Addiction Medicine: Closing the Gap between Science and Practice

anxiety and depression, and cocaine and heroin
use are associated with anxiety.* 163

Methamphetamine, cocaine and other stimulant
use (including the use of amphetamine-related
and other “designer drugs”) are associated with
violent behavior, hallucinations, paranoia and
delusions which can be acute time-limited
symptoms or which can persist long after the
cessation of use.† 164 There is a range of
substance-induced disorders included in the
DSM-IV that reflect secondary mental health
effects of addictive substance use.^165

Approximately 160,000 pregnancies in 2004
were associated with illicit drug use.^166 Illicit
drug use during pregnancy increases the risk of
neurological and cognitive deficits in the fetus
and future behavior problems.^167 Heavy
marijuana use has been associated with low birth
weight, premature delivery and complications in
delivery.^168 Marijuana and cocaine exposure
have been linked to impaired attention, language
and learning skills, as well as to behavioral
problems.^169

Infants exposed to prenatal illicit drug use are at
increased risk of low birth weight,^170
developmental and educational problems and
future substance use and addiction.^171

Controlled Prescription Drugs .....................................................................................

In 2008,‡ there were an estimated 20,044
overdose deaths§ attributable to risky use of
controlled prescription drugs. The majority of
these deaths (73.8 percent or 14,800) were
attributable to the risky use of prescription
opioids.^172 Overdose deaths from controlled
prescription drugs have increased significantly

• Adjusting for potentially confounding factors such

as those listed above.
† Producing what is described in the DSM-IV as a

Substance-Induced Mental Disorder.
‡ Most recent available data that distinguishes

between illicit and controlled prescription drugs.
§ Data on other causes of death (e.g., accidents) that

are attributable to the misuse of controlled
prescription drugs are not available.

over recent years and now surpass the number of

overdose deaths caused by illicit drugs.** 173

In 2009, there were 224 deaths that involved

drivers impaired by controlled prescription drugs

(or an unknown combination of prescription

drugs, alcohol and other drugs).^175 The risky use

of controlled prescription drugs was involved in

an estimated 1,079,683 emergency department

visits,†† accounting for 39.8 percent of all

substance-related emergency department visits

in the U.S. Among prescription drug-related ED

visits, 73.3 percent involved opioids, stimulants,

sedatives and barbiturates.‡‡ 176

The risky use of prescription opioids can result

in a range of consequences from drowsiness and

constipation to depressed breathing, at high

doses. Even a large single dose of opioids can

lead to severe respiratory depression or death.^177

One study found that individuals with addiction

involving opioids had significantly higher rates

of comorbid health conditions, including

hepatitis, pancreatitis and psychiatric illness than

those without addiction involving opioids.^178

At high doses, risky use of prescription

stimulants can produce anxiety, paranoia,

seizures^179 and serious cardiovascular

complications including stroke.^180 Other

possible adverse effects include slowed growth

in children, allergic reactions, potentially fatal

interactions with other drugs§§ and sudden

death.^181

** Specifically, heroin and cocaine.

†† Measured in terms of patient visits, not individual

drug reports.

‡‡ The remaining prescription drug-related ED visits

involved antidepressants and antipsychotics (12.3

percent) or other types of prescription drugs (14.4

percent).

§§ Such as MAO inhibitors.

Enough prescription painkillers were prescribed

in 2010 to medicate every American adult

around-the-clock for a month.^174

--Centers for Disease Control and Prevention