Prescription drug abuse by teens increasing

Primary care physicians are being encouraged to help stem the tide by offering patients office-based drug treatment.

By Susan J. Landers, AMNews staff. Feb. 10, 2003. Additional information

Washington -- Kyle Moores, a 19-year-old recovering drug addict, got his first "oxys" from a classmate. She gave him free samples from a prescribed supply of Oxycontin that her father readily shared with her. After a couple of months she started charging for the pain relievers. By then, Moores was hooked.

After 1½ years of addiction, Moores enrolled in a substance abuse program and managed to break his habit. But his experience leading up to rehab places him among the growing ranks of teens and young adults who admit to recreational use of prescription opioids, antidepressants and stimulants.

In 2001, nearly 3 million 12- to 17-year-olds and 7 million 18- to 25-year-olds reported abusing prescription medications, according to the National Household Survey on Drug Abuse.

"The human, social and economic costs associated with the abuse of prescription medication are truly profound," said Westley Clark, MD, MPH, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration. "Young adults, even teens ... do not seem to realize that this misuse can lead to serious problems with addiction."

Last month, the Food and Drug Administration and SAMHSA kicked off an effort designed to raise awareness about the increasing rates of abuse.

In 2001, 3 million teenagers reported abusing prescription medications.

The annual number of new prescriptions for pain relievers has increased since the mid-1980s from about 400,000 to 2 million in 2000 -- making these medications more accessible, according to SAMHSA data. Meanwhile, many young people may not understand the danger posed by the improper use of prescription pain relievers, said John Jenkins, MD, director of FDA's Office of New Drugs.

While the proper use of pain medications is fully supported by the FDA, said Dr. Jenkins, prescription pain relievers, particularly opiates, have well-recognized and potentially serious side effects, including the risk of respiratory depression, that a physician must carefully monitor.

Data from SAMHSA's Drug Abuse Warning Network show that visits to emergency departments increased significantly from 1994 to 2001 for narcotic prescription pain relievers. Visits naming oxycodone increased 352%; methadone, 230%; morphine, 210%; and hydrocodone, 131%. The data also show that many people were using more than one drug.

New treatment option

Dr. Clark is seeking the help of primary care physicians in the effort to curb this increased abuse. "Primary care clinicians, through their regular, long-term contact with patients, are in an ideal position to screen for misuse of prescription medications and, more broadly, indications of substance abuse," he said.

Dr. Clark expressed disappointment with the low interest in a new treatment option intended to allow primary care physicians to treat their addicted patients in their offices as they would treat any patient with a chronic disease.

"Nothing better reflects the important role of primary care physicians in facilitating substance abuse care than the emergence of office-based opioid treatment," he said.

Annual prescriptions for pain relievers increased from 400,000 in mid-1980s to 2 million in 2000.

The new treatment option was made possible by a law signed in 2000 and the approval by the FDA in October 2002 of two formulations of buprenorphine to treat patients addicted to opiates.

Physicians who take an eight-week instructional course about buprenorphine, file a waiver with SAMHSA and receive certification would be able to treat opiate addiction in their offices and prescribe a 30-day supply of the medication for patients to take at home.

A head count on the SAMHSA Web site shows that, so far, only about 600 physicians have received certification and many of those had apparently already been treating addictions. SAMHSA is hoping that more generalists will sign up as word of the drugs' availability spreads.

There have also been some problems with the program. The new medications, manufactured by Reckitt Benckiser Pharmaceuticals as Subutex and Suboxone, were difficult to come by until recently and larger treatment facilities are bumping up against a provision that limits to 30 the number of patients they can treat with buprenorphine.

The medications are apparently now reaching pharmacies, but it remains up to Congress to clarify or eliminate the 30-patient cap.

ADDITIONAL INFORMATION:

Bad news numbers

New data from the 2001 National Household Survey on Drug Abuse revealed that:

Of the estimated 11.1 million people who reported using prescription drugs nonmedically in 2000, nearly half, or 5.4 million, were age 12 to 25.
Pain relievers were the most common category of prescription drugs used by teens and young adults.
6% of 12- to 17-year-olds and 10% of 18- to 25-year-olds used prescription pain relievers.
2% of 12- to 17-year-olds and 3% of 18- to 25-year-olds used stimulants.
2% of 12- to 17-year-olds and 4% of 18- to 25-year-olds used tranquilizers nonmedically.

Source: The Substance Abuse and Mental Health Services Administration

Weblink

Subutex and Suboxone tablets resource page, Center for Drug Evaluation and Research (http://www.fda.gov/cder/drug/infopage/subutex_suboxone/)

Campaign against prescription drug abuse, HHS Substance Abuse and Mental Health Services Administration (http://www.rx.samhsa.gov/)

SAMHSA statistics on substance abuse (http://www.drugabusestatistics.samhsa.gov/)

HEALTH & SCIENCE