The good news, pediatrician Hoover Adger noted at Johns Hopkins’ annual Pediatrics for the Practitioner Update in September, is that surveys indicate a leveling off of illicit drug abuse by teenagers, though current rates remain high. The bad news? Continued high rates of prescription drug abuse with little decline over the past six years. Also, seven of the top 10 drugs abused by 12th graders in the past year were prescribed or purchased over-the-counter.
“Although illicit drug use by teens is declining,” Adger said, “now there is a new threat, the family medicine cabinet.”
Just how big is the problem?
More than 6.3 million Americans report current use of prescription drugs like pain relievers, tranquilizers, stimulants and sedatives for purposes other than that for which the drug was prescribed. And as prescriptions have increased, emergency room visits for non-medical abuse have also increased, with a teenager often the patient.
In a 2005 attitude tracking study conducted by Partnership for a Drug-Free America, almost two out of five teens reported having friends who abuse prescription pain relievers and nearly three out of 10 reported having friends who abuse prescription stimulants. Why? They’re easy to get from medicine cabinets and through other people’s prescriptions, teens can claim they have a prescription if caught, they are cheap and easy to purchase over the Internet, they are perceived as safer than illegal drugs, and less shameful to use. Yet they can be deadly, Adger said, citing so-called “pharm parties” in which a contribution of pharmaceuticals is required for admittance.
“They are combined in a bowl or bag and referred to as trail mix,” said Adger. “Many times handfuls of pills are washed down with alcohol, producing lethal drug combinations.”
Abuse of stimulants, including non-medical use of Adderall among college students, and of over-the-counter cough and cold preparations, is also on the rise. More than 120 cough and cold remedies, Adger noted, contain dextromethorphan, or DMX, a chemical similar to morphine and the most widely used cough suppressant in the United States. A normal dose of cough medicine is 15 to 30 milligrams; mind-altering effects can occur at doses of 100 milligrams. Consume a large quantity quickly, Adger said, and you will get high.
The code names for these users, he added, include “syrup heads” and “robotards,” and their experience is referred to as “robotripping,” with symptoms that include nausea and sweating, slurred speech, drowsiness, loss of coordination, disorientation, dizziness, hypertension, tachycardia, blurred vision, agitation and lethargy. Despite nearly 8,000 emergency department visits related to dextromethorphan misuse in 2008 – up from 4,634 in 2004 – according to the U.S. Food and Drug Administration (FDA), an FDA advisory panel in mid-September voted against requiring prescription for cough preparations containing DXM.
Use of inhalants among 8th, 10th and 12th graders continues, Adger noted, with short-term effects like difficulty breathing, heart palpitations, dizziness and headaches. The warning signs of Rx or OTC drug abuse? Personality changes, mood swings, irritability, sleepiness or avoiding sleep, loss of appetite, forgetfulness, secretiveness, loss of interest in personal appearance, and decline in school performance. What can parents do?
“Safeguard all drugs at home, monitor quantities and control access,” Adger said. “Also, set clear rules for teens about all drug use, and be a good role model by following these same rules.”
What can pediatricians do?
“Talk to your teen patients about the dangers of prescription and over-the-counter drugs,” Adger stressed, “and be available to assist patients and families who have a need for further assessment or evaluation, referral and/or treatment.”
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