Pakistan Pharmacists Association  

Teen Prescription and Over-the-Counter Drug Abuse

 

Introduction

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,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.Although illicit drug use among young people has dropped by 23% during the past 5 years,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." According to the National Institute on Drug Abuse (NIDA),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 Healthrevealed that more than 2 million teenagers misused prescription drugs in 2005. According to SAMHSA:

  • 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.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.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;
  • 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;
  • Among Hispanic teens,1 in 5 (21%) or about 581,000 teens have taken prescription medications to get high;
  • In the same group, 1 in 8 (13%) or about 352,000 Hispanic teens reported abusing cough medicine to get high; 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.

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.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 2008found 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.

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.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%).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.The misuse of OTC cough and cold medicines among 8th and 12th graders has been declining gradually, although holding steady among 10th graders.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.