Most dangerous prescription medications

Naveed Saleh, MD, MS | April 28, 2021

When a patient “misuses” prescription drugs, it usually means one of three things: taking the drug in a manner or dose other than prescribed; taking the drug to get high or to achieve some other altered state; or taking another person’s medication, even if it’s for a legitimate complaint, such as pain.

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Doctor writing out prescription

A number of common prescription drugs have serious adverse effects when misused, and doctors should use caution in prescribing them.

That’s according to the National Institute on Drug Abuse (NIDA), and such misuse is a major problem in the United States. “Prescription drug misuse can have serious medical consequences. Increases in prescription drug misuse over the last 15 years are reflected in increased emergency room visits, overdose deaths associated with prescription drugs, and treatment admissions for prescription drug use disorders, the most severe form of which is an addiction,” the agency wrote.

What’s more, nearly 50,000 people in the United States died in 2019 from opioid-involved overdoses. “The total ‘economic burden’ of prescription opioid misuse alone in the United States is $78.5 billion a year,” based on CDC estimates, noted NIDA. And, the pandemic has only made this problem worse. 

With that, let’s take a closer look at some of these prescription drugs of misuse to watch out for, as well as the dangers of other prescription drugs.

Anti-anxiety medications and sedatives

A variety of prescription drugs to treat anxiety or induce sleep are available, including benzodiazepines, barbiturates, zolpidem, and eszopiclone. Although each drug has a different mechanism of action, they all can lead to dependency and tolerance. Keep in mind that dependence refers to the manifestation of symptoms once a drug is stopped, whereas substance use disorder means that people have problems—including social, work, and legal—when they use the drugs, yet continue to use the drugs anyway, according to the Merck Manual.

Chronic use of these drugs can lead to memory loss, decreased attention, bad judgment, and emotional lability. Users may also experience impaired mentation and nystagmus. Overdose on these drugs can lead to drowsiness, confusion, and decreased respiration—and, it should be noted, alcohol intensifies these effects.

In addition, people who stop using these drugs after continued use experience irritability, anxiety, and sleep problems. Dependence is often treated by slowly weaning a patient off the drug with reduced dosages, and can manifest after a mere 2 weeks of continuous use.

In the case of benzodiazepines, withdrawal can lead to tachycardia, rapid breathing, confusion, and even seizures. People taking these drugs for just a few days often claim that they cannot sleep without them.

In terms of danger, barbiturates are likely the scariest of these drugs. According to the aforementioned Merck Manual article, “Serious withdrawal reactions can occur with barbiturates. If high doses have been taken, abrupt withdrawal can produce a severe and potentially life-threatening reaction, much like alcohol withdrawal. Other effects include dehydration, delirium, insomnia, confusion, and frightening visual and auditory hallucinations (seeing and hearing things that are not there). People are usually hospitalized during the withdrawal process because a severe reaction is possible.”

They added, “Severe or life-threatening symptoms are less likely with benzodiazepines than with barbiturates because, for benzodiazepines, the difference between prescribed doses and dangerous doses (called the margin of safety) is large. People can take relatively large amounts of benzodiazepines without dying.” 

On a related note, MDLinx previously reported on research that suggests antidepressant medications, also often used to treat anxiety, are overprescribed. Read more here.

Stimulants

Prescription stimulants are used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. They include dextroamphetamine (Dexedrine), dextroamphetamine/amphetamine (Adderall), and methylphenidate (Ritalin or Concerta).

These drugs are misused in a variety of ways. They can be taken orally, crushed and dissolved in water, injected, snorted, or smoked.

In the short term, these drugs cause euphoria, along with hypertension, tachycardia, increased respiration, increased blood sugar, decreased blood flow, and patency of airways. Moreover, at high doses, these drugs can cause a dangerous elevation in body temperature, arrhythmia, heart failure, and seizures.

Even short-term repeated misuse can lead to anger, psychosis, or paranoia, as well as infectious disease in those injecting.

Importantly, those misusing stimulants may also be misusing other drugs, according to the research. In a study published in Substance Use & Misuse, researchers surveyed 2,989 students from seven US universities and found 17% misused prescription stimulants. This misuse was mostly driven by a desire to boost academic performance and was associated with other drug misuse.

“Although most college students do not report NMPS [non-medical use of prescription stimulants],” the authors wrote, “those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a ‘red flag’ for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.”

Opioids

Prescription and other opioids are notoriously dangerous, so there’s probably little need to belabor the damage and death these drugs incur on society. What bears mention, however, is how much more deadly opioids have become during the pandemic.

As highlighted in a CDC press release, in the 12 months ending in May 2020, 81,000 overdose deaths occurred, which was the highest yearly incidence ever. Moreover, the pandemic catalyzed this increase.

According to former CDC Director Robert Redfield, MD, “The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard. As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”

To combat this rise in overdose, the CDC, in part, recommended expanded distribution of naloxone (a medication designed to rapidly reverse opioid overdose) and expanded awareness/access to treatment for substance use disorders.  

Anabolic steroids 

Anabolic steroids are best known as drugs of misuse by bodybuilders and other athletes hoping to bolster performance or buff up their physical appearance. Remember the term “roid rage”? That refers to the notion that people who abuse anabolic steroids are prone to aggressive or angry outbursts. 

Healthcare providers, however, prescribe these steroids to treat delayed puberty and other hormone issues, as well as to build up muscle in those with atrophy secondary to cancer and AIDS.

Over the long term, these drugs can be quite dangerous and result in kidney problems/failure; liver damage/tumors; increased risk of blood clots; and cardiac hypertrophy, hypertension, and changes in lipid levels. Of note, these cardiac complications can lead to stroke and heart attack in any age group.

Antibiotics

Antibiotic prescription perpetuates a dangerous rise in antibiotic-resistant infections. According to an article by the CDC, “Antibiotic resistance is one of the biggest public health challenges of our time. Each year in the US, at least 2.8 million people get an antibiotic-resistant infection, and more than 35,000 people die.”

In addition to posing risks to public health, antibiotics can also spell danger for the gut microbiome, thus contributing to recurrent infection, increased risk of depression, kidney stone formation, and more. What's more, specific antibiotics pose their own dangers. Fluoroquinolones, for instance, carry a black-box warning for risk of tendinitis and tendon rupture in some patients. Aminoglycosides can cause hearing loss induced by cochlear damage, as well as dizziness, ataxia, and nystagmus due to damage of the vestibular apparatus. 

According to the Centers for Disease Research and Policy at the University of Minnesota, “Antibiotic overprescribing is most prominent in outpatient settings such as clinics and emergency departments. In Europe, approximately 80% to 90% of antibiotic prescriptions are written by general practitioners. Rates of outpatient prescribing are similar in the United States, and the CDC estimates that at least 30% of outpatient antibiotic prescriptions are unnecessary. Most inappropriate use of antibiotics in outpatient facilities occurs when antibiotics are prescribed for viral respiratory infections, such as viral bronchitis, otitis, and sinusitis.”

They added, “Other examples of inappropriate use include prescribing a non-first-line antibiotic or an antibiotic with excessively broad-spectrum activity for a susceptible infection or an infection that may be treated with a narrow-spectrum drug.”

Bottom line

Various prescription drugs have dangerous adverse effects. When prescribing these drugs, it’s imperative to consider whether they are truly required, in addition to keeping an eye out for complications, signs of misuse, and dependence. It’s also a good idea to prescribe these drugs for only as long as they are needed. 

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