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Archive for Tuesday, June 17, 2008

Double Take: Prescription drugs’ availability makes them easy to abuse

June 17, 2008

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Dear Dr. Wes & Julia: Do you see prescription drug abuse becoming a more prevalent problem, especially among teenagers? What advice would you have for parents and children about prevention?

- March chat participant

Wes: I wouldn't say "becoming." This trend has been ongoing for some time. When we started this column in 2004 we had several letters about this topic early on. Since then we've heard less and published less about it, so the time is ripe to revisit the issue. From the drug abuser's standpoint, there are many advantages to prescription drugs - and a few over-the-counter meds - when compared to street drugs. They're easy to carry and consume, difficult to detect, potent, and because they are FDA approved, generally pure. They're also easier to pass around and use during school or in public. As with all drugs, kids have a hundred stories about how so-and-so has abused this-or-that drug and "nothing bad happened to him." This sense of security is only enhanced by the fact that these really are medicines.

Obviously this isn't a great idea. What makes modern medication so effective is also what makes it so dangerous in misuse. Moreover, the goal of any medication is to help one feel more normal - not to make one feel abnormal. The medications that make pain more bearable, reduce severe anxiety, combat insomnia and help people with ADHD focus their attention can provide modern miracles for those afflicted. However, most of these meds also have potential for dependency and serious side effects when used without proper oversight.

Beyond simply getting high, there's been an increase in what I would term the "instrumental" use of prescription medications - usually Adderall and Ritalin. At the risk of oversimplifying things, these medications work kind of like a superdose of caffeine and, if taken in moderation, can help improve anyone's concentration. This makes them very interesting to college and high school students who are overburdened, burning the candle at both ends, desperate for better grades, and perhaps not as good of students as they would like to be. So they beg, borrow, buy or otherwise obtain stimulants in an attempt to hype up their study habits. HOWEVER, when used by people who don't actually have ADHD, these medications have many problematic side effects, not the least of which is tolerance building - the more you take, the more you need to take to get the same effect. There is so much of this going on that prescribers are careful not put these meds into the wrong hands. This is why most psychiatrists and nurse practitioners won't prescribe stimulants without a full evaluation of the condition, which includes input from others on a standardized test instrument. They want to be sure the person really has the disorder and isn't simply drug-seeking. Obviously a very determined person could fake the test, but it does make it harder, and I'd advise any parent considering use of these meds to have their child fully evaluated first.

Specific to prescription drugs, the best prevention is for parents to lock up all medications for the duration of childhood and adolescence. I find that the vast majority of prescription drugs being abused can be linked back to a very familiar supplier - the home medicine cabinet - so be sure to keep them secure. This is just as true for stimulants, which have a high street value. And as always, the best defense for your child is a good relationship with you and your active participation in his or her life.

Julia: I am not an underground prescription drug dealer or abuser, so my knowledge on the subject is a little limited. The most I see about preventing prescription drug abuse is the ads on TV that say "don't do it," which is about as useful as saying "don't run in front of cars" to a squirrel. As Wes mentioned, drugs like Adderall and Ritalin can be intentionally abused, but I have noticed another not-so-obvious trend amongst teens: the unintentional abuse or addiction to drugs. It sounds extreme, but hear me out. I've noticed that teens are popping up with more and more random afflictions: chronic headaches, sleeplessness, a sprained something. Although these ailments can be legitimate, pills get prescribed left and right to the point that kids younger than me are getting drug cocktails for multiple problems.

My concern is not only for the seemingly extreme prescription for a mild problem, but also how lax kids can get about their medications - "Oh my sleeping meds didn't work, so I took a few extra." Then I see these same kids off their medication and their problem is even worse than before they were prescribed medication. It isn't safe to assume that just because a doctor prescribes it, medication is necessary or harmless. I would say to parents and children, consider the other causes of problems. Is a child tired? Don't assume insomnia - maybe they are stressed, caffeinated at a late hour or just need more sleep. Also, before accepting a prescription, make sure you know the full range of its effects and whether it is truly necessary.

Next week: Kids, money, and chores. How to create a working economy.

- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Julia Davidson is a Bishop Seabury Academy junior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to doubletake@ljworld.com. All correspondence is strictly confidential.

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