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Adolescents and Prescription Drug Abuse


Prescription Drugs ... Abusing prescription drugs for the first time before age 16 leads ... Prescription drug misuse was significantly linked to poor academic ... – PowerPoint PPT presentation

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Title: Adolescents and Prescription Drug Abuse

Adolescents and Prescription Drug Abuse
  • Rodgers M. Wilson, M.D.,CHCQM
  • Arizona Department of Health Service Division of
    Behavioral Health Services

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)

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

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

Accessibility and Availability
Availability and Accessibility
  • 2005 National Survey on Drug Use and
  • 47.3 obtain from friends for free
  • 18.3 from one doctor
  • 10.2 took from a friend or relative without
  • 10.0 bought from friend or relative
  • 4.5 bought from a dealer or other stranger

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
  • (2006, SAMHSA)

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
  • Anabolic Steriods
  • testosterone

Top Five Drugs Used by12th graders in the Past
  • 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

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)

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)

2007 Monitoring the Future Study
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)

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)

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)

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.

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

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

Use of Medications to Treat Prescription Drug
  • 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//

Opioid Addiction Treatment Clonidine vs.
  • 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)

Risk/ Protective Factors
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
  • NIDA,2008

Prevention Principles (cont.)
  • 5. Prevention should address family bonding and
  • 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

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
  • NIDA,2008

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
  • 14. Prevention should involve teacher training
  • 15. Prevention should be interactive( i.e., peer
    discussion, parent role playing)
  • NIDA,2008

Educating Parents on Prescription Drug Usage
  • 1. Monitor adolescents on-line
  • 2. Be Observant of over-the-counter drug usage in
  • 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

Physicians and Prescribing
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
  • 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)

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.

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

Informational Linkages
  • http//
  • National Youth Anti-Drug Media Campaign,
  • Office of National Drug Control Policy,

The End
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