Adolescents and Prescription Drug Abuse

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Adolescents and Prescription Drug Abuse

• Rodgers M. Wilson, M.D.,CHCQM
• Arizona Department of Health Service Division of
  Behavioral Health Services

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Prescription Drugs in Adolescence

• Adolescence is a developmental period
  characterized by suboptimal decisions and actions
  that are associated with an increased incidence
  of unintentional injuries ,violence, substance
  abuse, unintended pregnancy, and sexually
  transmitted diseases.
• ( Ann.N.Y.Acad.Sci.,2008)
• Research suggests that areas in the brain
  associated with higher order functions such as
  impulse control develop in the 20s
• ( Giedd,2004)

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Prescription abuse?

• Non-medical use, misuse, and abuse of
  prescription drugs are defined as the use of
  prescription medications without medical
  supervision for the intentional purpose of
  getting high, or for some reason other than what
  the medication was intended (Office of National
  Drug Control Policy Executive Office of the
  President,2007)

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Non-Medical Use of Pain Relievers in the Past
Year Person aged 12
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Last Decade
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National Issue

• 48 million(20 of the U.S .population) aged 12 or
  older had used prescription drugs for non-medical
  reasons in their lifetime. (NIDA 2005)

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Accessibility and Availability
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Availability and Accessibility

• 2005 National Survey on Drug Use and
  Health(SAMSHA,2006)
• 47.3 obtain from friends for free
• 18.3 from one doctor
• 10.2 took from a friend or relative without
  asking
• 10.0 bought from friend or relative
• 4.5 bought from a dealer or other stranger

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Availability and Accessibility

• Creative Possession
• 2.6 from more than one doctor
• .1 bought on the internet
• .1 wrote a fake prescription
• .5 stole from doctors office, clinic, hospital
  pharmacy
• (2006, SAMHSA)

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Prescription Drugs Commonly abused by Adolescents

• Opiates
• Morphine, codeine, oxycodone (oxycontin),
• Hydrocodone (vicodin), and demerol
• Depressants
• Diazepam (valium), Alprazolam (xanax)
• Stimulants
• methylphenidate (ritalin), dextroamphetamine(dexe
  drine)
• Anabolic Steriods
• testosterone

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Top Five Drugs Used by12th graders in the Past
Year

• Cannabis 31.5
• Vicodin 9.7
• Amphetamines 8.1
• Cough Medicine 6.9
• Sedative and Tranquilizers 6.6
• (Monitoring the Future Study, The University of
  Michigan,2006)

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National Survey on Drug Use and Health(2005)

• Sample of 18,678 with focus on ages 12-17
• Opioids were the most frequently misused class
• (Schepis,2008)

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Types of Prescription Drugs abused by Adolescents

• Pain relievers are currently the most abused type
  of prescription drugs by 12-17 year olds followed
  by stimulants, tranquilizers and sedatives(
  NSDUH, 2006)
• In 2005, past year use of vicodin is high among
  8th, 10th and 12th graders with 1/10 school
  seniors using it in the past year (MTF,2006)
• On average, almost for 3.5 of 8th-12 graders
  reported using OxyContin and 6 reported using
  Vicodin in the past year. (MTF,2006)

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2007 Monitoring the Future Study
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Gender Differences

• Girls are more likely than boys to intentionally
  abuse prescription drugs to get high.12-17 9.9
  vs. 8.2
• Pain relievers 8.1 vs. 7
• Tranquilizers 2.6 vs. 1.9
• Stimulants 2.6 vs. 1.9
• Dependency is higher in girls across the
  categories( SAMSHA, 2006)

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Age
17
Outcomes of Prescription Drug Abuse

• In 2004, more than 29 of teens in treatment were
  dependent on tranquilizers, sedatives,
  amphetamines and other stimulants (TEDS,2004)
• More 12-17 year old than young adults (18-25)
  became dependent on or abused prescription drugs
  in the past year (SAMHSA, 2006)
• Abusing prescription drugs for the first time
  before age 16 leads to a greater risk of
  dependence later in life( SAMHSA,2006)
• In the last 10 years the number of teens going
  into treatment for pain killer addiction
  increased by 300 (TEDS,2006)

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Outcomes of Prescription Drug Abuse

• Prescription drug misuse was significantly linked
  to poor academic performance, a major depressive
  episode in the last year, history mental health
  treatment in the last year and concurrent use of
  cigarettes, alcohol, marijuana, or inhalants
• 33 of the surveyed adolescents were developing
  symptoms of dependency
• (Schepis, and Krishnan-Sarin,2008)

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Outcomes of Prescription Drug Abuse

• In 2005,2.1 million adolescents abused
  prescription drugs( NSDUH,2006)
• The gap between cannabis abuse and prescription
  drug abuse is narrowing .The gap closed to 5.9
  between 2003-2005.(SAMSHA,2006)
• CDC(2007) Most common poisonings result from the
  abuse of prescription drugs.
• Number of deaths increased from 12,186 in 1999 to
  20,950 in 2004---62.5 increase over five years.

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(No Transcript)
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Deaths in Arizona2006
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Deaths in Arizona2006
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Holistic Treatment Approaches required in
Adolescence

• 1. Understanding Family Dynamics and Culture
• 2. Understanding Growth and Development
• 3. Understanding Sexual and Physical Abuse
• 4. Assessing co-morbid diagnoses
• 5. Psychopharmacological Interventions
• 6. Cognitive and Learning Disorders
• 7. Legal matters and issues of consent
• 8. Use of Community Resources

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Holistic Treatment Approaches required in
Adolescence

• 9. SES
• 10. Intelligence
• 11.Living Environment (rural vs. urban)
• 12. Pattern of use and Relapse Prevention
• 13. Medical and Detoxification Needs

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Use of Medications to Treat Prescription Drug
Usage

• Opiate Addiction
• The use of buprenorphine in adolescents has not
  been systemically studied.
• Many experts believe buprenorphine should be the
  treatment of choice for adolescents with short
  addiction histories or adolescents who have had
  multiple relapses
• http//www.kap.samhsa.gov/general/order.html

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Opioid Addiction Treatment Clonidine vs.
Buprenorphine

• Buprenorphine (partial opioid agonist) and
  Clonidine (alpha adnergeric blocker)
• Ages 13-18 with a opioid dependency diagnosis
• Behavioral therapy augmented buprenorphine and
  clonidine therapy
• Buprenorphine increased abstinence
• ( Marsch et al,2005)

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Risk/ Protective Factors
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Prevention Principles

• 1. Prevention programs should enhance protective
  factors and reverse or reduce risk factors.
• 2. Prevention should address all forms of drug
  abuse, alone, or in combination.
• 3. Prevention should address the type of abuse in
  the local community.
• 4. Prevention should address the specific
  population.
• NIDA,2008

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Prevention Principles (cont.)

• 5. Prevention should address family bonding and
  parenting
• 6. Prevention should be design to address early
  risk factors (i.e., aggression, poor social
  skills, academic difficulties)
• 7. Prevention should work with educational
  systems with a focus on skill development
  (i.e.,self-control,emotional awareness,
  communication, problem-solving, academic support)
• NIDA,2008

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Prevention Principles (cont.)

• 8. Middle and high school intervention to
  increase academic and social competence.
• 9. Prevention should be aimed at general
  populations at key transition points( e.g.,
  middle school)
• 10.Prevention should seek to combine effective
  programs (i.e., family-based and school-based
  programs)
• NIDA,2008

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Prevention Principles (cont.)

• 11. Prevention should focus on reaching
  populations in multiple settings
• 12. Research-based elements of prevention must be
  maintained during cultural adaptation.
• 13. Prevention should be long-term with repeated
  interventions
• 14. Prevention should involve teacher training
• 15. Prevention should be interactive( i.e., peer
  discussion, parent role playing)
• NIDA,2008

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Educating Parents on Prescription Drug Usage

• 1. Monitor adolescents on-line
• www.TheAntiDrug.com/E-Monitoring/index/asp
• 2. Be Observant of over-the-counter drug usage in
  Adolescents
• 3. Discard old and unused medications
• 4. Keep track of the quantities of prescription
  drugs in the Medicine Cabinet
• 5. Educate Parents on Talking to Teens

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Physicians and Prescribing
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FDA and Required Training

• Due to increasing the deaths and complications,
  the FDA is considering mandating education for
  narcotic prescribers. A decision is pending in
  2009.
• There is a concern that this will reduce the
  availability of pain treatment providers.
• This may have implications on the disparity in
  pain treatment. Only 45 of Hispanics and 39
  of Blacks receive treatment for severe pain in
  contrasts to White(52)
• (Pletcher,2008)

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Arizona Prescription Monitoring Program

• 17 of substance abusers obtain drugs by
  presenting pain to multiple physicians(SAMSHA,2006
  )
• Strategy
• A. Individuals who refill five prescriptions with
  five or more pharmacists in one month( schedules
  II, III, IV). APMP will notify the prescriber.
• B. Doctors will be able to query the databank
  with a username and password.
• Initial implementation September 08 with full
  implementation by March 2009.

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Arizonas Next Steps.

• 1. Prevention education with School Systems on
  the use of prescription drugs.
• 2. Increasing emphasis on coordination care
  between PCPs and Behavioral Health
• Medical Providers related to opiates.
• 3. Prescription Monitoring Program and
  participation by providers
• 4. Evidence-Based Practice Detoxification
  Protocols for Adolescents
• 5. Arizona Substance Abuse Partnership
  Collaboration

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Informational Linkages

• http//www.couragetospeak.org/
• National Youth Anti-Drug Media Campaign,
  http//www.theantidrug.com/
• Office of National Drug Control Policy,
  http//www.whitehousedrugpolicy.gov/

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The End