By Jason Powers, M.D.

As an addiction specialist, I am often asked, “what are the good drugs?” and “what are the bad drugs?” Drug dealers get asked the same question! But people who ask me generally want to know which prescription medications they can safely take and which to avoid.  It can be confusing trying to figure out what is safe to take--I’ll outline some common reasons below.

Too often, medications that were already on the market and approved by the Food and Drug Administration (FDA) are withdrawn due to serious side effects, many medications are overprescribed, others have serious ‘black box’ warnings (for example, a warning that the medication may cause suicidal thoughts), and we also face the problem of counterfeit medications that look like the real thing, but contain little or no active ingredients.

From an addiction perspective, the safest approach you can take is to avoid any and all mind-altering addictive substances unless absolutely necessary.  While this may appear to be common sense at first glance, keep in mind that many such drugs are often prescribed with no questions asked.  We face an epidemic of painkiller abuse in this country, and anti-anxiety medications are so easy to find that they are often the gateway drugs to which our 12-17 year olds are first exposed.

The risk/benefit ratio for continued use of most medications that fall into the category of mind-altering addictive substances clearly argues against prolonged use.  For many, even one is too many.  Of course, no one should suffer, and even opiate addicts deserve pain relief.  It is always a balance.  However, we live in a culture that seems to demand quick fixes despite long-term consequences.

Stimulant medications for attention-deficit disorder are also overprescribed simply because they help students study for (and do slightly better on) exams.  Yet these carry a risk of sudden death, apparently deemed a small chance inconvenience for students competing amidst a sea of medicated masses.

Another group of bad medications are those that we assume are safe because the FDA approves them.  Medications are sometimes brought to market, and then later withdrawn because they are too dangerous.  While I support drug research and development—who wouldn’t?—I’m also in favor of using better judgment, and more stringent efficacy and safety standards when it comes to introducing new medications to the market.

As for those medications with serious ‘black box’ warnings that may include suicidal thoughts, disruptive nightmares and other concerning side effects, I strongly suggest you ask your doctor about specific side effects and do your own research.  A black box warning sounds ominous, but the reasons behind your particular medication receiving that distinction may be dubious. It can be hard to know.  Of course, serious potential side effects make it wise to do your homework and speak at length with your prescribing doctor.  

The existence of counterfeit medicine is a tough pill for me to swallow, pun intended. It is particularly disturbing that people manufacture shams that deprive others of potentially life-saving medicine.  If you unknowingly take fake medicine for blood pressure, for instance, you may be walking around at high risk.  And since high blood is known as the ‘silent killer’ most folks don’t feel a thing when their blood pressure is elevated, and high blood pressure can lead to heart attacks and strokes.

The good news is that drug companies are developing safeguards to protect you against this most vile type of bad medicine--new technology, like advanced holographic films, helps prevent tampering or duplication. Of course, you can protect yourself by avoiding Internet medication sales.  Even though they are less expensive, there is no way you can know if they have the active ingredient you need or if there are other dangerous adulterants or not.

When considering whether or not to take a medication, here is a list of questions to ask your prescribing doctor:

  1. Is this medicine necessary and why?
  2. Are there safer options?
  3. Is this medication (which is necessary and has no safer alternative) going to cause me to become physically dependent on it?
  4. How long will I be taking this medication?
  5. What is the plan when it is time to stop it?
  6. What can I expect when I do actually stop taking it?

Lists are nice, and the one above is helpful, but in the end the distinction between good and medicines depends on the context.  For instance, cocaine is bad when you abuse it but if you need eye surgery, it can often be the perfect anesthetic tool.  People who legitimately have attention deficit disorder may actually prevent negative consequences, such as having to self medicate with drugs (and possibly developing addiction later in life), when they take their medications as prescribed.   Of course some drugs are easy to ban: drugs like heroin, methamphetamine, and crack cocaine are harmful and have no medical benefit. 

So when it comes to deciding on whether or not to take a pill, I hope you see that like in other areas of life, exercise caution, seek the council of wise people, get more than one opinion, and do your own research. 

Jason Powers, M.D., is certified by The American Boards of Addiction Medicine and Family Medicine. He serves as the Chief Medical Officer of San Cristobal, Spirit Lodge and Right Step.  He also manages an addiction medicine practice, works as an interventionist and is the author of "When the Servant Becomes the Master" (2012), and "Positive Recovery," due out in the fall of 2013, by Central Recovery Press. Dr. Powers was voted one of Houston's "Top 50 Doctors" for three years running by H Texas magazine.  In 2008, he was awarded the Compassion Award by Sierra Tucson.

Dr. Powers will be speaking at The Eating Disorders, Compulsions & Addictions Service of the William Alanson White Institute of Psychiatry, Psychoanalysis & Psychology on Tuesday, May 7th, at 10am. Click here to register.

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