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Prescription Drug Abuse By Teens Back to Course Index

Prescription Drug Abuse By Teens

Pres7

 

Prescription and over-the-counter drugs are the most commonly abused substances by Americans age 14 and older, after marijuana and alcohol.  There are 139 deaths a day from drugs, the majority of these from prescription drugs.  The accessibility of prescription drugs in the home make this an easy target for teens looking for an escape, a high, a distraction or even focus on a test.

Jake, a 14 year old high school teen, reported that he had taken some Adderall his brother had gotten from a friend during exam week.  “Everyone at the school was popping it to do better on their tests.  It was no big deal”.  

Prescription drug abuse is when someone takes a medication that Pres5was prescribed for someone else or takes their own prescription in a way not intended by a doctor or for a different reason—like to get high.  It has become a health issue because of the dangers, particularly the danger of abusing prescription pain medications. For teens, it is a growing problem:

  • Teens abuse prescription drugs for a number of reasons, such as to get high, to stop pain, to be cool or because they think it will help them with athletics and/or school work.
  • Most teens get prescription drugs to abuse from friends, parents, and other relatives, sometimes without the other person knowing.
  • Boys and girls tend to abuse some types of prescription drugs for different reasons. For example, boys are more likely to abuse stimulants to get high or because they perceive that they enhance their athletic ability, while girls tend to abuse them to stay alert or to lose weight.

There following categories of medications are typically abused:

 


OPIOIDS

Opioids are a class of drugs chemically similar to alkaloids found in opium poppies; consequently, Opioid prescription drugs are most commonly prescribed as pain killers, especially in circumstances such as following surgery or to provide relief for patients who are in severe, chronic pain.  These drugs are so addictive and potent that even for patients, they’re prescribed with great caution and with very specific orders regarding dosage, frequency and duration.  If the medications are taken as prescribed, then they can be effective and patients can remain safe from detrimental effects and reduces the risk of addiction.  However, virtually any use outside of those prescribed increased the patients’ risk of addiction, overdose, and even death.  In fact, opioids are so strong that even one large dose can be fatal.  Repeated use greatly increases the risk of developing an opioid use disorder. The use of illegal opiate drugs such as heroin and the misuse of legally available pain relievers such as oxycodone and hydrocodone can have serious negative health effects. According to the CDC, 44 people die every day in the United States from overdose of prescription painkillers.    Opioid abuse is a significant health issue as the following statistics indicate (these numbers reflect both adult teen abuse):

  • 4.3 million Americans engaged in non-medical use of prescription painkillers in the last month.
  • Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year.
  • 1.4 million People used prescription painkillers non-medically for the first time in the past year.
  • The average age for prescription painkiller first-time use was 21.2 in the past year.

Heroin is a powerful opiate drug. It is a white or brownish powder, or as the black sticky substance known on the street as “black tar” heroin. It is generally diluted with other drugs or with sugar, starch, powdered milk, or quinine before injecting, smoking, or snorting. Some of the physical symptoms of heroin are euphoria, drowsiness, respiratory depression, constricted pupils, nausea, and dry mouth.  A heroin overdose causes slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and can be fatal.  Many people who inject heroin report misuse of prescription opioids before starting to use heroin. Heroin is frequently cheaper and easier to obtain than prescription medications.  In addition to increasing the risk of overdose, the intravenous use of heroin places individuals at higher risk of diseases like HIV and hepatitis.  Again Heroin abuse represent a serious health problem is the United States as the following statistics indicate:

  • 4.8 million People have used heroin at some point in their lives.
  • Among people between the ages of 12 and 49, the average age of first use was 28.
  • 212,000 people aged 12 or older used heroin for the first time within the past 12 months.
  • Approximately 435,000 people were regular (past-month) users of heroin. Heroin abuse is less frequent in teens especially in early teens. The general flow of drug abuse starts with tobacco, then marijuana and then to hard drugs.  The general trend is for heroin abuse to start in the early twenties.

PRes6While the misuse and abuse (or “non-medical use”) of prescription and over-the-counter drugs continues to decline slowly among the nation’s youth, the past-year non-medical use of the stimulants Adderall and Ritalin (often prescribed for ADHD) remained relatively steady at 6.8 percent and 1.8 percent respectively for high school seniors.  Past-year use of the opioid pain reliever Vicodin has dropped significantly over the past 5 years; 4.8 percent of 12th graders used Vicodin for non-medical reasons in 2015, compared to 9.7 percent in previous years. Past-year use of narcotics other than heroin (which includes all opioid pain relievers) among high school seniors dropped from 7.1 to 6.1 percent in 2015; 

There was also a drop in the past year use of cough/cold medicines containing dextromethorphan (DXM) among eighth graders, with only 2 percent using them for non-medical reasons, down from 3.8 percent five years ago. By contrast, past year non-medical use of the stimulant Adderall (often prescribed for ADHD) remained relatively steady, at 6.8 percent for high school seniors. The survey continues to show that most teens get these medicines from friends or relatives and to a lesser degree from their own prescriptions.

With these numbers declining we are still in a very dangerous position.  

 

DEPRSESSANTS

The second category of mediations that are commonly abused is depressants.  They typically lower neurotransmission levels in the brain that in turn lowers arousal and/or stimulation.   Depressants are also referred to as “downers” as they typically slow most mental and physical body functions.  For centuries, people of almost every culture have used chemical agents to induce sleep, relieve stress, and calm anxiety. While alcohol is one of the oldest and most universal agents used for these purposes, hundreds of substances have been developed that produce central nervous system (CNS) depression.  While these drugs are made for legitimate medical needs of patients, they are often abused with dangerous results. They are often referred to as barbs, reds, red birds, phennies, yellows, yellow jackets; candy, and downers.  These drugs may also be used as sedatives, hypnotics, minor tranquilizers, anxiolytics, and anti-anxiety medications.  While these drugs are made for legitimate medical needs of patients, they are often abused with dangerous results.  PRes8When they are used improperly, the effects often include ataxia which is a neurological sign consisting of lack of voluntary coordination of muscle movements that includes gait abnormality. They also effect muscle relaxation, lowered blood pressure or heart rate, respiratory depression, and anticonvulsant effects, and even complete anesthesia or death at high doses.  Depressants exert their effects through a number of different pharmacological mechanisms, the most prominent of which include facilitation of gamma-aminobutyric acid (GABA), and inhibition of glutamatergic or monoaminergic activity. Other examples are chemicals that modify the electrical signaling inside the body. The most prominent of these being bromides and channel blockers.

Higher doses can cause impairment of memory, judgment and coordination, irritability, paranoia and suicidal thoughts. Some people experience the opposite effect, such as agitation or aggression. Using sedatives (drugs used to calm or soothe) and tranquilizers with other substances, particularly alcohol, can slow breathing and the heart rate and even lead to death.  The short-term effects may be summarized as:

  • Slow brain function, pulse and breathing;
  • Lowered blood pressure;
  • Poor concentration/confusion/dizziness/slurred speech;
  • Depression/addiction.

Tolerance to depressants can develop rapidly, with larger doses needed to achieve the same effect. The user, trying to reach the same high, may raise the dose to a level that results in coma or death by overdose.  Long-term use of depressants can produce depression, chronic fatigue, breathing difficulties, sexual and sleep problems. As a dependency on the drug increases, cravings, anxiety or panic attacks are common if the user is unable to get more.  Withdrawal symptoms include insomnia, weakness and nausea. For continual and high-dose users, agitation, high body temperature, delirium, hallucinations and convulsions can occur. Unlike withdrawal from most drugs, withdrawal from depressants can be life-threatening.

In a study conducted by USA Today, based on Food and Drug Administration data over a four-year period, antipsychotics (a type of depressant) were the prime suspects in forty-five deaths caused by heart problems, choking, liver failure and suicide. 

Depressants usually come in pill or capsule form. Drug abusers might take a CNS depressant not prescribed for them or take a larger dose than prescribed. Sometimes people take them with other drugs or to counteract the effects of other drugs, such as stimulants.

Most CNS depressants affect the brain in the same way—they enhance the activity of gamma-aminobutyric acid (GABA), a naturally occurring chemical in the brain that sends messages between cells (neurotransmitter). GABA works by slowing down brain activity. Although different classes of CNS depressants work in unique ways, they ultimately increase GABA activity, which produces a drowsy or calming effect.

The non-medical use of prescription drugs is highest among young adults. Researchers indicate that in the past year six percent of 12- to 17- year-olds, 12 percent of 18- to 25- year-olds, and 5 percent of persons age 26 or older, used prescription drugs non-medically in the past year. Also, researchers indicate that more than 17,000 young adults died from Rx drug overdose in 2015-–a 4-fold increase from 1999, that’s nearly 5 persons per day.  Data also shows prescription-drug-related overdose deaths increasing among person’s ages 18- to 25- years-old from 418 deaths in 1999 to 1,741 deaths in 2015.  Among young adults, for every death due to Rx drug overdose, there were 22 treatment admissions6 and 119 emergency room visits.   This problem is real!

 


STIMULANTS

Pres2The third category of commonly abused medications is stimulants.  They are psychoactive drugs that induce temporary improvements in either mental or physical functions or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others. Due to their rendering a characteristic “up” feeling, stimulants are also occasionally referred to as “uppers”. Depressants or “downers”, which decrease mental and/or physical function, are in stark contrast to stimulants and are considered to be the functionally opposite drug class. Stimulants are widely used throughout the world as prescription medicines and without prescription both as legal substances and illicit substances of recreational use or abuse. Stimulants are used both individually and clinically for therapeutic purposes in the treatment of a number of indications, including the following:

  • To counteract lethargy and fatigue throughout the day while at work or while doing other activities;
  • To reduce sleepiness and to keep the person awake when necessary, as well as to treat narcolepsy;
  • To decrease appetite and promote weight loss, as well as to treat obesity;
  • To improve concentration and focus, and reduce restlessness and hyperactivity, especially for those with attentional disorders such as ADHD;
  • Occasionally, used off-label to treat clinical depression and bipolar disorder, in particular, atypical depression and treatment-resistant depression;
  • To relieve nasal congestion and to treat orthostatic hypotension and postural orthostatic tachycardia syndrome;
  • To aid in smoking cessation. (Bupropion, nicotine);
  • To counteract fatigue and maintain alertness for extended periods and critical operations in military aviation and space flight;
  • To offset sedative effects of opioids used long term at higher doses such as in cancer or AIDS patients;
  • To relieve pain, in part by potentiating other drugs. (Caffeine).

A New York Times article indicates that it is a common practice for prescription stimulants used to help children with ADHD are being sold on the black market to healthy students seeking a quick fix to increase focus, concentration and test performance. The Times article, written by Alan Schwarz, describes the typical student involved in the illicit use as a model citizen. He or she already earns good grades, participates in a dizzying number of extracurricular activities, and thoroughly expects to attend a prestigious college. He or she is convinced that they need a little extra boost to elevate their SAT scores to the optimum level (without even thinking of the risks they are exposing themselves to). Obviously this is very concerning to parents of teenagers.

 A medical practice, which focuses on ADHD/ADD, works with many teenagers attending highly competitive prep schools. The student workload is heavy and the pressure to succeed can be daunting. It’s understandable why a student would turn to his friend’s Ritalin to get that added advantage. Forbes staff writer Matthew Herper, in a recent article, asks a number of penetrating questions regarding the growing use of ADD drugs: Is reliance on brain-enhancing drugs just another symptom of our society’s need for quick-fix solutions? Why do parents and children choose this route, rather than investigating other means of improving focus? Does easy access to such drugs provide an unfair advantage to kids who already have every advantage at their disposal?

It is clear there are many people suffering from the often debilitating symptoms of attention deficit disorder. For these children, teenagers and adults, medication is a lifesaver. But there are also a number of parents who come wondering if their straight-A student has ADD. The parents claim their child is “not performing up to their potential.” They ask “If medication will help them improve their focus.” Of course it will. According to the Times report, drugs like Adderall and Ritalin help kids with ADD calm down, and non-affected kids experience something completely different. This is simply not true. ADD medications foster improved focus in all individuals by increasing the levels of the neurotransmitters norepinephrine and dopamine in the prefrontal cortex, the part of the brain that controls behavior and attention. Once these areas are snapped into place, so to speak, everything else gets controlled.

To quote from Nature.com: “For years, it was assumed that stimulants had paradoxical calming effects in ADHD patients. It is now known that low doses of stimulants focus attention and improve executive function in both normal and ADHD subjects.” So while we might all improve our focus on ADD medications, these drugs are a controlled substance, illegal without a prescription and dangerous if abused. If even a small percentage of teenagers are abusing ADD medications, it’s too many.

The remedy to this is for clinicians to do careful evaluations of teenagers to determine if they in fact have ADD or not. Limiting ADD drugs to those that truly need the medication is paramount. But how do we determine need? The main requirement for a diagnosis of ADD is an “impairment in functioning.” Getting B’s or getting denied admission to Harvard is not an impairment in functioning. It may be painful, but it is not debilitating. Crashing your car, getting arrested, destroying relationships (often the result of ADD) are painful and certainly an impairment in functioning.

Comprehensive evaluations for ADD require going much further than most doctors that simply read a list of ten questions. In addition to a clinical interview, looking at both childhood and current symptoms, frequently computer based assessments and/or tests of executive functioning can be used in determining ADD. Even with this thorough assessment, the greatest determining factor for a diagnosis of ADD/ADHD is how impaired the individual is based on societal norms. By focusing on true impairment, improved diagnosis can be achieved and medications will be used by those that truly need them.

Past-year non-medical use of the stimulants Adderall and Ritalin (often prescribed for ADHD) remained relatively steady in 2015, at 6.8 percent and 1.8 percent respectively for high school seniors. The survey continues to show that most teens get these medicines from friends or relatives; a smaller percentage misuse or abuse pills that had been prescribed for them for a medical problem. Although teens did not misuse or abuse prescription stimulants at higher rates than in past years, there has been a decline in teens’ perceptions the risks of doing so. In 2015, 55.1 percent of seniors saw regularly taking prescription amphetamines as harmful, down from 69.0 percent in previous years.   This general trend continues through 2015 and into 2016.



THE EFFECT ON THE BODY AND BRAIN

Prescription drugs that effect the brain, including opioid painkillers, stimulants, and depressants, may cause physical dependence that can turn into addiction.

Dependence happens because the brain and body adapt to having drugs in the system for a while. A person may need larger doses of the drug to get the same initial effects. This is known as “tolerance.” When drug use is stopped, withdrawal symptoms can occur. Dependence is not the same as addiction, but it can contribute to a person developing an addiction. It is one of the many reasons why a person should only take (and stop taking) prescription drugs under a doctor’s care. 

Carefully following the doctor’s instructions for taking a medication can make it PRes3less likely that someone will develop dependence or addiction, because the medication is prescribed in amounts and forms that are considered appropriate for that person. However, dependence and addiction are still potential risks when taking certain types of prescription drugs. These risks should be carefully weighed against the benefits of the medication and patients should communicate any issues or concerns to their doctor as soon as they arise.

Medications that affect the brain can change the way it works—especially when they are taken over an extended period of time or with escalating doses. They can change the reward system, making it harder for a person to feel good without the drug and possibly leading to intense cravings, which make it hard to stop using. This is no different from what can happen when someone takes illicit drugs—addiction is a real possibility. When a person is addicted to a drug, finding and using that drug can begin to feel like the most important thing—more important than family, friends, school, sports, or health.

Other kinds of medications that do not act in the brain, such as antibiotics used to treat infections, are not addictive.

 


SUMMARY

Abuse of prescription and over-the-counter medications is a real problem for teens and adults as well but the solution is not obvious and certainly not easy to implement.  Some considerations:

  • Education—parents and caregivers should be well versed on teen abuse of prescription and over- the-counter meds. If you don’t already know find out about health risks, addiction and overdose as well as abuse in your local school and community.  Talk to your school administrator and become active in community activities and PTA.  
  • Parent and caregivers should secure all medications from teens. This may require locking them in a safe or other secure place.
  • Educate all teens regarding the harmful effects of abuse of medications (overdose, addiction and health risks). Caution your teen that information from a friend is not always reliable.
  • Parents should be aware of rapid mood changes that occur without warning. The changes can be due to medications.  Mood changes can be a flag that says watch me!
  • Help expose and eliminate pill mill clinics that dispense a great deal of medication without extensive scrutiny of the patient. They are easy to identify as they generally exhibit the following signs:
  • Limited physical and diagnostic tests;
  • Minimum medical records. Typically deal on cash basis to avoid paper trail;
  • No alternative treatment for pain recommended (pills only).

Pill Mills provide strong medications to almost anyone that wants to purchase them; consequently, they put people’s health and lives at risk. A legitimate medical purpose is required for anyone to legally disperse medications.



QUESTIONS AND ANSWERS

Q1: Are Prescription Drugs Safe?

Prescription drugs are often strong medications, which is why they require a prescription in the first place. When they are abused, they can be just as dangerous as drugs that are made illegally. Even when they are not abused, every medication has some risk for harmful effects, sometimes serious ones. Doctors consider the potential benefits and risks to each patient before prescribing medications and take into account a lot of different factors. People who abuse drugs might not understand how these factors interact and put them at risk.

Q2:  What personal information does a Doctor consider when writing a prescription?

Doctors take into account a person’s weight, how long they’ve been prescribed the medication, and what other medications they are taking. Someone abusing prescription drugs may overload their system or put themselves at risk for dangerous drug interactions that can cause seizures, coma, or even death.  The Doctors also knows how long it takes for a medication to dissolve in the stomach, release drugs to the blood, and reach the brain. When abused, prescription drugs may be taken in larger amounts or in ways that change the way the drug works in the body and brain, putting the person at greater risk for an overdose. For example, when people who abuse OxyContin crush and inhale the pills, a dose that normally works over the course of 12 hours hits the central nervous system all at once. This effect increases the risk for addiction and overdose.

Q3:  What are the side effects?

 Prescription drugs are designed to treat a specific illness or condition, but they often affect the body in other ways, some of which can be dangerous. These are called side effects. For example, OxyContin stops pain, but it also causes constipation and sleepiness. Stimulants, such as Adderall, increase a person’s ability to pay attention, but they also raise blood pressure and heart rate, making the heart work harder. These side effects can be worse when prescription drugs are not taken as prescribed or are abused in combination with other substances—including alcohol, other prescription drugs, and even over-the-counter drugs, such as cold medicines. For instance, some people mix alcohol and depressants, like Valium, both of which can slow breathing. This combination could stop breathing altogether

Q4:  Can You Get Addicted to Prescription Medications?

Yes, prescription drugs that effect the brain, including opioid painkillers, stimulants, and depressants, may cause physical dependence that can turn into addictions.  Dependence happens because the brain and body adapt to having drugs in the system for a while. A person may need larger doses of the drug to get the same initial effects. This is known as “tolerance.” When drug use is stopped, withdrawal symptoms can occur. Dependence is not the same as addiction, but it can contribute to a person developing an addiction. It is one of the many reasons why a person should only take prescription drugs under a doctor’s care. Carefully following the doctor’s instructions for taking a medication can make it less likely that someone will develop dependence or addiction, because the medication is prescribed in amounts and forms that are considered appropriate for that person. However, dependence and addiction are still potential risks when taking certain types of prescription drugs. These risks should be carefully weighed against the benefits of the medication and patients should communicate any issues or concerns to their doctor as soon as they arise.  Medications that affect the brain can change the way it works—especially when they are taken over an extended period of time or with escalating doses. They can change the reward system, making it harder for a person to feel good without the drug and possibly leading to intense cravings, which make it hard to stop using. This is no different from what can happen when someone takes illicit drugs—addiction is a real possibility. When a person is addicted to a drug, finding and using that drug can begin to feel like the most important thing—more important than family, friends, school, sports, or health.  Whereas other kinds of medications that do not act in the brain, such as antibiotics used to treat infections, are not addictive.

Q5:  How Are Prescription Drugs Abused?

People abuse prescription drugs by taking medication in a way that is not intended, such as taking someone else’s prescription to self-medicate or by taking a prescription medication in a way other than prescribed. Even when someone takes another person’s medication for its intended purposes (such as to relieve pain, to stay awake, or to fall asleep) it is considered abuse.  This includes taking more of the medication than prescribed or changing its form—for example, breaking or crushing a pill or capsule and then snorting the powder.

Q6:  Should parents be concerned with the drug problem is our schools and communities?

YES.