Illicit drugs like marijuana, cocaine and heroin have always been a parent's nightmare. But perfectly legal and easily accessible prescription medications are now the recreational drugs of choice for many teenagers, prompting physicians at Johns Hopkins Children's Center to urge pediatricians to screen specifically for their abuse during routine visits.
"Ask teens explicitly about prescription drug use with concrete questions like 'Have you ever taken a pain pill or other medication not prescribed for you?'" Hopkins Children's Melissa Long, M.D., told fellow pediatricians during a recent presentation at the hospital.
In 2009, some 2.6 million teenagers reported using a controlled substance recreationally for the first time, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). And a 2010 study by the Drug Abuse Monitoring Network found that the number of emergency room visits related to abuse of prescription pain pills doubled between 2004 and 2008, signaling just how dangerous these medications can be.
Increased prescription drug abuse is likely related to the growing legitimate use of these drugs, Hopkins experts say, as more physicians today prescribe controlled substances than 10 years ago. A 2010 study in Pediatrics showed that the number of controlled medication prescriptions to teenagers nearly doubled between 1994 and 2007, from 6.4 percent to 11.2 percent of all teen visits to the ER and outpatient clinics. This number does not include medications prescribed to family members that the teens may have access to, experts say.
Nearly 70 percent of teens and adults who abuse prescription drugs said they got them from relatives and friends, according to SAMHSA research, a finding that underscores the importance of safeguarding medications at home and closely monitoring their quantities.
"It's important for pediatricians to ask parents what they have in their medicine cabinets at home and alert them that any controlled substances not stored and disposed of properly may inadvertently lead to misuse of these medications," Long says.
Experts believe that another factor fueling the widespread abuse is teen perceptions of controlled medications as the "safer drugs."
"Cocaine and heroin might sound scary and dangerous and might seem like big stuff, but a pain pill that mom takes and that was prescribed by her doctor doesn't carry the same dangerous connotations," Long says.
This "safe" misconception is compounded by direct-to-consumer advertising seen in magazine ads and TV commercials, which further legitimize the use of these medications, Long says. The truth, experts say, is that prescription drugs could be just as dangerous when used inappropriately as hard-core street drugs.
General signs of drug abuse that pediatricians and parents should watch out for include constricted pupils, slurred speech, severe mood swings, personality changes, irritability, excessive energy, loss of appetite, and insomnia. Symptoms specific to painkillers include depression, somnolence, confusion, constipation, slow breathing and low blood pressure. Signs suggestive of tranquilizer/sedative abuse include drowsiness, slurred speech, unsteady gait, confusion, involuntary rapid eye movement. Stimulants usually lead to weight loss, irritability, high blood pressure and heart rhythm disturbances, inability to sleep and nervousness.
The most frequently abused medications include pain relievers, such as Vicodin (street name vitamin V), Oxycontin (known as O.C. or Oxy) and Percocet (called Perc), tranquilizers, such as Xanax and Valium, and stimulants that include ADHD medications such as Ritalin and Adderall.
Johns Hopkins Children's Center