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Ask the Mental Health Expert Archives 2001-2004

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Prescriptions for an Addict

Q. I am an alcohol, tobacco and other drug abuse prevention specialist. I was asked, "What type of prescription and over-the-counter medications should a person who is and has been addicted to alcohol or other drugs avoid?" For example, "What medications should a doctor not prescribe to a person who suffers from addiction to drugs?"

A. It's hard to come up with hard-and-fast rules about what medications a doctor should, or should not, prescribe to someone with a history of alcohol/substance dependence or abuse. In general, a responsible physician would try very hard to avoid use of narcotic analgesics, barbiturates, and benzodiazepine medications (such as Valium, Xanax, Librium, etc.) in such a patient. Psychostimulant medications, such as methylphenidate [Ritalin] or amphetamines, would also be risky in a patient who has a history of stimulant or cocaine abuse. (By the way, I do not believe there is good evidence that methylphenidate [Ritalin] is a major drug of abuse for individuals properly diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD); however, there is a big diversion market for these medications, such that they frequently may fall into the wrong hands).

Even antihistamines, sold over-the-counter, may be abused by some drug-addicted individuals, so it's not just a matter of prescription drugs. There are also some so-called natural products on the market (such as kava-kava, often touted as an herbal anti-anxiety agent) that may be overused or abused by susceptible individuals. Some agents that are quite safe if prescribed and used appropriately might be hazardous in an individual who is drinking heavily--benzodiazepines are a good example.

For more information, you may want to try the website for the Substance Abuse and Mental Health Administration (http://www.samhsa.gov/).

November 2001

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