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Prescription drug misuse: Epidemiology, prevention, identification, and management

William Becker, MD
Joanna L Starrels, MD, MS
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Opioid analgesics, benzodiazepines, other sedatives and tranquilizers, and stimulants have important medical uses, but they also stimulate the reward center of the brain. In susceptible individuals, this can lead to misuse, substance use disorders/addiction, and other serious consequences. It has led to the development of an illicit market for these medications.

Despite government regulation of these medications, prescription drug misuse and its consequences have persisted and increased. Physicians who prescribe these medications have an important role in reversing these trends.

This topic reviews the epidemiology, prevention, identification, and management of prescription drug misuse. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of opioid use disorder, benzodiazepine use disorder, and stimulant use disorder are discussed separately. (See "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Pharmacotherapy for opioid use disorder" and "Benzodiazepine use disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Psychosocial interventions for stimulant use disorder in adults" and "Pharmacotherapy for stimulant use disorders in adults".)


Controlled substances — Because of their potential for misuse, addiction, and illicit diversion and sale, opioid analgesics, stimulants, and benzodiazepines and other sedatives/hypnotics are regulated, restricting whether and how they can be prescribed. In the United States, these drugs are referred to as "controlled substances" and subject to federal regulations (table 1).

Prescription drug misuse — Any use of a prescription medication that is outside of the manner and intent for which it was prescribed; this includes overuse, use to get high, diversion (sharing or selling to others), having multiple prescribers or nonprescribed sources of the medication, and concurrent use of alcohol, illicit substances, or nonprescribed controlled medications. Misuse is a necessary but not sufficient criterion for a substance use disorder.

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Literature review current through: Oct 2017. | This topic last updated: Sep 19, 2017.
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