overwhelm. Accessing support in a social manner can help to create a welcoming community and a new sense of confidence. Studies show that people who engage in peer support have improved treatment outcomes.

Access prescription drug rehabilitation at Primrose Lodge

At UKAT, we offer support through our specialist options at our prescription drug addiction treatment centres. At Primrose Lodge, we can offer free aftercare, extended support and small group environments. With access to a gym, 1-1 sessions and bespoke treatment options, Primrose Lodge is an ideal location to begin your journey to recovering from prescription medication addiction.