Is Prednisone a Drug of Abuse?

Steroid hormones are a main class of hormones. They are organic compounds that are fat-soluble and able to pass through cell membranes easily. They function as signal molecules. There are five classes of steroid hormones, namely glucocorticoids, mineralocorticoids, progestagens, estrogens, and androgens.

• Glucocorticoids are involved in the creation of glucose and glycogen, the breakdown of protein and fat, and the prevention of inflammation. Glucocorticoids are involved in the stress response and they are mainly produced by the adrenal cortex. One important glucocorticoid is cortisol.
• Mineralocorticoids work with the kidneys to adjust blood volume and blood pressure. They are also primarily produced by the adrenal cortex. Glucocorticoids and mineralocorticoids are sometimes referred to as corticosteroids, since they are both produced by the adrenal cortex. An important mineralocorticoid is aldosterone.
• Progestagens are involved in the menstrual cycle and pregnancy maintenance. They are synthesized chiefly by the corpus luteum. The primary progestagen is progesterone.
• Estrogens promote the development of female secondary sex characteristics and play a role in the ovarian cycle. They are primarily synthesized by the ovaries. One important estrogen is estrone.
• Androgens promote the development of male secondary sex characteristics. They are mainly produced by the testes. An important androgen is testosterone.

Anabolic steroids are manmade forms of testosterone. They are called anabolic because they build muscle. Anabolic steroids may be prescribed for various reasons, such as treating some types of anemia, treating hereditary angioedema, treating some types of breast cancer, and helping individuals gain/maintain weight after a serious injury, illness, infection, or unexplained medical issues. However, anabolic steroids are sometimes misused by individuals seeking to improve their athletic performance and/or their physical appearance. When people talk about steroid abuse or misuse, they are typically talking about anabolic steroids.

Is prednisone a Steroid?

Prednisone is not an anabolic steroid. Rather, it is a corticosteroid, a class which has catabolic effects. More specifically, prednisone is a synthetic derivative of cortisol, so it is also a glucocorticoid. Glucocorticoids can decrease inflammation and the immune response, so they may be prescribed to treat various inflammatory, autoimmune, or allergic conditions, such as:

• Asthma
• Rheumatoid arthritis
• Psoriatic arthritis
• Lupus
• Multiple sclerosis
• Severe allergic reactions
• Gout
• Ulcerative colitis

Prednisone can also be used to alleviate symptoms of low levels of corticosteroids. It may also be used to treat bone marrow, blood, endocrine, eye/vision, gastrointestinal, skin, or kidney problems. Prednisone is taken orally, but other systemic corticosteroids may be injected.

Side Effects

Just like any medication, prednisone may cause side effects. Possible common side effects include:

• Facial puffiness (moon face)
• Weight gain
• Male-pattern growth of hair in women
• Skin reddening
• Changes in appetite
• Stomach discomfort
• Mood swings
• Itchiness/rash
• Nausea/vomiting
• Retaining sodium and fluid

Some of the more serious side effects that are possible but rarely occur include:

• Psychosis
• Anaphylaxis
• Insufficient adrenal gland function
• Muscle problems
• Infection
• Diabetes
• Cushing syndrome
• Increased pressure in the skull
• Seizures
• Pseudotumor cerebri
• High blood pressure
• Congestive heart failure
• Pancreatitis
• Perforation of the gastrointestinal tract
• Peptic ulcer disease
• Tendon rupture
• Death of bone tissue
• Bulging eyes

With long term use, rare but serious possible side effects include:

• Cataracts
• Glaucoma
• Suppression of the immune system
• Osteoporosis
• Kaposi sarcoma (a type of cancer)
• Growth suppression in children

Furthermore, among long-term or high-dose users, abruptly stopping prednisone may result in withdrawal symptoms. This can occur in individuals who were taking the medication exactly as prescribed but then suddenly stopped or significantly decreased their dose.

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Withdrawal Issues with Glucocorticoids like Prednisone

Administration instructions are typically to take prednisone with food. A person’s dose may be adjusted by the prescriber over time, depending on the patient’s response to the medication. When it is time to discontinue the drug, this typically should be done by gradually decreasing the amount of prednisone taken to prevent or reduce withdrawal symptoms.

The adrenal glands produce cortisol. Because cortisol is similar to prednisone, the adrenal glands will decrease the production of cortisol if prednisone is present for more than a few weeks. Slowly decreasing the amount of prednisone taken allows an individual’s adrenal glands time to adjust to the decreasing amounts of the prednisone in the system and gradually increase cortisol production back to normal. If prednisone is suddenly stopped or drastically decreased, the person may experience withdrawal symptoms such as:

• Weakness
• Extreme fatigue
• Dizziness
• Joint pain
• Aches
• Decreased appetite
• Nausea

Tapering schedules should be individualized based on how much, how often, and how long prednisone was taken; what prednisone was being used to treat; and other medical factors.

Overdose

Any overdose is a significant issue, and anyone who suspects that someone has overdosed on any medication or other drug should immediately contact emergency medical services. Although prednisone is not considered addictive, an individual may accidentally take too much of the medication or may intentionally take more than directed because they think it will be more effective.

Possible symptoms of overdosing on a corticosteroid include:

• Psychosis
• Depression
• Anxiety
• Drowsiness
• Weakness
• Impaired hearing
• Increased or irregular heartbeat
• Increased appetite
• Nausea/vomiting
• Swelling
• Itching, burning, and/or dry skin
• Increased infections
• Seizures
• Menstrual changes

If you think that you or someone else may have overdosed, call the poison control helpline at 1-800-222-1222 or call 911. In an emergency, always call 911.

Physical Dependence & Addiction

Physical dependence and addiction are not the same. Dependence is when a person’s body acclimates to a drug being present and requires it to function normally. Addiction is when a person compulsively uses a drug even though it is causing detrimental consequences. According to the National Institute on Drug Abuse (NIDA), key characteristics of addiction include:

• Being unable to stop drug use
• Having trouble fulfilling work, family, or social responsibilities
• Experiencing tolerance and/or withdrawal (not all addictions are associated with this, it depends on the drug)

Thus, being physically dependent on a drug may or may not be a sign that a person has developed an addiction. An individual can take a medication as directed by a medical professional but still develop physical dependence on the medication. An individual can have an addiction but his/her drug of choice does not cause physical dependence. An individual can have physical dependence as part of their addiction. Therefore, when someone is physically dependent on a medication, it is important to screen for addiction and other misuse, but it is also important to not assume the person is misusing the medication.

Prednisone Abuse

Prednisone is not a common drug of abuse. Although obtaining it does require a prescription, it is not listed as a controlled substance by the United States Drug Enforcement Administration (DEA). Neither rates of steroid use nor misuse are provided in the detailed results from the 2017 National Survey on Drug Use and Health (NSDUH) published by the Substance Abuse and Mental Health Services Administration (SAMHSA).

This does not mean that misuse of prednisone does not occur. There are several possible reasons that an individual may misuse prednisone. For instance, some people report that corticosteroids cause increased energy and/or euphoria, so a person may misuse prednisone seeking those effects. Additionally, a person may mistake prednisone for an anabolic steroid and so may be seeking to improve their performance or appearance; however, prednisone does not produce those effects as it is a different type of steroid. Furthermore, an individual who is prescribed prednisone for health reasons may feel that their current dose is not effective enough and so may take larger and/or more frequent doses than prescribed, hoping that it will help them feel better.

Regardless of why someone is misusing prednisone, it can be dangerous. When a person is prescribed prednisone, the health care provider monitors him or her for any adverse effects. If a person obtains prednisone without a prescription, they do not have that health monitoring, so negative consequences can go undetected and lead to further problems. Additionally, whether or not someone is prescribed it, a person who is misusing prednisone may take very large amounts of it, increasing the risk of adverse effects. They may even overdose. Moreover, a person who is trying to get prednisone without a prescription may think they’ve obtained it from an illicit source but actually got a different drug, which could have unpredictable, dangerous effects.

There is little research on prednisone or corticosteroid abuse. Although any medication can be abused, it is not thought that corticosteroids are commonly abused.

An individual who is prescribed prednisone should not fret about becoming addicted. Rather, he or she should take the medication as directed by the prescriber. If any concerns arise, the person should discuss them with the prescriber and together they can find a way to address those concerns.

However, if you are struggling with misusing prednisone and think you may have a substance use disorder, you should contact a health care professional who can assess you. There are effective treatments that can help individuals struggling with substance use disorders learn how to manage their illnesses and avoid relapse.

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