Prescription drugs play a vital role in modern healthcare, providing pain relief and symptom management for a range of health conditions. That being said, we have to recognise and acknowledge that a number of prescription drugs have the potential to lead to addiction, posing risks to mind and body. Being able to recognise the early warning signs of addiction and withdrawal, along with credible knowledge and advice on how to effectively deal with the withdrawal symptoms in whatever way they present, are critical steps towards beating prescription drug addiction.
The world of prescription drug abuse can be confusing. There are thousands of drugs, dozens of ways of ingesting them, and countless drug interactions between different drugs and/or alcohol. When does legitimate use end and abuse begin?
NIDA (National Institute on Drug Abuse), a division of the US NIH (National Institutes of Health) defines prescription drug abuse as “taking a medication in a manner or dose other than prescribed; taking someone else’s prescription; or taking a medication to feel euphoria or get high” (“Summary of Misuse of Prescription Drugs”). In many developed countries, some of the more abused prescription drugs include:
All of these drugs have proven medical uses and can help people live better and more fulfilling lives. All of these drugs can be abused and lead to serious physical and mental health problems, possibly death.
Since trying to cover all abused prescription drugs in one article is futile, we’ll focus on examining the signs of addiction and the severity of their withdrawal symptoms for two commonly abused drugs here in the UK – codeine and pregabalin.
UK physicians prescribe both codeine and pregabalin for a range of ailments. Codeine is used as a moderate-to-severe pain medication and is classified as an opioid analgesic (painkiller), while Pregabalin is an anticonvulsant or antiepileptic medication used in the treatment of certain types of nerve pain. It also has a mood-stabilising effect, opening itself up to abuse.
With more than 20 years of experience in helping people break free from their addictions, Gladstones Clinic has helped a large number of clients overcome their prescription drug addictions, many of them addicted to codeine and pregabalin. Since these two drugs have different medical classifications, they’re good examples to look at when learning about prescription drug addiction.
While both of these drugs can be abused on their own, it’s often the case that they’re combined with other drugs to enhance their effects. For example, codeine might be mixed with alcohol, and a 2017 study published in Addiction found that heroin users described getting access to pregabalin as easy, and claimed that it enhanced the narcotic effects of the heroin. The same study also showed a strong correlation between deaths mentioning pregabalin and deaths mentioning gabapentoids (the class of drugs that pregabalin belongs to) & opioids. Both of these drug-related deaths increased in frequency between 2004 and 2015, during which time the amount of pregabalin prescribed increased tenfold. In other words, as more doctors prescribe pregabalin, more people die from heroin overdoses as the two are often abused at the same time. (Lyndon)
Codeine can be taken orally as a tablet or a liquid, or could be injected, although this is typically only done in a hospital. Like other euphoria-inducing opioids, it’s extremely effective when taken to relieve pain; however, our bodies quickly build up a tolerance to its medicinal and narcotic effects (Sebastiano et al.). This increased tolerance might cause a person to self-increase the dosage, either because they are still in pain and seeking relief, or because they are pain-free but enjoy the feelings of euphoria associated with opioids. In either case, self-increasing one’s own codeine dosage is among the first signs that one might be on the road to dependency – and is best not ignored.
Another sign that a codeine dependency might be forming is using codeine along with other narcotic substances. Some people use codeine to enhance the effects of alcohol or other drugs, creating a potentially life-threatening situation.
When it comes to the physical symptoms of codeine abuse, it’s important to remember that they can take time to develop. By the time serious drug abuse symptoms such as seizures or liver failure present themselves, a lot of damage could already have been done. Do not ignore the first two signs of codeine dependency!
Other early signs of codeine addiction include obsessive thoughts and preoccupation with codeine, increased frequency of use (tied in with dosage), neglecting responsibilities and activities, and continued use despite negative consequences.
A doctor might prescribe pregabalin to treat a variety of ailments, including neuropathic pain, epilepsy, and fibromyalgia, among others. Although it isn’t an opioid (it’s classified as an anticonvulsant), pregabalin can also create feelings of euphoria, well-being, relaxation, and an escape from physical or emotional discomfort.
The early addiction signs are similar to those of codeine in that the user will self-increase their dose or abuse pregabalin along with other substances such as alcohol or other narcotics. Pregabalin might also be taken as a nasal inhalant. This is contradictory to the recommended way of taking it and a very obvious sign of pregabalin abuse. (Schjerning et al.).
With longer-term abuse, be on the lookout for changes in sleep patterns, insomnia, excessive drowsiness, sudden and unexplained weight loss or gain, and impaired coordination.
Codeine, being an opiate, demonstrates the typical withdrawal symptoms one could expect from opioids. As is the case with many classes of drugs, the withdrawal symptoms can vary greatly from person to person based on factors such as regular use dosage, how long they’ve been abusing the substance, interaction with other substances, and so on. The timeline for the onset of symptoms can also vary, but in general, a person going through opioid withdrawal is likely to experience symptoms that present within a few hours of the last use, with a high likelihood of more symptoms developing over the next 4 days or so. Some common early-onset symptoms include:
More severe and psychological later-onset symptoms of codeine withdrawal could include:
The physical symptoms will typically peak over the first four days, with slight relief between days 5 and 7. During this time, psychological symptoms such as depression might present, and the person is likely to feel weak and dehydrated due to the sweating and diarrhoea. After 8 days, it is largely only the psychological symptoms that remain as the person finishes their detox. (Perez)
In cases where the codeine abuse is ongoing and severe, going through detox under medical supervision is advised. Licensed physicians might prescribe opioid receptor agonists (e.g. methadone), partial agonists (e.g. buprenorphine), and adrenergic receptor agonists (e.g. clonidine and lofexidine) (Srivastava et al.). These substances ease many of the physical and psychological discomforts of withdrawal, but may only be used under medical supervision as many of them are habit-forming themselves.
Pregabalin, sold as Lyrica, has a half-life of about 6 hours, and withdrawal symptoms typically start presenting within the first 24 hours. Once again, these symptoms could present in any combination based on a number of factors mentioned in the previous section.
The symptoms usually last for about 48 hours. Residual and psychological symptoms can last for several weeks. (Kaliszewski) & (Hayahito).
Under medical care, a patient is usually tapered off pregabalin over a period of time as recommended by the attending physician (Ishikawa et al.). Tapering the doses down can still cause withdrawal symptoms, but not as severe as an abrupt stop. Due to the psychiatric symptoms that it can cause, this detox process should be complemented by a primary care programme aimed at uncovering and treating the root causes of the addiction.
Many of the prescription drugs that are commonly abused today –including the two discussed in this post– can be very challenging to stop using cold turkey. The withdrawal symptoms can overwhelm one’s resolve to stop using and restart the cycle of abuse. This is not an uncommon scenario when people try to go through prescription drug detox at home.
Going through detox under medical supervision at a comfortable and well-equipped residential facility away from access to the drug not only means that one is more likely to complete the process without using, but also that medically approved steps can be taken to alleviate the pain and discomfort of withdrawal.
Gladstones Clinic has decades of experience helping people from all walks of life successfully go through the detox and get primary rehabilitative care for every type of pharmaceutical addiction you can think of. We offer residential rehab programmes that focus first on getting our patients through the detox process, then on uncovering and treating the root causes of addiction using a combination of evidence-based modern and alternative therapies.
If you or a loved one are struggling with a prescription drug addiction, please don’t hesitate to call Gladstones Clinic for information, support, or advice. You can reach us at 0808 258 2350, or contact us directly using our portal.
Learn more about Gladstones Pharmaceutical Rehab Programme.
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Ishikawa, Hayahito, et al. “Pregabalin withdrawal in patients without psychiatric disorders taking a regular dose of pregabalin: A case series and literature review.” Neuropsychopharmacology Reports, vol. 41, no. 3, 2021, pp. 434-39. Wiley Online Library, https://onlinelibrary.wiley.com/doi/full/10.1002/npr2.12195. Accessed 8 6 2023.
Kaliszewski, Michael. “Lyrica Withdrawal Symptoms, Timeline & Treatment.” American Addiction Centers, 31 March 2023, https://americanaddictioncenters.org/prescription-drugs/lyrica-withdrawal-symptoms. Accessed 8 June 2023.
Lyndon, Abigail. “Risk to heroin users of polydrug use of pregabalin or gabapentin.” Addiction, vol. 112,9, 2017, pp. 1580-89. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635829/. Accessed 8 6 2023.
Perez, Alexandra. “Codeine Withdrawal: Symptoms, Diagnosis, and More I Psych Central.” Psych Central, 31 August 2021, https://psychcentral.com/addictions/codeine-withdrawal#timeline. Accessed 8 June 2023.
Schjerning, O., et al. “Abuse Potential of Pregabalin: A Systematic Review.” CNS Drugs, vol. 30, no. 1, 2016, pp. 9-25. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/26767525/. Accessed 7 6 2023.
Sebastiano, Mercadante, et al. “Opioid-Induced Tolerance and Hyperalgesia.” CNS Drugs, vol. 33, no. 10, 2019, pp. 943-55. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/31578704/. Accessed 6 6 2023.
Srivastava, AB, et al. “New directions in the treatment of opioid withdrawal.” Lancet, vol. 395,10241, 2020, pp. 1938-48. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385662/. Accessed 8 6 2023.
“Summary of Misuse of Prescription Drugs.” National Institute on Drug Abuse, 16 June 2020, https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview. Accessed 8 June 2023.
