Prescription Drugs

Prescription Drugs

There is a misperception among some young people that prescription medications are safe to use – even without a prescription. Kids may have easy access to prescription or over-the-counter medications in their own homes that could pose a serious risk to their health. Below are the details of the most commonly prescribed medications in Canada:

Opioids/ Painkillers

Opioid drugs act by effectively changing the way a person experiences pain.

Commonly referred to as painkillers, Opioids are drugs that contain opium or are derived from and imitate opium. They are prescribed for pain relief and are only available by prescription.

Most opioid or painkilling drug prescriptions are non-refillable and, when used properly under a medical doctor’s supervision, are safe and effective.

Morphine derivatives, or narcotics, come from opioids and are used to therapeutically treat pain, suppress coughing, alleviate diarrhea, and induce anesthesia. When using these narcotics, abusers experience a general sense of well-being by reduced tension, anxiety, and aggression.

Although painkillers have different potencies and are taken in different ways, when they are used they all pose a risk for addiction and other serious effects.

Examples of Opioid Painkillers

Some of the most well known painkillers are listed below with the names you might find on a prescription label.

Opioid table2
  • Codeine: like morphine, this is found in opium, is weaker in action than morphine, and is used especially as a painkiller.
  • Fentanyl (and fentanyl analogs): a man-made opioid painkiller similar to morphine that is administered as a skin patch or orally.
  • Morphine: the powerful, active ingredient of opium is used as a painkiller and sedative.
  • Opium: from the opium poppy, formerly used in medicine to soothe pain but is now often replaced by derivative alkaloids (as morphine or codeine) or man-made substitutes (opioids).
  • Hydrocodone: often combined with acetaminophen for use as a painkiller. Vicodin (which is not available in Canada, but can be found in the USA) is an example.
  • Oxycodone: a narcotic painkiller, for example Percocet and Percodan.
Street or Slang Terms for Painkillers

Oxies, OC, oxycotton, 80s, percs, vikes, and vikings are commonly used slang terms to refer to painkillers.

Opioid painkillers are the prescription drugs most often used non-medically by young people.

According to the 2019 CAMH OSDUHS study, one in ten high school students (Grade 7 – 12) reported using a prescription opioid pain reliever at least once during the past 12 months. In Ontario alone that represents 95,000 students.

In Canada as a whole, it’s estimated that approximately 310,000 Canadian students have taken prescription drugs not prescribed to them. (DFKC estimate based on 2019 CAMH OSDUHS study)

There are several ways painkillers can be taken. Most teens report swallowing pills, but they can also be crushed and snorted for an intensified effect.

Signs and Symptoms of problematic painkiller use
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Short-term effects
Painkillers can cause drowsiness, inability to concentrate, apathy, lack of energy, constriction of the pupils, flushing of the face and neck, constipation, nausea, vomiting, and most significantly, respiratory depression.

Long-term effects
If a person uses painkillers for a period of time, they can become addicted to the drug and experience withdrawal symptoms when they stop taking the drug. Associated with addiction is increased tolerance, which means more and more of the drug or a combination of drugs is needed to produce the same high or euphoric feeling, possibly leading to an accidental overdose.

Withdrawal
Due to the physical dependence produced by chronic use of opioid painkillers, people who are prescribed opioid medications need to be monitored not just when they are appropriately taking the medicine, but also when they stop using the drug to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and involuntary leg movements.

Potentially dangerous drug interactions

Painkillers should never be used with alcohol, antihistamines, barbiturates, or benzodiazepines.


Since these substances slow breathing, their combined effects could lead to life-threatening respiratory depression.

If you or your teen is already taking a prescribed painkiller, always consult with your physician before taking any other medicine.

Signs of an Opioid Overdose

Physical signs of painkiller overdose include pinpoint pupils, cold and clammy skin, confusion, convulsions, severe drowsiness, and slow or troubled breathing, nausea, confusion, constipation, sedation, respiratory arrest, unconsciousness, coma, and death.

Naloxone is one kind of medication called opiate receptor antagonists which acts by blocking the effects of opiate drugs.

If someone in your family is problematically using opioids and/or street drugs or who has a substance use disorder to opioids, be sure to keep Naloxone in the home.

If you see your teen or anyone else in this state, call 911 immediately.

Let’s Talk Opioids … including fentanyl

“Let’s Talk Opioids, including fentanyl”

This resource will provide you with the knowledge and strategies to help you prevent your child from using opioids problematically, spot problematic use by recognizing the signs and symptoms, and take action effectively to prevent an accidental overdose.

If your son or daughter is already using opioids problematically, this resource suggests several important steps you can take to help protect them from harm.

DFK offers links to resources in your region to help you and your family find the right kind of help for opioid or painkiller dependency or addiction.


Fentanyl


Sedatives/Central Nervous System (CNS) Depressants

Prescription sedatives are central nervous system (CNS) depressants, meaning that they depress or slow down the body’s functions.

These medications are mainly used to relieve anxiety and assist with sleep problems. Other medical uses include inducing sedation for surgical and other medical procedures, treatment of alcohol withdrawal, seizure control and relaxation of skeletal muscles.

Often referred to as sedatives and tranquilizers, CNS depressants are substances that can slow normal brain function. Most CNS depressants reduce brain function through a neurotransmitter called gammaaminobutyric acid (GABA), a chemical that enables communication between brain cells.

Prescription sedatives and CNS depressants are usually taken in pill form; however, some are available as suppositories or prepared as a solution for injection.

Sedatives are often prescribed by doctors to treat a variety of health conditions including anxiety and panic attacks, tension, acute stress reactions, and sleep disorders. When given in high doses, sedatives may act as anesthesia. Sedatives have the potential for problematic use and should be used only as prescribed.

Examples of Depressants

There are three different classes of sedatives: benzodiazepines, non-benzodiazepine sleep medications and barbiturates.

Barbiturates are a type of depressant often prescribed to promote sleep.

Benzodiazepines are a type of depressant prescribed to relieve anxiety.

Some of the most well known sedatives and CNS depressants are listed below with the names you might find on a prescription label.

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  • Estazolam (ProSom)
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)
  • Eszopiclone (Lunesta)
  • Mephobarbital (Mebaral)
  • Sodium pentobarbital (Nembutal)
  • Secobarbital (Seconal)
  • Chlordiazepoxide (Librium)
  • Chlorazepate (Tranxene)
  • Meprobamate (Miltown)
  • Chloral hydrate (Noctec)
  • Ethchlorvynol (Placidyl)
  • Methaqualone (Quaalude)
  • Oxazepam (Serax)
Street or Slang Terms for Sedatives
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Benzos, xanies, xani-bars, xani-bombs, and roofies are commonly used terms to refer to sedatives.

Problematic use of Sedatives

While different sedatives work in unique ways, they produce a drowsy or calming effect that can help those suffering from anxiety or sleep disorders. Because they can produce a state of intoxication, they have a high potential for problematic use.

Some people tamper with the medication to use it for the drug’s euphoric effects. Tampering involves changing the form of the medication or the route by which it is taken or both.

Signs and Symptoms of problematic Sedative use

Sedatives and CNS Depressants should be used only as prescribed.

Be on the lookout for these side effects:

  • Physical side effects: include dilated pupils and slurred speech; relaxed muscles; intoxication; loss of motor coordination; fatigue, respiratory depression; sensory alteration; and lowered blood pressure. Teens taking barbiturates may exhibit side effects such as slurred speech, dizziness, sedation, drowsiness, and fever.
  • Psychological side effects: include poor concentration or feelings of confusion; impaired judgment; and lowered inhibitions. Teens on barbiturates may experience depression, fatigue, confusion, and irritability.
     
Side_effects_of_Vicodin

If you have observed any of the symptoms or side effects listed above, contact a medical professional immediately.

Withdrawal from Sedatives

Because all CNS depressants work by slowing the brain’s activity, when someone stops taking them, the brain’s activity can rebound and race out of control, possibly leading to seizures and other serious consequences.

Withdrawal symptoms: include anxiety, insomnia, muscle tremors, and loss of appetite. Going “cold-turkey” off of some depressants can have life-threatening complications, cause convulsions, delirium, and in rare instances, death.

If you have observed any of the symptoms or side effects listed above, contact a medical professional immediately.

Potentially dangerous Drug and Alcohol interactions with Sedatives
Woman taking painkillers and alcohol

Sedative use can be combined with the use of other drugs like alcohol, other prescription or over-the-counter drugs, and street drugs.

Combining these substances can be highly dangerous:

  • Alcohol – Using sedatives with alcohol can slow both the heart and breathing and may lead to death. When combined with alcohol, the effects and risks of depressants are seriously increased.
  • Prescription drugs – Some interactions with other drugs can be risky. Sedatives should be used in combination with other medications only under a physician’s close supervision.
  • Over-the-counter drugs –  Sedatives should not be combined with any other medication or substance that causes central nervous system depression, including some over-the-counter cold and allergy medications. Doing so may slow the heart and breathing, a serious health risk.
Signs of Sedative overdose

Symptoms including shallow breathing, clammy skin, dilated pupils, weak and rapid pulse, coma, or death.

If you see anyone in this state, call 911 immediately.

DFK offers links to resources in your region to help you and your family find the right kind of help for sedative dependency or addiction.


Stimulants

Stimulants are a broad category of substances that act to increase the level of activity of the central nervous system. Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration.

The category includes commonly used substances such as caffeine and nicotine, over-the-counter decongestants, (e.g., pseudoephedrines like Sudafed TM), illegal drugs (e.g., cocaine, methamphetamine), and prescription medications.

The most common use of prescription stimulants is to treat individuals diagnosed with attention deficit hyperactivity disorder (ADHD). Prescription stimulants are also prescribed by doctors to treat conditions such as asthma, respiratory problems, obesity, and the treatment of narcolepsy and other sleep disorders.

Examples of Stimulants
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Amphetamines and dextroamphetamine  –  are stimulant drugs whose effects are similar to cocaine.
Methamphetamine is a highly addictive stimulant drug that is part of a larger family of amphetamines.
Methylphenidate is a central nervous system stimulant. It has effects similar to, but stronger than, caffeine and less potent than amphetamines.

Street or Slang Terms for Stimulants

Ritz, rippers, dexies, and bennies are commonly used terms to refer to stimulants.

Problematic stimulant use by teens

This class of drug is often used for its ability to produce euphoric effects or to counteract sluggish feelings induced by tranquilizers or alcohol.

Stimulants are used to stay awake, increase alertness and concentration, boost energy, and get high. Teens and university students report saving and selling their own ADHD drugs around exam time. Sometimes teens go beyond swallowing these pills, they also crush and snort them, or mix pills with alcohol.

Signs and Symptoms of problematic stimulant use
CHG034_studying-attempt-stimulat-abuse_FS

There are a number of symptoms and side effects to look for:

  • Physical side effects – include dilated pupils; decreased appetite; loss of coordination; collapse; increased heart and respiratory rates; elevated blood pressure;dizziness; tremors; headache; flushed skin; chest pain with palpitations; excessive sweating; vomiting; and abdominal cramps.
  • Psychological side effects  – include feelings of restlessness, anxiety, and delusions;hostility and aggression; and panic, suicidal, or homicidal tendencies. Paranoia, often accompanied by auditory and visual hallucinations, may also occur.

If you have observed any of the symptoms or side effects listed above, be mindful of the possibility of withdrawal or accidental overdoses.

Withdrawal from Stimulants

Withdrawal symptoms associated with discontinuing stimulant use may include depression, disturbance of sleep patterns, fatigue, and apathy.

Potentially dangerous Drug and Alcohol Interactions with Stimulants

Stimulant use often goes along with the use of other substances like alcohol, other prescription drugs, over-the-counter drugs, and street drugs.

Alcohol: People who use alcohol and stimulants together are likely to drink more before feeling the effects of alcohol because of the stimulant effects; The result? When the stimulant effects wear off, the alcohol kicks in.

Prescription drugs:  Stimulants should only be used in combination with other medications under a physician’s careful supervision.

Over-the-counter drugs:  There are dangers associated with mixing stimulants and over the counter drugs that contain decongestants. Blood pressure can become dangerously high or lead to irregular heart rhythms.

Signs of Stimulant overdose

The symptoms of a sublethal stimulant overdose may include dizziness, tremor, irritability, confusion, hostility, hallucinations, panic, headache, skin flushing, chest pain, palpitations, cardiac arrhythmias, hypertension, vomiting, cramps, and excessive sweating.
Overdose or death is preceded by high fever, convulsions, and heart failure.

Since death in these cases is partially due to strain on the heart, physical exercise increases the risks of stimulant use.

If you see anyone in this state, call 911 immediately.

DFK offers links to resources in your region to help you and your family find the right kind of help for a stimulant depressant dependency or addiction.


Over-the-Counter (OTC) Medications

OTC drugs are medications intended to treat headaches, sinus pressure, or cold/flu symptoms that contain the active ingredient dextromethorphan (DXM). These products are easily available and can be purchased at supermarkets, drugstores, and convenience stores.

When taken in high doses, dextromethorphan DXM can produce a “high” feeling and can be extremely dangerous in excessive amounts.

Being an OTC medicine, dextromethorphan is mostly perceived by young people as safe and not addictive. It is important to raise awareness among youth concerning dextromethorphan’s possible toxicity.

Laxatives, diuretics, and diet pills are also used without a medical reason in order to achieve an idealized weight.  

Young people may start taking just a few diet pills which can develop into dependence. Ephedrine, caffeine, and phenylpropanolamine are just some of the dangerous and addictive substances found in diet pills. Herbal, sometimes referred to as “natural”, weight loss products can be just as dangerous as diet pills. All of these substances act as stimulants to the central nervous system and much like speed can have serious side effects.

Signs and symptoms of OTC medicine use

Short-term effects

Impaired judgment, nausea, loss of coordination, headache, vomiting, loss of consciousness, numbness of fingers and toes, abdominal pain, irregular heartbeat, aches, seizures, panic attacks, psychosis, euphoria, cold flashes, dizziness, and diarrhea.

Long-term effects

Addiction, restlessness, insomnia, high-blood pressure, coma, or even death. In many parts of the country, teens can easily buy OTC cough and cold remedies at any supermarket, drugstore, or convenience store where these products are sold. They can also get them from home, or order them over the Internet. And even if they do not order OTC drugs online, they can surf the Web to find information and videos on what drugs to try and mix together.

Can someone accidentally overdose on OTC drugs?

Yes. The point at which a young person may overdose on OTC drugs varies depending on the amount of the drugs they took, over what time period, and if other drugs were mixed. Some OTC drugs are less potent and cause minor distress, while others are very strong and can cause more serious problems. If your teen is unresponsive, and you suspect an accidental overdose of OTC drugs, call an ambulance immediately and get to the emergency room for proper care and treatment by a medical doctor.

Other drug and alcohol interactions

Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, and loss of coordination. It can put users at risk for internal bleeding, heart problems, and difficulties in breathing. Alcohol also can decrease the effectiveness of many medications or make them totally ineffective.

Some of these medications can be purchased over-the-counter without a prescription, including herbal remedies and others you may never have suspected of reacting negatively with alcohol.

Dextromethorphan, Let’s Talk about it!

Dextromethorphan, Let’s Talk about it!

Get more information about dextromethorphan in this informative booklet prepared by Doctor of Pharmacy Students from the University of Montreal.