Prescription Drug Abuse by Adolescents

The rate of prescription drug abuse among adolescents has increased dramatically over the past decade. Prescription drugs are the second most commonly abused illicit drug among adolescents—surpassed only by marijuana (Substance Abuse and Mental Health Services Administration, 2008). Painkillers, depressants, and stimulants are the medications most frequently abused. The negative consequences of prescription drug abuse can be severe. Many teenagers abuse prescription drugs in combination with alcohol or other drugs, increasing the risk for adverse outcomes. Unlike other types of illicit drugs, prescription drugs can be fairly accessible to teenagers, who most often find these drugs in their own homes. Accessibility, along with the common misconception that prescription drugs are a “safe high,” make adolescent prescription drug abuse an increasingly significant problem that demands the attention of educators, parents, law enforcement officials, policy makers, health professionals, and prevention specialists.

Trends in Adolescent Prescription Drug Abuse

• Nearly one in five teens report abusing prescription drugs to get high (Partnership for a Drug-Free America, 2006).
• One third of all new abusers of prescription drugs in 2006 were 12 to 17 years old (SAMHSA, 2008).
• More than 2.1 million teens ages 12 to 17 reported abusing prescription drugs in 2006. Among 12- and 13-year olds, prescription drugs are their drug of choice (SAMHSA, 2008)
• Twelfth graders have recently had the highest rates of prescription drug abuse. (Johnston et al, 2008)
• Pain relievers, like Vicodin and Oxycontin, are the prescription drugs most commonly abused by teens (SAMHSA, 2008). Nearly half of teens who have abused prescription painkillers also report the use of two or more other drugs, most commonly alcohol and marijuana (Office of National Drug Control Policy, 2007).
• Nearly 40 percent of teens report having friends who abuse prescription pain relievers and nearly 30 percent report having friends who abuse prescription stimulants (Partnership for a Drug-Free America, 2006).
• Over half of teens say they abuse prescription painkillers because the medications aren’t illegal; one in three believes there is less shame attached to using prescription drugs than illicit drugs; and one in five said parents “don’t care as much if you get caught” abusing prescription drugs (SAMHSA, 2008).

Where Do Teenagers Get Prescription Drugs?

• Sixty-four percent of youth ages 12 to 17 who have abused pain relievers say they got them from friends or relatives, often without the other person’s knowledge. (SAMHSA, 2008).
• More than 60 percent of teenagers say prescription pain relievers are easy to get from the medicine cabinet at home. Half of teens say they are easy to get through other people’s prescriptions; and more than half say prescription pain relievers are “available everywhere” (Partnership for a Drug-Free America, 2006).
• Almost forty percent of youth ages 14 to 20 say it is easy to get prescription drugs online or by phone. Of that total, more girls than boys said it was easy (48% vs. 31%) (Office of National Drug Control Policy, 2007).

While research indicates that less than one percent of teens acquire prescription drugs from the Internet, adolescents do visit manufacturer and pro-drug Web sites to obtain dosage information, identify pills, learn about drug interactions and effects, and find out how to pass drug tests. Teens also engage in online chat rooms and read blogs to hear about others’ experiences using prescription drugs illicitly. This online drug culture, researchers believe, may contribute to the misconception that most teenagers abuse prescription drugs and/or that prescription drug abuse is relatively risk-free (Community Anti-Drug Coalition of America, 2008).

Prescription drug abuse by adolescents should be taken as seriously as alcohol, tobacco, and other drug (ATOD) abuse. It can lead to increased truancy and behavioral problems, as well as abuse of ATOD. It can also negatively affect academic performance. Research on and prevention strategies for prescription drug abuse are underway. In the meantime, parents, educators, health professionals, legislators, and most importantly adolescents themselves need to be aware of the pervasiveness of prescription drug abuse and its harmful consequences. The following are strategies for parents, educators, and communities to combat prescription drug abuse among adolescents. Parents

Parents and caregivers can have an enormous impact on their children’s attitudes towards prescription drugs. While 60 percent of parents report discussing drugs like marijuana “a lot” with their children, only a third discuss the risks of abusing prescription drugs (Partnership for a Drug-Free America, 2006). When parents talk to their children about ATOD abuse, they need to address the dangers of prescription drug abuse. When a child is prescribed a medication by a health care provider, the provider and parents should clarify that the medication is only to be taken as prescribed and is never to be shared with friends or acquaintances. Additional steps parents and caregivers can take include the following:

• Be a role model: use medications only as prescribed by your health care provider and do not share prescription medicines with others.
• Keep adults’ and children’s medications in a secure location in your home. Monitor their use (for example, by doing a periodic inventory of medications in the home).
• Hide or properly dispose of old and/or unused medications. Do not flush them down the toilet as this pollutes the water supply. Contact local pharmacies to enquire about drop-off programs for unused prescription medications. If none exists in your community, ask a pharmacist to consider creating one.
• Talk to other family members (especially grandparents) and the parents of your child’s friends about the importance of safeguarding medications in the home (Parents. The Anti-Drug, 2008).
• Monitor your teen’s Internet use and look out for suspicious packages delivered to the home.

Schools

Schools are another location where teens have access to prescription drugs, especially since some students are prescribed medications that must be taken during the school day. Administrators and school nurses need to ensure that only those students with prescriptions take medications on campus. To understand the prevalence of prescription drug abuse among students, school leaders and health educators can add questions about prescription drug abuse to health risk surveys administered to students. Health educators can teach lessons to help students understand the dangers of prescription drug abuse and build students’ skills to avoid illicit use of prescription drugs. Guest speakers can be invited to school to address students. In Tazewell County, Virginia, a community substance abuse task force developed a program in which a police officer, a physician, a pharmacist, and a probation officer visit the classroom to talk about the risks of prescription drugs (CADCA, 2008).

Most states have policies regarding student self-medication in schools. Many schools require students who take prescription medications and their parents to sign a self-medication agreement that reviews policies related to using medications on campus and the consequences of sharing medications with other students. (Government Accountability Office, 2001)

School nurses and all other school staff should be on the lookout for the following signs that a student may be abusing prescription drugs:

• loss of enthusiasm
• irritability or hypersensitivity to criticism
• truancy
• withdrawal from usual activities
• unexplained decline in academic performance
• loss of interest in hygiene or personal appearance
• unexplained change in friends/peer group
• constricted pupils, nausea, vomiting, respiratory depression (signs of pain reliever abuse)
• anxiety, delusions, flushed skin, and heart pain with chest palpitations (signs of stimulant abuse)
• slurred speech, dizziness, and respiratory depression (signs of depressant abuse) (Parents. The Anti-Drug, 2008)

The Community

Schools, physicians’ offices, and local pharmacies should collect and disseminate information about prescription drug abuse to adolescents and their parents. Such information should address the dangers of prescription drug abuse; relevant local, state, and national hotlines and online resources; where to seek treatment; and strategies for parents to use when talking with their children about prescription drug abuse.

Some communities have sponsored a roundtable discussion or town hall meeting to raise awareness about prescription drug abuse among adolescents. The event can be organized and facilitated by school staff, but should include community representatives such as parents, physicians and nurses, pharmacists, law enforcement officials, educators, school board members, local media representatives, and adolescents (this may include individuals in recovery from prescription drug abuse). The objective of such a forum are for participants to learn about the issue from a variety of perspectives, share their experiences, discuss strategies for preventing prescription drug abuse, and explore how various sectors of the community can collaborate to prevent it.

Physicians

Because physicians give youth and adults access to prescription drugs, they must play a central role in preventing prescription drug abuse and educating their patients about its dangers. Important steps for physicians to take include the following:

• Keep detailed records of patients’ prescriptions.
• Ensure that prescription pads are secured to prevent theft.
• Discuss with all patients information about the medications they are prescribed, as well as the dangers of prescription drug abuse. Such conversations are critical when patients are prescribed medications that can lead to physical and/or psychological dependence.
• Screen for adolescent prescription drug abuse by inquiring about the individual’s substance abuse history and which medications he or she is taking and why.
• Use medication agreement forms that outline the appropriate amount of medication to take; methods to monitor abuse (e.g. pill inventory, urine and blood drug tests, unexplained increase in the amount of medication taken, frequent and unscheduled refill requests); the physician’s medication refill policy; and the adverse consequences of prescription drug abuse. (Isaacson et al, 2005)
• Remind parents and grandparents of adolescents not to share prescription medications with others, to keep all medications in a secure location in the home, and to hide or properly dispose of old and/or unused medications.

Pharmacists can play an important role in preventing and reducing prescription drug abuse by employing the following strategies:

• Discuss with patients the dosage of their medications, potential side effects and drug interactions, and the risks of prescription drug abuse. Additionally, remind patients not to share prescription medications with others, to keep all medications in a secure location in the home, and to hide or properly dispose of old and/or unused medications.
• Give patients written information about the risks of prescription drug abuse and how to safeguard medications in their home.
• Be on the alert for altered or forged prescriptions.
• Create a drop-off program for expired and/or unused prescription medications.
• Where available, participate in a local hotline to alert other pharmacies when a falsified prescription is discovered.

Law Enforcement Officials and Legislators

Prescription drug monitoring programs (PDMPs) enable physicians and pharmacists to log filled prescriptions into an electronic database. Information in the database is used to identify illegal activity such as prescription forgery, indiscriminate prescribing, and doctor shopping–visiting several physicians or pharmacies to obtain controlled substances. There are currently 38 states with legislation requiring PDMPs (USDOJ, 2008).

PDMPs help reduce the time and effort of law enforcement officials and medical professionals to identify potential prescription drug abusers and illegitimate prescriptions. Every PDMP provides safeguards to protect patient confidentiality, and only authorized individuals can access the prescription information (USDOJ, 2008).

States with PDMPs have reduced their rates of illegal use of prescription drugs. Unfortunately, when one state enacts a PDMP, bordering states that do not have a PDMP often report an increase in illicit use of prescription drugs (Government Accountability Office, 2002). Funding is available through the U.S. Department of Justice to state authorities for creating or enhancing PDMPs.

Conclusion

Prescription drug abuse among adolescents is gaining the attention of parents, educators, and community officials. There are promising strategies for parents, schools, medical professionals, and law enforcement agencies to employ to combat the abuse. Building state and community coalitions with relevant stakeholders helps to create awareness of the issue and determine how best to enact strategies to reduce this significant threat to our nation’s youth.
 

Resources

General

Prescription Drug Abuse Toolkit

This toolkit is designed for school nurses as a means to facilitate their education and support of various groups in preventing, identifying, and managing teen prescription drug misuse and abuse. All materials have been compartmentalized into several categories, based on the most appropriate groups with which to use the information. In addition to tools appropriate for school nurses and educators, we have categorized information for use with students, parents, and the community at large. Also, we have provided a collection of links to noteworthy web sites. http://www.nasn.org/Default.aspx?tabid=509

Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens

A 2008 report from the President's Office of National Drug Control Policy describing recent trends in adolescent prescription drug misuse http://www.nasn.org/Portals/0/resources/pd_toolkit_nurses_2008_report.pdf

Prescription Drugs: Abuse and Addiction

A comprehensive National Institute on Drug Abuse publication reviewing trends in prescription drug abuse, effects and interactions of the most-abused prescription drugs, and methods of treating addiction to the various drugs. http://www.nasn.org/Portals/0/resources/pd_toolkit_community_publication...

Parents

Parents. The Anti-Drug: Rx Drugs

The site provides parents and other adults caregivers access to: Helpful articles and advice from experts in the fields of parenting and substance abuse prevention; science-based drug prevention information, news and studies; support from other parents striving to keep their children drug-free; and perspectives of teens themselves. http://www.drugfree.org/

When It Comes to Prescription Drug Abuse, Parents Need Education A Well

Specific advice on how to safeguard drugs in the home to prevent misuse http://www.nasn.org/Portals/0/resources/pd_toolkit_parents_advice.pdf

What Can You Do? Tips for Preventing Rx Abuse

Tips for parents to prevent prescription drug abuse http://www.nasn.org/Portals/0/resources/pd_toolkit_parents_tips.pdf
 

Schools

Smart Moves, Smart Choices

NASN has launched “Smart Moves, Smart Choices,” a program that responds to the growing rate of prescription drug abuse among middle and high school students nationwide. NASN has teamed up with PriCara®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. on the program, which features free resources for school nurses and teachers to educate teens about the serious risks of abusing prescription medicines. The program includes videos and lesson plans for the.Medic, a health and wellness feature of MacNeil/Lehrer Productions’ the.News, a new national news service for middle and high school students. http://www.pbs.org/newshour/thenews/themedic/list.php

Prescription for Trouble

This lesson plan for 6-8th graders has the objectives, procedures, print and online materials for teachers, and an evaluation rubric. A video is available for purchase as well. http://www.discoveryeducation.com/teachers/

Prescription Drug Abuse: Teens in Danger

A lesson plan from Dr. Nora Volkow, the director of the National Institute on Drug Abuse, for student education regarding drug abuse http://www.nasn.org/Portals/0/resources/pd_toolkit_nurses_lesson_plan.pdf

Prescription Drugs: Their Use and Abuse

A handout for students regarding the dangers of drug abuse, myths about drug use, and other related facts http://www.nasn.org/Portals/0/resources/pd_toolkit_nurses_handout.pdf

Prescription Drug Abuse

An article written for teenagers about misuse of prescription drugs http://kidshealth.org/

FreeVibe.com: Prescription Drug

Abuse An online service of the National Youth Anti-Drug Media Campaign that offers information, fact sheets, games and posters for teens with a special section on early intervention http://www.abovetheinfluence.com/facts/drugfacts/

Self-Medication Agreement

A sample of a student self-medication agreement with the school nurse regarding the self-medicating student's responsibilities http://www.nasn.org/Portals/0/resources/pd_toolkit_nurses_self_medicatio...

Communities

CADCA Strategizer 52, Teen Prescription Drug Abuse: An Emerging Threat – Strategies to Prevent Prescription Drug AbuseAmong Teens in Your Community

The Prescription Drug Abuse Strategizer outlines approaches for effective programs, including: Engaging local print, radio, and TV media; recruiting and briefing experts for a community roundtable; developing resources and materials - including online content, call-in numbers, and print materials; executing local town hall meetings; and engaging corporate and community partners - including pharmacists, schools, libraries, PTAs, medical associations, and local businesses. http://www.dufferinpark.com/images/File/CW%20Rx%20drug%20abuse%20strateg...

Easy Access: The Abuse of Legal Drugs

Some of the biggest drug threats out there are right in your own home. While use of illicit drugs is declining, the abuse of prescription and over-the-counter medications is on the rise. During this hour-long CADCA-TV broadcast, learn about what you can do to prevent the abuse of these medicines among youth and hear about one community’s successful medicine abuse prevention efforts. Some of the solutions are simpler than you might think. https://secure.macrointernational.com/mctft/webcasts/w.aspx?ID=557

“Do the Right Dose” campaign poster

http://www.nasn.org/Portals/0/resources/pd_toolkit_community_poster.pdf

FAQ: Prescription Drug Monitoring Programs (PDMPs)

This Drug Enforcement Agency Web site describes what a PDMP is and answers some common questions around state policies. http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion

This report from the Government Accountability Office gives a background on PDMPs, how they differ from state to state, and then examines their effectiveness and challenges faced by looking at three specific state programs. http://www.gao.gov/new.items/d04524t.pdf