By Steve Pasierb, President and CEO, Partnership for Drug-Free Kids
You are raising a good teenager in a loving home.
He’s an athlete, a friend, a brother and an admired and popular high school student. He has ambitions and dreams for his future. Sure, he exhibits moodiness and agitation here and there, but what teen doesn’t? This isn’t cause for alarm, until his behavior worsens and becomes more erratic. You realize something is very wrong, and that he may need help for a problem with drugs.
He spends time in rehab for a number of substances, but relapses and begins abusing prescription pain medicine.
The unbelievable becomes all too real as he overdoses on painkillers at a party, and no one helps him in fear of getting in trouble. He is eventually taken to the emergency room, where doctors prepare you for the worst. “Your son likely won’t make it.”
After time on life support and many scares in the hospital, it becomes clear that he will live, but as a prisoner in his own body. His prescription medicine abuse leaves him paralyzed and unable to speak for the rest of his life.
This is a real story of an overdose in 2005. So what have we, as a nation, done to prevent something like this from happening to other kids? Good kids, who for a myriad of reasons, are choosing to abuse medicine and paying the consequences.
To address the abuse of prescription drugs, we need to first understand the attitudes and beliefs that exist around these legal drugs. The abuse of medicine is often driven by the attitude that prescription drugs are a safer alternative for abuse than illicit street drugs. After all, these are important and beneficial medications when used appropriately. They are approved by the Food and Drug Administration. They are prescribed by a doctor.
It’s estimated that over 60 people die each day due to a prescription overdose.1 We know that drug overdoses – poisoning of the body with the drug – now exceed car crashes as the number one cause of accidental death in the United States, and one driver of the trend is the abuse of prescription painkillers.1 In fact, the Centers for Disease Control and Prevention (CDC) has deemed overdoses involving prescription drugs an epidemic.2
One of those overdoses was a young, popular high school athlete who started abusing prescription drugs at the age of 15. With a full football scholarship to Tennessee State and on the road to play professionally, he lost his life because of his abuse of prescription medicine, before he or his family could see his dreams become a reality.
Contrary to what many think, motivations for misusing or abusing these medications go beyond just getting high or having fun. Many teens and adults abuse prescription drugs to help manage their life – to self-medicate anxiety or depression or to escape from stresses and pressures. Sure, some abuse painkillers on the weekend to get high. But others abuse stimulant medicines (typically used to treat ADHD) to stay awake in class, study for longer or stay up later. This latter behavior puts even the “good kids,” the “smart kids” and the “studious kids” in the category of potential abusers, and it should cause the parents who say “not my kid” to think again.
What’s worse: some of those who abuse these drugs end up transitioning to abusing heroin – which is often cheaper and/or more widely available than prescription opioids. In fact, according to the CDC, four out of five recent heroin initiates previously abused prescription pain relievers for non-medical use.3
Science proves that 90 percent of addictions start in the teenage years.4 At the time a teen takes her first pill – and for some, that’s as young as age 12 or 13 – she increases her risk for addiction. Odds for abuse rise with the ease of access to prescription drugs. Our research shows that four in 10 teens who have misused or abused a prescription drug got it from their parent’s medicine cabinet.5 It doesn’t stop at the medicine cabinet, either; one in five parents indicates that they have given their teen a prescription drug not prescribed for them.6 Modeling good behavior and following the prescribing instructions is crucial, and can go a long way toward preventing teen medicine abuse at home.
Recently, we have seen a stabilization and some decline in individuals abusing prescription drugs for the first time.7 We can attribute this flattening in use to a number of factors, including an increased awareness, declining perception of availability and better prevention and education around prescription drug abuse.
Encouraging trends show that medicine abuse is on the radar of those in positions to make change.
Policymakers and law enforcement have worked to curb “doctor shopping” – the act of a person visiting multiple doctors to obtain more prescriptions. They’ve employed prescription drug monitoring programs (PDMPs) and shut down thousands of “pill mills,” places where doctors, clinics or pharmacies prescribe or dispense powerful narcotics inappropriately or for nonmedical reasons.
The Drug Enforcement Administration’s (DEA) National Prescription Drug Take-Back Days have taken in 390 tons of unwanted, expired medicines and kept them out of the hands of potential abusers.8 And, among health care providers, there is a heightened awareness of screening programs and utilization of prescription drug monitoring programs.
So yes, we are making good strides, but how can we maintain the momentum to reverse a persistent public health problem that has grown to affect millions? It is not up to one discipline, but to a full spread of policymakers, health care providers, industry leaders and even families to do their part in addressing medicine abuse.
Health care providers – especially prescribers – are in a powerful position to address and prevent medicine abuse. The Partnership for Drug-Free Kids supports not only the use of monitoring programs that track prescriptions in all practices across the country. We advocate for the need for these systems in all 50 states, including Missouri; the one state in America that has declined to keep a prescription drug database of any sort. We also join with the National Association of Boards of Pharmacy in promoting the need for interconnectivity of each State’s system, ending “doctor shopping” between states and helping prescribers spot patients of theirs who may be abusing or selling medicines. And finally, the information fed into the PDMP system should be available and updated in real-time so prescribers and pharmacies can make informed decisions.
The use of PDMPs should be supplemented with the use of other tools, including those available to help doctors screen their patients for substance abuse issues and help them refer patients to treatment programs. Screening is now eligible for health care reimbursement, yet we have a long way to go before screening and treatment referral is regularly practiced by prescribers everywhere.
Findings from our preliminary work toward educating prescribers around the country indicate that while many prescribers are aware that these and other tools exist, many practices are simply not making use of them. These methods can be lifesaving, and the vigilance of doctors is critical in beginning to control this problem.
Technology also plays an important role in curbing medicine abuse. The Food and Drug Administration’s approval of painkillers, also known as opiate analgesics, with abuse-deterrent properties is one monumental development.
There are several technological approaches being employed to develop these new medicines. The first approach is adding physical or chemical features to make it harder to crush or dissolve the tablets. Another is to add ingredients that block the effect of the opioid or cause an unpleasant feeling when the product is manipulated. Finally, others are developing a precursor drug, known as a prodrug, that doesn’t exhibit opioid effects until it metabolized in the gastrointestinal tract. These technological innovations won’t prevent all forms of abuse, such as simply taking too many pills or too frequent doses - which increases the risks of overdose - but they can be a useful part of a multi-faceted effort to reduce misuse and abuse.
These steps forward will be a crucial part of the public health effort to balance reducing abuse, while ensuring that these medicines remain available to those who need them for a legitimate medical purpose and under a physician’s care. Nearly two-thirds of American teens who abuse pain relievers say that they get them from family members and friends.9 If all prescription opiates were formulated to include abuse-deterrent properties, it would be a major important step forward toward addressing this problem. Increasing the use of medications with abuse-deterrent properties among the Medicare population would be of particular importance as teens often steal prescription medication from their grandparents. Finally, but perhaps most importantly, reversing the medicine abuse epidemic can begin right at home. Research conducted by the Partnership for Drug-Free Kids shows that parents are simply not communicating the dangers of prescription drug abuse to their children as often as they talk about street drugs, like cocaine and heroin.6 This is partly because many parents are unaware of the behavior, unheard of when they were teenagers themselves, but also because those who are aware of teen medicine abuse tend to underestimate the risks. But research shows that if teens think their parents disapprove of a specific drug or behavior, they are far less likely to engage in that behavior.6 That’s why it’s so important that parents talk early, often, and specifically about the health consequences of abusing medicine with their teens.
One mom felt that her teen daughter had all of the knowledge she would need to stay off drugs. She talked about all of the common street drugs, but never spoke about prescription medication. But in her daughter’s mind, it was better to do pills than cocaine or meth, and she would steal pills from friends and family.
These stories serve as a wake-up call for parents, who realize they need to be exceptionally attentive to this issue, and take a three-step approach to protect their families from harm – educating themselves about the issue, safeguarding and properly disposing of unused medicines in the home, and having detailed, frequent conversations with their kids about the dangers of abusing any medicine, prescription or over-the-counter. It’s easy to forget that over-the-counter medications can be abused as well. Ingesting large quantities of OTC cough and cold remedies containing dextromethorphan (DXM) can produce a slightly hallucinogenic high, and seven percent of teens report “robotripping” or “skittling” (slang for abusing or getting high from OTC cough medicine) in the past year.5
Family issues, depression, social anxiety disorders, learning disabilities, problems with friends, trouble at school and other everyday pressures can drive teens experiencing these issues to turn to prescription drugs to help them cope. That’s why it’s so important that parents address pressures as they arise, be cognizant of what their teen is feeling and thinking and provide support. Vigilance and awareness are key. Both talking and listening to teens about their problems can help steer them on the right track before they turn to prescription drugs to manage their stressors.
Many parents are not aware that their own medicine cabinets are potential sources for teenage abuse, so a first step is to monitor and safeguard the medications in their medicine cabinet, keep count of pills and ensure that they are out of the reach of kids. Parents should also properly dispose of any and all unused, expired or unwanted medications.
The good news is that through new DEA regulations, people will be able to dispose of their unused and expired medications by dropping them off at pharmacies, hospitals, clinics, and other easily-accessible places in their communities. Patients, or their family members, can mail their prescribed controlled substances to an authorized collector using pre-paid mail-back packages that can be obtained at their pharmacy, or from other locations like libraries and community centers.
Yes, medicine abuse is a problem we all need to act on now; but no one has to do it alone.
Parents are faced with different outcomes for their kids who abuse medicine. Some may count their blessings that their child is still alive in the wake of his addiction. Others mourn the loss of hopes and dreams dashed.
We all have a vital role, a responsibility and a part to play to end teen medicine abuse. Working together is our only chance at success. It’s time to take a stand as one and address this devastating problem.
Learn more about how to prevent prescription drug abuse:
There are plenty of resources available to help anyone do their part in addressing the issue.
One resource is the Medicine Abuse Project, a national action campaign that aims to prevent half a million teens from abusing medicine by 2017. We launched this program in 2012, and it provides free, comprehensive resources for parents and caregivers, law enforcement officials, health care providers, educators and community leaders, so that everyone can take a stand and help end medicine abuse.
The Medicine Abuse Project website – MedicineAbuseProject.org – includes information about how to prevent prescription drug abuse and over-the-counter cough medicine abuse. It provides tips on how to dispose of medicine and how to safeguard the medicine in your home. It features a comprehensive prescription drug guide to help parents learn about the prescription and over-the-counter drugs that teens most commonly abuse- including what they look like, their street or slang names, how they're taken and what the potential side effects are.
We also offer a toll-free helpline (1-855-DRUGFREE). Our helpline is a nationwide support service, open Monday through Friday from 10 – 6 p.m. Eastern Time, which offers assistance to parents and other primary caregivers of children who want to talk to someone about their child’s drug use and drinking. Our trained helpline specialists help parents make a plan and guide them to the right treatment options that work for their teen.
- Prescription Drug Overdose in the United States: Fact Sheet. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Published on July 3, 2014. Accessed on September 29, 2014.
- Prescription Painkiller Overdoses in the US. Centers for Disease Control and Prevention (CDC). November 2011.
- Muhuri, PK et al. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Center for Behavioral Health Statistics and Quality CBHSQ. August 2013.
- Adolescent Substance Use: America's #1 Public Health Problem. CASA Columbia. Adolescent-substance-use-americas-no-1-public-health-problem%20.pdf. Published in June 2011. Accessed on September 30, 2014. 30 Sept. 2014.
- 2013 Partnership Attitude Tracking Study. Partnership for Drug-Free Kids. http://www.drugfree.org/wp-content/uploads/2014/07/PATS-2013-FULL-REPORT.pdf. Published on July 22, 2014. Accessed on September 30, 2014.
- 2012 Partnership Attitude Tracking Study. Partnership for Drug-Free Kids. http://www.drugfree.org/wp-content/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf. Published on April 22, 2013. Accessed on April 22, 2013.
- Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect7peTabs1to45-2013.htm#tab7.37a.
- DEA’S National Drug Take-Back Day Collected Nearly 16 Tons in the Pacific Northwest. DEA.gov Web site. http://www.justice.gov/dea/divisions/sea/2014/sea050814.shtml. Published on May 08, 2014. Accessed on September 30, 2014.
- Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health: Detailed Tables, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect6peTabs1to54-2013.htm#tab6.47b
*Note: Partnership For Drug-Free Kids receives charitable support from Purdue