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Rx — The Facts About “Pharming”By Jennifer Sisk, MA Social Work Today Vol. 6 No. 2 P. 26 Teens are being tempted with easy access to drugs misperceived as safe because they’re in the family medicine cabinet. Ninth-grader Zach, who has attention-deficit/hyperactivity disorder (ADHD), was excited when his new friends invited him to a weekend party. When he asked them what he could bring, they said, “Your Adderall and anything else you can find in your parents’ medicine cabinet.” Zach knew his mother was taking a strong prescription painkiller for her backache, and his father sometimes took pills to help him cope with his stressful job. At the party, Zach traded his Adderall, his mother’s Vicodin, and his father’s Xanax for some marijuana to help him “chill out” and some pills his friends said would help him stay up late when he needed to study. When Zach asked what the pills were, his friends said, “Ashley takes them for her ADHD. They’re just like your Adderall. They won’t hurt you.” At school six months later, Zach was selling his Adderall and his father’s Xanax to buy OxyContin and Dexedrine, which he needed to get through the school day, soccer practice, and late-night homework sessions. The Partnership for a Drug-Free America calls them “Generation Rx”—teens who intentionally abuse prescription drugs to get high, relieve stress, or improve academic or athletic performance. Generation Rx-ers have coined the term pharming to describe their acquisition and ingestion of prescription drugs. For some teens, pharming is just a new type of party and experimentation; for others, it can lead to abuse and addiction. In a November 2005 report, the Partnership for a Drug-Free America released the findings of their 2004 Partnership Attitude Tracking Study (PATS), which surveyed approximately 7,300 teens about their substance use and abuse behaviors and perceptions. While use of illicit “street” drugs is decreasing among teens, prescription drug use is increasing. According to PATS, one in five teens (18%, more than 4 million) have used prescription painkillers to get high, and one in 10 (10%, more than 1 million) have used ADHD stimulants without a physician’s prescription. In comparison, 9% of surveyed teens reported using cocaine/crack and Ecstasy, 8% reported using methamphetamine, and 4% reported using heroin. The December 2005 Monitoring the Future (MIF) survey, sponsored by the National Institute on Drug Abuse and conducted by the University of Michigan, found a similar trend in drug use by approximately 50,000 surveyed 8th-, 10th-, and 12th-grade students from 400 public and private schools. According to MIF data, a steady decline in marijuana use has occurred since 2001, and amphetamine, methamphetamine, steroid, and alcohol use showed a statistically significant decline in one or more grades. Ecstasy use has decreased by more than one half since 2001, with usage prevalence rates of 3% or less. In contrast, use of prescription sedatives and OxyContin have increased, according to the MIF survey. At its highest usage rate since 1991, sedatives were used by 7.2% of 12th-grade students. OxyContin use increased by 40% among high school seniors since 2002, with 5.5% reporting use over the past year. PATS and the MIF study have only recently begun tracking prescription drug abuse among teens. The National Center on Addiction and Substance Abuse (CASA) at Columbia University has been tracking prescription drug abuse in both the general population and teens since 1992. CASA calls prescription drug abuse and addiction an epidemic—more Americans reported abusing prescription drugs than those who reported abusing cocaine, hallucinogens, inhalants, and heroin combined. Their most recent report in July 2005 reported a disturbingly high increase in teen prescription drug abuse compared with the general population. From 1992 to 2003, prescription drug abuse increased 212% in the teenage population compared with 94% in the general population. The number of first-time abusers was four times greater among teens than among those aged 18 and older. What lies behind this alarming trend in teen prescription drug abuse? Just
Open the Medicine Cabinet Tessa Vining, LMSW, is director of the Intervention Moves Parents and Children Together (IMPACT) program at Phoenix House in Manhattan. Phoenix House is the largest nonprofit addictions agency in the United States, offering a continuum of care for drug abusers and addicts from prevention and education to interventions in residential, outpatient, and aftercare treatment programs. In the IMPACT program, Vining works with teens in an intensive outpatient program designed to treat drug abuse problems. She has noticed that prescription drug abuse more commonly occurs in teens from middle- and high-income families, which she attributes mostly to access. Parents in these families may be prescribed painkillers, antidepressants, antianxiety drugs, or sedatives. Vining says teens from lower-income families more often come to IMPACT due to problems with marijuana and alcohol and are less likely to have access to prescription drugs currently being abused by teens. The increasing trend in teen prescription drug abuse can be partly attributed to the easy availability and partly to the overall sociocultural growth in prescription drug use, says Robert Ammerman, PhD, ABPP, a psychologist and professor of pediatrics in the division of behavioral medicine and clinical psychology at Cincinnati Children’s Hospital Medical Center in Cincinnati. “Overall, as a society, we are using more prescription drugs, and abuse of those drugs has increased with that use,” he says. CASA calls it “America’s pill-popping culture,” and reports that more than 50% of Americans regularly take prescribed medications. “There is also a culture associated with drug use, and this is particularly true in teens,” says Ammerman. Worried about fitting in, being popular, and having friends, teens are susceptible to peer pressure. Whether friends abuse drugs can influence whether an individual will also abuse drugs. “Teens who hang out with drug users are more likely to use and abuse drugs themselves,” Ammerman notes. “Peer influence is definitely a major factor,” Herman agrees. CASA surveys revealed that, from 2004 to 2005, the percentage of teens who know friends or classmates who abuse prescription drugs skyrocketed by 86%. In contrast, the percentage of teens who know friends or classmates who use illegal street drugs increased only 20%. Based on its survey data, CASA predicts that 28% of middle school students (2.4 million) and 62% of high school students (10.6 million) will attend schools where drugs are used and easily acquired. Another reason for the dramatic upsurge in prescription drug abuse compared with street drugs is the misperception that drugs approved for medical treatment are much safer than illegal street drugs. “Teens often do not realize the danger of these drugs,” Vining warns. “Because there is a misperception of safety due to their medicinal uses, prescription drugs don’t have the big danger sign that is associated with illegal street drugs,” she explains. Partnership research indicates that nearly 50% of teens see prescription drugs as “much safer” than street drugs and approximately 30% believe they are not addictive. “In fact, narcotic prescription drugs are highly addictive,” says Ammerman. While prescription drugs may be viewed as a safer alternative to other substances, their abuse can quickly escalate and, for many teens, lead to abuse of multiple substances including alcohol, marijuana, and street drugs. CASA reported that teens who abuse prescription drugs are twice as likely to use alcohol, five times more likely to use marijuana, and 12 to 20 times more likely to use illicit street drugs such as heroin, Ecstasy, and cocaine than teens who do not abuse prescription drugs. CASA data indicates that nearly 80% of teenage prescription drug abusers are polysubstance abusers. In Ammerman’s work with drug abuse prevention, he sees a strong association between abusing prescription drugs and using other drugs. “I have seen prescription drug abuse intertwined with abuse of marijuana, alcohol, and cocaine,” says Vining. For most teens treated in the IMPACT program, a prescription drug is not their “drug of choice,” she adds. From
Abuse to Addiction For example, the survey used in PATS asked whether teens had “ever tried” a particular drug. Statistics that measure whether teens have “ever tried” a drug, says Herman, cannot be used to infer abuse and addiction. “Data collection needs to be more definitive with regard to abuse,” he says, “and the continuum ranging from experimentation/misuse to abuse to addiction/dependence should be evaluated in teens.” More teens experiment with or misuse prescription drugs than become addicted to them, he believes. Clearly, an increasing trend of misuse can, in turn, lead to abuse and dependence for many teens, he says. He believes future research should focus on clarifying the range of teen drug abuse patterns. According to CASA data, approximately 15% of teens who abuse prescription drugs meet clinical diagnostic criteria for substance dependence or addiction based on the Diagnostic and Statistical Manual of Mental Disorders definition for substance dependence. “While many of my patients abuse prescription drugs along with other substances, I have not yet seen a patient who has been addicted only to prescription drugs,” says Vining. Like Herman, Vining also flagged the difference between teens who are experimenting with prescription drugs vs. teens who are on their way to becoming addicted. “Curiosity and experimentation with friends are very different from using [drugs] to numb painful feelings,” Vining emphasizes. Teens most likely to abuse prescription drugs and become addicted generally have an underlying and often undiagnosed psychological issue, she says—depression, social anxiety, or past trauma, for example. “Self-medication for these undiagnosed conditions can lead to addiction,” Vining notes. Prevention
and Treatment — A Family Affair However, because many teens easily acquire prescription drugs from their friends, education is the most important prevention method, Ammerman emphasizes. “Teens need to understand the consequences—the dangers—of misusing a prescription drug,” he says. “They need to realize that prescription drugs can be just as highly addictive as street drugs.” Ammerman supports school-based drug education and prevention programs. Integration into the regular middle school curriculum by teachers trained in drug abuse prevention would reach adolescents during what Ammerman calls the most critical time—the age of initiation into drug use. “Reaching kids early is critical for effective prevention. The average age of first drug use is 12 to 14 years—middle school. Teens who eventually become addicted to drugs have usually begun drug use early in adolescence,” he says. In addition to drug education, effective programs for prevention should also include training in life skills, social skills, and good decision making, says Ammerman. Vining echoes Ammerman. “Education is very important. Teens see their parents, their friends, characters on television, taking these prescription medications, and they just don’t realize the dangers associated with them, especially when used in combination with alcohol and other drugs,” she says. Education is an essential element of the IMPACT program, along with intensive therapy sessions. At Phoenix House, Vining has had success combining individual treatment with group and family therapy. “Group therapy involving behavioral modification—where peers hold each other accountable for their substance abuse behaviors—seems to work best with teens,” says Vining. Peer support can be enhanced by parental support. While most teens will insist that they don’t listen to their parents, research says otherwise. PATS data show that teens who learn about the risks of drugs from their parents are approximately 50% less likely to use drugs. PATS also surveyed 1,205 parents regarding teen drug use and found, surprisingly, that parents who grew up in the late 1970s and 1980s—at the height of teen drug use and are considered the most drug experienced—are less likely to talk to their teens about drug use and abuse. According to the study, the number of parents who reported never discussing drugs with their children doubled from 6% in 1998 to 12% in 2004. The survey revealed what the Partnership calls a “perceptual disconnect” between what parents believe regarding teen drug use and what their teens are actually doing. Most parents of teens significantly underestimate their teen’s exposure to drugs. One in five parents (21%) reported that they believe their teenagers have friends who use marijuana, yet 62% of teens reported having friends who use the drug. Although the survey indicated that parents are concerned about teen drug use, it also revealed that parents do not consider drug use as risky as parents surveyed in 1998. “Educating their parents is obviously very important,” says Herman. The Partnership for a Drug-Free America calls teen prescription drug abuse “one of the most significant recent developments in substance abuse trends.” To combat this troubling teen trend, revamping existing drug education programs to emphasize the dangers of prescription drugs is necessary. Modifying traditional intervention and education strategies—such as presenting drug education and prevention programs earlier, refocusing educational efforts to emphasize the real dangers of prescription drug misuse, and providing parents with the knowledge and support for effective communication with their teens about drug use—can help ensure that the future of Generation Rx teens is a healthy one. — Jennifer Sisk, MA, is a suburban Philadelphia-based freelance writer with 15 years of experience as a writer and a research analyst in the healthcare field. She has written on depression, attention-deficit/hyperactivity disorder, schizophrenia, mental wellness, and aging.
A recent Arizona State University research initiative measuring the effect of parent communication about adolescent drug use studied Project 7th Grade and found that 92.5% of parents who had completed the program would recommend it to other parents. In 1999, Steve and Debbie Moak founded notMYkid after watching teenage members of their own family struggle with substance abuse. They decided to use their resources to focus on drug abuse prevention as a way of helping other families address this national problem. After extensive study, Project 7th Grade evolved as a means to give parents and young people a tool in the fight against drug abuse. Building on a “trust, but verify” theme, Project 7th Grade provides parents direct education and tools not previously available. The founders and directors of the program will also attend a public reception in the U.S. Capitol Building hosted by Senators Jon Kyl and John McCain, and Congressman John Shadegg. Executives from Project 7th Grade’s corporate sponsor, First Check Diagnostics LLC, will also attend the event. Official Capitol Hill briefings are also scheduled with the Senators Bill Frist, MD (R-TN), Lamar Alexander (R-TN), Dick Durbin (D-IL), Michael Enzi (R-WY), Dianne Feinstein (D-CA), John McCain (R-AZ), Barack Obama (D-IL), and Charles Schumer (D-NY); Robert Stephenson of Health and Human Services; and Deborah Price of the U.S. Office of Safe and Drug-Free Schools. “We’re heartened by the interest expressed by numerous senators, representatives, and other senior government officials whom we’ve briefed on how to bring this program to the communities they represent,” says Pamala Plummer-Wright, national executive director for notMYkid. “In 2005, nearly 10% of surveyed teens reported using Vicodin in the past year. This alarming trend, combined with the significant increase in the abuse of OxyContin over the past three years, makes combating teenager abuse of prescription drugs as much an issue for today’s parents as illegal drug use. Our program aims to address abuse across the board.” During 2005, Project 7th Grade was successfully rolled out in cities such as Phoenix, Cincinnati, Dallas, and Omaha. This year, the program has already received invitations from schools in Atlanta, Baltimore, Boston, Chicago, Miami, and Pittsburgh, and pending initiatives will soon be engaged in 25 cities by the fall of this year. While the project has in the past distributed free test kits to parents that test just for illicit drugs, more recent data and concerns from parents, schools, and legislators has prompted Project 7th Grade to provide new expanded kits that detect prescription drugs to address what has become a growing problem. For additional information on Project 7th Grade, visit www.project7thgrade.org or www.notmykid.org. — Source: notMYkid, Inc.
— JS
Some teens are ordering for personal use while others are “dealing” for a significant profit. Pills purchased online for 50 cents can be resold to friends and classmates for $3.00 to $5.00. According to a February 2004 CASA Report on Internet drug pushers, of the approximately 160 Web sites identified as selling controlled prescription drugs over the Internet in 2004, 90% did not require a prescription, and none of the Web sites had protocols in place to stop children and teens from purchasing drugs. The U.S. Department of Justice estimates that as many as 5 million Web sites may be making prescription drugs available without a prescription and advertising their service via e-mail “spam.” The most commonly available and advertised Internet prescription drugs on these Web sites are also those that top the list of prescription drugs most frequently abused by teens—benzodiazepines (Valium, Xanax) and opioid painkillers (Vicodin, OxyContin). With the proliferation of online shopping, many teens don’t realize that ordering prescription drugs without a prescription is a federal offense. And teens may not be getting what they paid for—illegitimate Internet pharmacies have no quality control standards and may be supplying unsafe drugs or substituting drugs. — JS
The National Center on Addiction and Substance Abuse at Columbia University. Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. July 2005. Available at: http://www.casacolumbia.org/supportcasa/item.asp?cID=12&PID=138 National Survey of American Attitudes on Substance Abuse X: Teens and Parents. August 2005. Available at: http://www.casacolumbia.org/supportcasa/item.asp?cID=12&PID=139 Partnership for a Drug-Free
America. Generation Rx: National Study Reveals New Category of Substance Abuse
Emerging: Teens Abusing Rx and OTC Medications Intentionally to Get High.
November 16, 2005. Available at: http://www.drugfree.org/portal |
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