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Adolescent Substance Abuse

Adolescent Substance Abuse. Rachel Gonzales, Ph.D. What is Prescription and Over the Counter Drug Misuse?. Any Rx and OTC drug can be “ misused ” Misuse = “ Non-medical use ” or any use that is outside of a medically prescribed regimen Examples can include:

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Adolescent Substance Abuse

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  1. Adolescent Substance Abuse Rachel Gonzales, Ph.D.

  2. What is Prescription and Over the Counter Drug Misuse? Any Rx and OTC drug can be “misused” Misuse = “Non-medical use” or any use that is outside of a medically prescribed regimen Examples can include: Taking for psychoactive “high” effects Taking in extreme doses Mixing pills Using with alcohol or other illicit substances Obtaining from non-medical sources

  3. Adolescents & Young Adults

  4. Nationally, there’s Good News… Alcohol Cigarettes -35% Illicit Drugs -57% -47% MTF Study; Past Month Use for 12th Graders

  5. Nationally, there’s also Bad News… Every Generation of Teens Looks for New Ways to Get“High”

  6. Generation “Pharming Culture” Vicodin Cough medicine Inhalants

  7. Epidemiology of Rx and OTC Drug Misuse Among Youth

  8. What do we know about the problem? • Nationally • National Survey on Drug Use and Health (NSDUH) • Monitoring the Future Study (MTF) • State/County • Biannual California Student Survey • Publicly-funded treatment admission data from county data systems

  9. Landscape of Drug* Abuse among Teens Marijuana 8.6 million 4.5 million Prescription Medicine 2.4 million Cough Medicine Crack/Cocaine 2.4 million Ecstasy 1.9 million Meth 1.9 million 1.3 million LSD Heroin 1.1 million Ketamine 1 million 1 million GHB NSDUH, 2006 *Excludes ETOH

  10. “Pharming Culture” • Today's teens are more likely to have abused Rx and OTC drugs than most illicit drugs • Every day 2,500 teens 12-17 try a painkiller for the 1sttime MTF, 2006

  11. Commonly Misused Rx Drugs • Opiates: pain-killers • Ex) Vicodin, Oxycontin • Sedatives/Tranquilizers (Depressants): treat anxiety and sleep disorders • Ex) Xanax, Valium • Stimulants: treat ADHD • Ex) Aderall, Ritalin, Concerta

  12. DextromethorphanDXM (narcotic codeine) the active ingredient in over 100 cold/cough remedies. • Found in tablets, capsules, gel caps, lozenges & syrups • Teens discovered using mass quantities of DXM-containing products get them “high”. OTC Medicine Misuse

  13. Coricidin HBP Cough & Cold Robitussin Cough products Sudafed Cough medicines Dimetapp DM Tylenol Cold products Vicks NyQuil and Dayquil Alka-Seltzer Plus Cold & Cough Triaminic Cough syrups Examples of Popular OTC Products

  14. Top 5 Drugs Used by 12th Graders 3.8% Ritalin SOURCE: MTF, 2006

  15. OTC Medications Misused by Teens SOURCE: MTF, 2006

  16. Concerning Trends • Adolescents 12-13 • Teen Females • Young Adults 18-24

  17. Extent of Rx & OTC Drug Misuse among Youth in California

  18. 12th Biennial California Student Survey: Drug, Alcohol & Tobacco Use • Secondary students (7th, 9th, 11th graders) • Representative State sample: random schools & classrooms • 13,930 students • 48 middle and 68 high schools (including 10 continuation)

  19. Misuse of opiate painkillers (no prescription) to get high 2006: • 15% of 11th graders • 9% of 9th graders • 4% of 7th graders California Student Survey 2006

  20. Changes to Survey • 2007: Expanded substances and made separate question on recreational use of pharmaceuticals (high school only) • Added cold/cough medicines, diet pills, and Ritalin/Adderal

  21. Lifetime Prevalence *to get high – not for medicinal reasons

  22. The Pharming Subculture: Generation Rx Youth & Young Adult Risk Factors

  23. Top Reasons for Rx & OTC Drug Misuse • Social with friends • Legal - WidelyAvailable • Easily Accessible • Affordable: Low Cost/Free • Safe - Prescribed • Non-addictive: Medicine Partnership Attitude Tracking Survey (PAT): Released in April 2006 by The Partnership for a Drug-Free America

  24. Teens admit to misusing Rx drugs for reasons other than getting high, including to relieve pain or anxiety, to sleep better, just to experiment, to help with concentration orto increase alertness. (Boyd, McCabe, Cranford & young, 2006). • More than 1/3 of teens say they feel pressure to abuse Rx drugs and say using these drugs is an important part of fitting in with their friends. (Seventeen, 2006). • When teens abuse Rx drugs, they often characterize their use as “responsible” or “controlled” (Friedman, 2006). Recent Research: Why Teens Use?

  25. Access & Availability

  26. Family & Friends Homes • Retail Pharmacies

  27. Modern Culture Increasing trend to use Psychiatric Drugs to Treat Youth Behavioral Problems… Problem: Massive Media Marketing from Pharma

  28. Direct-to-Consumer Advertising of Rx Drugs “Amazon.com pushing ADHD drugs with front-page, celebrity-endorsed” Free Trials

  29. The Reality • Big Pharma • Ex) Several reports suggest that Purdue Pharma, the maker of OxyContin, helped fuel widespread abuse of the drug by aggressively promoting it to general practitioners not skilled in pain treatment or in recognizing drug abuse… • Sales grew from $48 million in 1996 to $1.1 billion in 2000 • Became leading drug of abuse in 2004… • Oxycontin alone had 21 million prescriptions written for them in 2007 to 3.7 million patients (many of which were minors and young adults) Van Zee, 2009

  30. # of new non-medical users Pharm Sales Grew • Oxycontin alone had 21 million prescriptions written for them in 2007 to 3.7 million patients (many of which were minors and young adults)

  31. Endorsements from MDs Development of MedicineSubculture

  32. The Internet & Technology

  33. Social Networking Web SitesVenues for penetrating the Medicine Abuse Subculture YouTube MySpace LiveJournal Facebook • Footage of teens “high” • User Guides: Rx & OTC abuse instructions (recipes) • Blogs & videos of experiences

  34. Social Rx & OTC Slang • Xbrs or xanabars:anti-anxiety Xanax • Vic: Vicodin • Skittles, Dex, Robo, Tussin, (any OTC cold pill containing DXM) • Triple Cs or CCC: Coricidin Cough & Cold med • SIZ’zurp: cough syrup & ETOH • Trail Mix: Pharm Party Keeping Parents Clueless

  35. Treatment for Rx Drug Misuse • Little known about specific treatments for addressing Rx drug abuse among youth. • Abusing Rx drugs before the age of 16 leads to a greater risk of dependence later in life. • The # of teens going into treatment for Rx drug abuse has increased by more than 300% during the last 10 years. • Between 2004-05, the proportion of youth seeking treatment for Rx drugs increased by 9%. TEDS, 2006

  36. Rx Drug Misuse: Treatment Settings • Youth coming to treatment for “self-medicating” with Rx drugs to treat underlying psychiatric condition. • Rx drug misuse among youth in treatment for co-occurring disorders is problematic: • “Cheeking” or saving unswallowed Rx meds for obtaining a later “high”…

  37. Consequences/Effects

  38. The “High” • Slurred speech • Flushed skin, sweating • Loss of appetite • Mild distortions of color/sound • Confusion, forgetfulness • Clumsiness/loss of motor control • Mood swings, irritability • Excessive energy or sleepiness

  39. Delusions Panic attacks Memory problems Blurred vision Stomach pain, nausea, vomiting High blood pressure & Rapid heart beat Numbness of fingers/toes Drowsiness & Dizziness Fever & headaches Rashes/itchy skin Loss of consciousness The “Lows”

  40. Side Effects can be Lethal if… • Combining Rx & OTC medications. • Taking Rx and OTC meds with alcohol. • Using Rx and OTC with other illicit drugs. • Interactions: Rx & OTC meds with other physical medications (i.e., HIV or Hepatitis)

  41. Poison Control System: Prescription Narcotics LA 2005-2008 SOURCE: California Poison Control System

  42. Rx & OTC Drug Over Doses • Last 2 months: Rapper Pimp C (Chad Butler): cough syrup & Hennessey– “sizerp” • This Year: Heath Ledger: lethal cocktail of Rx drugs - pain, sleeping, anti-anxiety • Last Year: Anna Nicole Smith & Son (Daniel) both died due to Rx drugs • Last 2 Years: Rapper ODB: fatal mixture of Rx drugs & cocaine

  43. Teens Don’t Understand the Risks & Effects of Abusing Rx and OTC Medicines Over 50% believe that abusing these medicines to get high is NOT risky… Join Together, 2006

  44. An Invisible Epidemic • Unrecognized • Under-screened • Under-treated

  45. Parents Don’t Recognize Problem • Only 8% of parents are aware of Rx & OTC abuse. • 75% don’t talk to their kids about the problem. • Unaware that the drug supply can come from their own home.

  46. Under-Screened 57.7% of physicians say they don't discuss Rx abuse with their patients because there is a lack of knowledge on what to screen for and how to treatment it... 35.1% of physicians cite time constraints & lack of reimbursements for screening and treating a Rx-abusing patient. CASA Released Survey of Primary Care Physicians & Patients, 2000

  47. Other Key Stakeholders • Lack of screening and awareness about Rx and OTC problem among: • Substance abuse treatment practitioners • Social workers, juvenile delinquent counselors, probation officers • School teachers, nurses, & counselors McCabe, S.E., Teter, C.J., & Boyd, C.J. (2004)

  48. Efforts to Address Rx & OTC Misuse

  49. Youth Prevention Activities • ONDCP • 12 week national public awareness campaign • Began with 2 Ads aired during Super Bowl • 1st paid TV advertising targeting parents in 2 years. • DARE • New School Curriculum Addresses Rx and OTC Drug Abuse • Five Moms Campaign • Stopping Cough Medicine Abuse – keeping parents informed and educated of the issue

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