Mental Health

Teen Prescription and Over-the-Counter Drug Abuse

Teen Prescription and Over-the-Counter Drug Abuse

Prescription drug misuse, especially by teens, has become a national public health problem. The rates for new users of prescription drugs are now almost equal to those for new users of marijuana, and prescription drugs are now the second most common drugs (after marijuana) used by teenagers to get high. According to the Partnership for a Drug-Free America,[1] the abuse of prescription and over-the-counter (OTC) medications is an “entrenched behavior” among America’s youth. The Office of National Drug Control Policy reports that most adolescents who misuse these products are getting them easily and for free.[2] Although illicit drug use among young people has dropped by 23% during the past 5 years,[3] experts warn that teens are intentionally abusing prescription drugs to get high because they believe, wrongly, that prescription drugs are safer than street drugs.
Prevalence of Drug Misuse and Abuse

Teen Prescription and Over-the-Counter Drug Abuse

Prescription drug misuse, especially by teens, has become a national public health problem. The rates for new users of prescription drugs are now almost equal to those for new users of marijuana, and prescription drugs are now the second most common drugs (after marijuana) used by teenagers to get high. According to the Partnership for a Drug-Free America,[1] the abuse of prescription and over-the-counter (OTC) medications is an “entrenched behavior” among America’s youth. The Office of National Drug Control Policy reports that most adolescents who misuse these products are getting them easily and for free.[2] Although illicit drug use among young people has dropped by 23% during the past 5 years,[3] experts warn that teens are intentionally abusing prescription drugs to get high because they believe, wrongly, that prescription drugs are safer than street drugs.
Prevalence of Drug Misuse and Abuse

Today’s teens are part of the “Rx Generation.[1]” According to the National Institute on Drug Abuse (NIDA),[4] 7 million people of all ages used psychotherapeutic drugs for nonmedical purposes in 2006. This included 5.2 million who misused pain relievers, 1.8 million who misused tranquilizers, 1.2 million who misused stimulants, and 0.4 million who misused sedatives. A significant proportion of these are adolescents. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health[3] revealed that more than 2 million teenagers misused prescription drugs in 2005. According to SAMHSA[5]:

* One in 5 teens has misused prescription drugs.
* One in 3 teens has reported that there is “nothing wrong” with using prescription drugs “every once and a while.”
* One in 3 teens has reported knowing another youth who misuses or abuses prescription drugs.
* Every day, nearly 2500 youths misuse a prescription drug for the first time.
* Prescription drugs are abused by teens more often than cocaine, heroin, ecstasy, and methamphetamine combined.
* Prescription drugs are the drug of choice among 12- and 13-year-olds.
* Girls are more likely than boys to intentionally use prescription drugs to get high.
* Most teens (57%) who use these products admit that they get prescription drugs for free from a relative or friend (47%) or take them from a relative or friend (10%) without permission. An additional 10% buy narcotic analgesics from a friend or relative.
* Adolescents are more likely than young adults to become dependent on prescription medication.

More than 3 million young people in the United States, aged 12-25 years, are thought to have used OTC cough and cold medications nonmedically in 2006.[3] Teenagers, especially 14- to 15-year-olds, act more independently than younger children in making decisions about what to take and when to use nonprescribed medications.[6] The following additional data in regard to the nonmedical use of OTC products found that:

* OTC cough and cold remedies were misused by 4% of 8th graders, 5% of 10th graders, and 6% of 12th graders in the past year[7];
* From 1999 to 2004, poison control centers reported a 7-fold increase nationwide in the abuse of dextromethorphan, the active ingredient in cough and cold medicine. Most of these cases were among 15- and 16-year-olds[8];
* Among Hispanic teens,1 in 5 (21%) or about 581,000 teens have taken prescription medications to get high[1];
* In the same group, 1 in 8 (13%) or about 352,000 Hispanic teens reported abusing cough medicine to get high[1]; and
* Overall, whites were more likely to report having abused OTC medications (6.2%) than blacks (2.5%). Rates were not estimated for Asian Americans or Native Americans.[3]

Why Do Teens Abuse Prescription or OTC Drugs?

The reasons that an increasing number of teens are abusing prescription and OTC drugs are not completely understood. Many teens think that these drugs are safe because they have legitimate uses and are often found at home in the medicine cabinet. Parents purchase OTC drugs for family use and may not realize that their kids are abusing these products. Teenagers generally lack a sense that OTC and prescription medications can be dangerous or addictive. As a rule, teens do not see any negative consequences of using OTC preparations, nor do they think that they can get in trouble if caught using them. It is thought that accessibility plays a large role in prescription drug misuse by teens. Additionally, the proliferation of Internet pharmacies provides an opportunity for illegally obtaining medications.

What we do know is that the misuse of prescription drugs can alter the brain’s pain signaling pathways and ultimately result in addiction. Opioids can produce drowsiness, constipation, and — depending on amount taken — can depress breathing. Central nervous system depressants slow down brain function; if combined with other medications or with alcohol, they can dangerously slow heart rate and respiration. Taken repeatedly or in high doses, stimulants can cause anxiety, paranoia, dangerously high body temperatures, irregular heartbeat, or seizures.

Some teenagers who abuse prescription medications and OTC preparations are sensation seekers; they “use” to get high, or are seeking to self-medicate. Either scenario represents an unacceptable health risk for adolescents.[9] Teens report that they use prescription drugs and OTC preparations because these products relieve pain, reduce anxiety, help them sleep, or give them an edge in school or sports.

Too often these drugs are taken in an inappropriate strength or dosage, which can have serious consequences. Teens also describe “pharm parties” during which they dump various prescription medications into a bowl or baggie and ingest handfuls of the drugs, often mixed with alcohol. This practice, similar to using inhalants, is a deadly game.
What Are These Kids Taking?

The Monitoring the Future Survey 2008[7] found that 5% of 12th graders reported taking oxycodone without a prescription during the previous year, and 9.3% reported taking hydrocodone, making it one of the most commonly abused drugs by this age group. The use of sedatives (barbiturates) among 12th graders has been gradually declining since 2005. The nonmedical use of tranquilizers (eg, diazepam, alprazolam) in 2008 was 2.5% in 8th graders, 5.1% in 10th graders, and 7.3% in 12th graders. Methylphenidate (Ritalin®) abuse has been decreasing steadily since 2004.[7]

Adolescents also misuse OTC medications, and they rarely consider the emotional risks that can be associated with OTC drugs. Many teens start experimenting with these medications to relieve stress or anxiety, increase alertness for studies, or to fit in socially. Abuse of dextromethorphan, the chief OTC culprit, is called “robo-tripping” by teens who use it as a vehicle to get high. Most teens who misuse OTC medications are unaware of the potential dangers, such as the dissociative effects that may occur when taken in high doses.[10] Because these drugs are legal and have been given to them by their parents when they’re ill, kids believe them to be safer than illegal drugs.

Studies have shown that young adults ages 18-25 years were more likely than youths ages 12-17 years to have used OTC cough and cold medications at some point in their lives for nonmedical purposes (6.5% vs 3.7%), but were less likely to do so in the past year (1.6% vs 1.9%).[7] Whites ages 12-25 years (2.1%) were more likely than Hispanics (1.4%) and blacks (0.6%) to have used an OTC cough and cold medication in the past year to get high.[7] The misuse of OTC cough and cold medicines among 8th and 12th graders has been declining gradually, although holding steady among 10th graders.[7] These statistics remind all that drug misuse, including prescription and OTC drug abuse, is an equal-opportunity disease. No group is spared the anguish and pain from abuse or addiction.

There are efforts to prevent OTC abuse. Many states have enacted laws to prevent or limit the sale of dextromethorphan to minors. Many pharmacies will ask to see identification before the sale is completed. Pharmaceutical companies are beginning to offer educational programs about OTC medication abuse.
Stopping Prescription Drug Abuse

The Role of Parents

The challenge for parents is to become aware of the problem, remain vigilant, and to educate themselves about the various means through which their children may be putting themselves at risk with prescription and OTC drugs. Parents may simply not be aware of the consequences of this type of abuse. Despite the increase in parent-teen discussions about the risks for drugs, many parents may not be discussing the risks of abusing prescription and OTC medicines with their children. Only 24% of teens have reported that their parents had talked with them about the dangers of abusing prescription drugs or the use of medications outside of a clinician’s supervision, and just 18% of teens have indicated that their parents had discussed the risks of abusing OTC cough medicine.[6] Prescription and OTC drug misuse often begins innocently with teens “borrowing” medications from each other. Recent research found that approximately 20% of adolescents have shared prescription medications.[10]

The Partnership for a Drug-Free America recommends a 3-step approach: (1) educate; (2) communicate; and (3) safeguard. Parents are encouraged to:

* Educate themselves about which medications can be misused or abused, and learn about the very real dangers and risks of this behavior;
* Communicate these risks to their kids, dispelling the notion that medicines can be safely abused; and
* Safeguard medications by limiting access to those that can be abused, keeping track of quantities, and safely disposing of medications that are no longer needed. Parents should also enlist the support of fellow parents to ensure that they do the same.

Role of Health Practitioners

Communication, honesty, and vigilance are the keys to success for healthcare professionals who treat teens. Practitioners should talk with adolescents directly to ascertain whether they are misusing or abusing prescriptions or other drugs. Questions that can be asked include:

* What cold preparations do you use? How often?
* What do you take when you have pain? How often?
* Do you borrow medications from your friends or family? If so, what have you taken? How much?
* Do you or your friends use OTC drugs to get high?
* Do you or your friends take prescription medications to get high?

It is important to address the health and safety risks that such practices present. For example, “borrowing” prescriptions, such as antibiotics, exacerbates antibiotic resistance. “Sharing” acne medication is dangerous because these drugs contain teratogens.[10] Research has demonstrated that education for teens must be reinforced over several encounters.[11] This reinforcement includes illustrations, repetition, and having the patient paraphrase messages from the healthcare practitioner. For example, practitioners can explain the pathology of a young person’s illness, along with how the medication will help it. Asking the adolescent patient to repeat back instructions for taking medications is important because this locks in the message.[11] This type of dialogue also allows the adolescent to participate in the treatment process.

Parents must be counseled to handle their own prescription medications carefully, by counting the number of pills and placing them in secure locations. Assisting parents to talk with their teens about alcohol and other drug abuse, including prescription and OTC drug misuse, is of critical importance. Parents need to familiarize themselves with the side effects of all prescription and OTC preparations that they bring into their homes. For example, parents should learn and teach their children about the dosages and side effects of the drugs that they take, such as which drugs can cause drowsiness and the possibility of stomach bleeding from taking aspirin. Parents can talk with their teenagers about the potential drug interactions that occur when drugs are shared or taken without checking with parents first.

Can prescription and OTC drug abuse be eliminated? Probably not; however, education, awareness, and clear communication with teens can go a long way to control the problem.
Resources for Healthcare Professionals

Join Together
A nonprofit organization that aims to inform Americans of the economic and social costs of substance abuse and its impact on their lives, as well as remove the stigma of substance abuse and replace shame and despair with hope.

SAMHSA’s Substance Abuse Treatment Facility Locator
An interactive map providing information and locations for treatment facilities providing substance abuse treatment.

Substance Abuse and Mental Health Services Administration
Focuses on building resilience and facilitating recovery for people with or at risk for mental or substance use disorders. You can also get help finding treatment near you by calling the SAMHSA 24-hour Helpline at 1-800-662-HELP (1-800-662-4357).

The National Institute on Drug Abuse (NIDA)
Provides information for youth, parents, teachers, medical and health professionals, and researchers on the science of drug abuse and addiction.

The Partnership for a Drug-Free America (PDFA)
A nonprofit organization that unites parents, renowned scientists, and communications professionals to help families raise healthy children.
Resources for Parents and Teens

Community Anti-Drug Coalitions of America (CADCA)
Trains local grassroots groups, known as community antidrug coalitions, in effective community problem-solving strategies, teaching them how to assess their local substance abuse-related problems and develop a comprehensive plan to address them.

Join Together
A nonprofit organization that aims to inform Americans of the economic and social costs of substance abuse and its impact on their lives, as well as remove the stigma of substance abuse and replace shame and despair with hope.

SAMHSA’s Substance Abuse Treatment Facility Locator
An interactive map providing information and locations for treatment facilities providing substance abuse treatment.

The National Institute on Drug Abuse (NIDA)
Provides information for youth, parents, teachers, medical and health professionals, and researchers on the science of drug abuse and addiction.

The Office of National Drug Control Policy’s (ONDCP) National Youth Anti-Drug Media Campaign has developed Websites to address specific audiences and to provide targeted, relevant information to visitors. The following Websites are sponsored by the ONDCP Media Campaign:

* Above the Influence
This campaign site reflects what teens across the country have told us is going on in their lives, and provides perspective on what influences they face every day.
* The Anti-Drug
This campaign site for parents provides drug facts, prevention strategies, and information.
* La AntiDroga
This Spanish-language site includes drug information, expert advice on how to handle youth drug use, and an interactive feature through which parents can submit questions to a drug-prevention expert and have them answered online.
* DrugAnswer.com
This site provides drug prevention advice for parents in Chinese, Korean, Vietnamese, and Filipino.
* The Anti-Meth Campaign
A portion of the Media Campaign is directed specifically toward the consequences of methamphetamine use and abuse. This site showcases the various advertising and communication vehicles used by the Anti-Meth Campaign to prevent methamphetamine use, dispel the myth that methamphetamine treatment does not work, and get people who need help for methamphetamine use into treatment.
* Community Resources Packages
A comprehensive compilation of print materials, Web content, fact sheets, and activities to assist community groups in addressing a specific topic.

Topics include:
o Bridging the Parent-Teen Generation Gap
o Teen Prescription Drug Abuse
o Teen Marijuana Use
o Teens and Technology
o Drugged and Drunk Driving
o Steroid Abuse
* The Partnership for a Drug-Free America (PDFA)
A nonprofit organization that unites parents, renowned scientists, and communications professionals to help families raise healthy children.

Kate Driscoll-Malliarakis, MSM, CNP, MAC
Medscape Public Health & Prevention © 2009

References:

1. Partnership for a Drug-Free America. The Partnership Attitude Tracking Study (PATS) Teen 2008 Report. New York: Partnership for a Drug-Free America; February 26, 2009. Available at: http://www.drugfree….joomla_teens_2008 Accessed November 14, 2009.
2. Office of National Drug Control Policy. Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens. Washington, DC: Office of National Drug Control Policy; 2008. Available at: http://www.theantidr…tion_report.pdf Accessed November 14, 2009.
3. Substance Abuse and Mental Health Services Administration (SAMHSA). National survey of drug use and health. Rockville, Md: Office of Applied Studies; 2005. Available at: http://oas.samhsa.go…cough/cough.cfm Accessed November 14, 2009.
4. National Institute on Drug Abuse. Topics in brief: prescription drug abuse. March 2008. Available at: http://www.drugabuse…escription.html Accessed November 14, 2009.
5. Substance Abuse and Mental Health Administration & National Council on Patient Education and Information. Maximizing Your Role as a Teen Influencer: What You Can Do to Help Prevent Teen Prescription Drug Abuse. Rockville, Md: National Council on Patient Education and Information; 2009. Available at: http://www.talkabout…mizing_role.jsp Accessed November 14, 2009.
6. Dengler R, Roberts H. Adolescents’ use of prescribed drugs and over-the-counter preparations. J Public Health Med. 1996;18:437-442.
7. Johnston LD, O’Malley PM, Bachman J G, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975-2008. Volume I: Secondary School Students. Bethesda, Md: National Institute on Drug Abuse; 2009. NIH Publication No. 09-7402.
8. Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IB. Dextromethorphan abuse in adolescence, an increasing trend: 1999-2004. Arch Ped Adolesc Med. 2006;160:1217-1222.
9. Boyd C, Young A, Grey M, McCabe S. Adolescents’ nonmedical use of prescription medications and other problem behaviors. J Adolesc Health. 2009;3:1-8.
10. Goldsworthy RC, Mayhorn CB. Prescription medication sharing among adolescents: prevalence, risks, and outcomes. J Adolesc Health. 2009;6:1-4.
11. Apa-Hall P, Swartz R, McConnell R. The current state of teenage drug abuse: a trend toward prescription drugs. J School Nurs. 2008.


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