The use of prescription drugs not recommended medically in schools and colleges is arising concern across the US. Several research studies have discovered that abuse of drug prescription is more prevalent than any other illegal drug consumption aside from the use of marijuana. An MTF survey in 2004 estimated 7.4 percent of students enrolled in college consumed Vicodin, a prescription pain reliever, for non-medical uses that period, an increase of over 6.9 percent using the drug in 2002 (Flowers, 2009). A similar rise was found in the use of other opioid drugs, sedatives, and stimulants.
Statistics indicate that as many as one in four students at some schools and colleges across the US have reported abusing stimulants. A 2001 survey by MTF of 10,904 students in 119 institutions of higher learning admitted use of a stimulant without a prescription at least on one occasion within the prior year (Flowers, 2009). The study also revealed: Ritalin, Dexedrine, and Adderall were abused twice as often by male students as female students; stimulant medication was abused by White students more often than African Americans or Asian students; it is more likely for sorority or fraternity members to abuse students than non-members; and a higher incidence of using marijuana, smoking cigarettes, use of cocaine and ecstasy, and drinking problems is common to abusers of drug abusers.
Other statistics also indicate worrying numbers of students abusing prescription drugs. In a study conducted at a large college in the Midwest of 9,161, an estimated 9 percent of students had consumed prescription pain-relieving medication on one occasion without a doctor’s recommendation (NIDA, 2007). Sixteen percent admitted they had ever abused medications. From this group, more than half admitted getting these drugs from friends, with about one in five getting prescription drugs from family members.
College students abuse prescriptions for many reasons. According to the National Institute on Drug Abuse’s (NIDA) department of Epidemiology, “students abuse medications to get high, to self-medicate to relieve pain episodes, to assist concentrate during exam time, and try to relieve stress”. Some evidence also suggests that the majority of students attending college believe falsely that using medically prescribed drugs is harmless, irrespective of whom the drug was prescribed for; or they are “brain steroids” that are safe and “help maximize performance with less risk. However, dosages prescribed by a medical doctor for one individual are not necessarily appropriate for another, and drug prescription abusers are potentially taking a serious risk. The risks of prescription drugs increase even more when such drugs are used with other illicit drugs or alcohol (NIDA, 2007).
The American society can today benefit immensely from improved use of pain killers hence relieved from chronic pains. This is attributed to the growing advancement in pharmacotherapy (ONDC, 2008). When these drugs are misused, however, they can affect brain activity and can result in dependence or addiction (NIDA, 2007). NIDA (2007) defines drug abuse as the use of illicit drugs. Illegal drugs are classified as marijuana, hallucinogen, stimulants, inhalants, phencyclidine, and narcotics. While most illegal drugs are procured from the street, some of the dangerous illegal drugs are found in familial medical cupboards. Notably, there is an increase in the abuse of prescription drugs in America today especially prescribed narcotics which are intended to relieve both chronic and acute pain (Novak, 2004). This in turn has significantly contributed to drug abuse and dependency (NSDUH, 2007). Medline Plus (2008) states that prescription or over-the-counter drugs may be abused if one takes more than the normal amount of the drug, or when one uses them for illegal purposes.
Prescription drugs include a broad category of psychotherapeutic medicines that includes pain relievers, sedatives, tranquilizers, and stimulants available by prescription (Medline Plus, 2008). Prescribed drugs have been developed, tested, and approved for legal medical uses, and are generally prescribed by medical doctors to treat a range of medical and psychological maladies. Illegal use of drugs may be declining among US teenagers, but prescription drug abuse has risen sharply, with prescription pain relievers leading the list of misused, misappropriated, or diverted substances (NIDA, 2007). Emergency medicine providers and other clinicians must reverse this dangerous trend.
A Review of Related Literature
Prevalence of Prescription Drug abuse among adolescents
Students in high school and colleges, particularly those who experience difficulties with a reasonable preparatory schedule to get work done, tend to cram for exams or to complete term papers at school. These students some In some cases, turn to use drugs that enable them to stay awake for longer periods hence helping them accomplish what needs to be covered in a relatively short time. Moreover, they may also derive they may use the same drug for recreational purposes. Several surveys indicate an alarming prevalence of abuse of prescribed medications among young people.
The studies carried out by McCabe and colleagues revealed prevalence of non-medical prescription stimulant use was 6.9 percent, compared to the past year’s prevalence of 4.1%. In their estimates:
“A total of 5.8% of males and 2.9% of females reported annual use of non-prescribed stimulants. Relatively, White students were likely to use stimulants compared to African American, Asian, or other groups of students, that is, annual use being; 4.1% compared to 1.6%, 1.3%, and 3.1% respectively” (Flowers, 2009).
According to NSDUH (2006), data estimates, “15.6% of young adults of ages 18 to 25, equivalent of about 5.1 million people across the US, abused prescription drugs annually during the period. Prescription drug misuse among young adults in California shows a slightly lower rate of just below 12% and an estimate of 456,000 Californians. In a comparison of the two percentages, and total numbers, prescription drug abuse among young adults is higher than prescription drug abuse among youth, by a factor of about two to one”.
The majority of parents were once worried about drugs such as Marijuana, heroin, and cocaine. These statistics show overwhelming numbers of students turning to prescription drugs, which are accessed with ease through peer groups (classmates) who get them from parents’ medical prescriptions. According to NSDUH (2006), a number of these students have developed ways on how to get these prescribed drugs by fibbing to physicians and then act as “candy men” who deliver medication to classmates. An increasing number of teenagers indulge in such vices while in peer parties, where bowls of prescription drugs are distributed around. Each kid picks a few pills from the “trail mix” (SAMHSA, 2006).
For adults, often indulge in a cycle of prescription drug abuse due to pain or are struggling with anxiety, lack of sleep, or difficulty in focusing or staying alert. In most cases, based on advertisements for the drugs in question, that specific pharmaceuticals will assist, and they receive the medications either through their doctor or on their own. Then they end up requiring more and more or continue to want to use the drug after their symptoms have been cured. In the teen’s dimension, however, it’s sometimes just the question of getting high, for those who are hooked; it’s about staying high, no matter the consequences. Other teens feel nothing wrong with taking a Ritalin when they need to stay up late studying or with taking a Valium when they have anxiety before an exam. This type of prescription drug abuse is sometimes referred to as self-medication.
Following these statistics, therefore, adolescent, college-aged young adults; medicate themselves with prescription drugs without help from a medical physician. These youth illegally receive or offer out non-prescribed medications and take them to try to modulate mood, self treat depression or anxiety, combat insomnia, or stay awake later at night. This practice is illegal but not often prosecuted (Burtler, 2007). Pain killers are the most commonly abused prescription drugs by young adults. Stimulants are also more common among college students (SAMHSA, 2006). The problem is more pronounced in young girls compared to boys. This problem of prescription drug abuse in adolescents has had everyone worried. The media has been awash with direct consumer ads, proffering a pill for every sickness. The fact is that most of the time, adolescents who use these pills need can easily get them in their parent’s prescribed medication. Many parents are increasingly taking home bottles of antidepressants, painkillers, stimulants, and sedatives. Doctors are also guilty of being quick to prescribe one of these drugs to someone as a first resort.
Clark Wesley, the director for substance abuse therapy at Substance Abuse and Mental Health Services Administration, asserts that “young adults, even teens…do not seem to realize that this misuse can lead to serious problems and addiction” (SAMHSA, 2006). Some kids end up dying because of a lack of knowledge that even FDA-recommended prescription drugs can lead to death when misused or administered in combination with each other or with alcohol (NIDA, 2007).
Parents have a responsibility to let their kids the dangers and availability of prescription drugs. They should let their children know that these prescription drugs are probably going to be available to them and that they will face considerable pressure to test these drugs. Teens should be informed that prescription and over-the-counter (OTC) drugs can be very dangerous when misused (ONDDCP, 2008). Pre-cooked or OxyContin narcotics, for instance, can slow the heart to dangerously low rates if taken in overdose or combination with alcohol or benzodiazepines. Parents should also point out that stimulants such as Ritalin have been known for causing death when abused, particularly when they are crushed and injected, or snorted. If parents happen to have any of these medications in the house, they should monitor them carefully and be sure to dispose of unused pills in a place where their children won’t find them (Paulozzi, 2006).
Dependency on Prescription Drug among Adolescents
Many parents and teachers are surprised to hear how easily students get drugs. Through surveys, they come to learn that drugs are prevalent everywhere. Special attention is provided to the school and college-going students because most of them are likely to experiment with drugs. The majority of them who experiment get hooked up or addicted or dependent during their lifetime. In the US, quite a several people have undergone treatment for substance dependence.
It is not easy to estimate dependence among students. Students especially may conceal their drug usage and may not be willing to reveal it to anyone if think they have a dependency problem. According to NIDA (2007), of those 1.7 million people who sought assistance from public programs in 2003, about 8.5% were students in school; and 6.5% attended college. In other surveys by the National Survey on Drug Use and Health (NSDUH) on persons aged 12 and above in 2002, an estimated 29.6 million Americans depended on pain relievers not prescribed by medical doctors. The number had risen to 32.7 million by 2005 (Maxwell, 2006). NSDUH (2002) revealed that “Un-prescribed use of prescription pain relievers was next only the use of marijuana use compared to past year use: un-prescribed pain reliever users were 11.3 million as compared to 25.5 million marijuana consumers in the past year”. In the period 1991 and 1994, the use of opioids rose from 44,518 to 99,317, an increase of 123% increase in use (NIDA, 2007).
According to NSDUH (2007),” it was determined that 57.7% of individuals who first used pain relievers un-prescribed in the past year used hydrocodone products and 21.7% used oxycodone products in a combination of data from 2002 to 2005”
In another survey by SAMHSA (2007), shows the rate of prescription drug abuse as more prevalent among youths aged 12 to 17 who are school going. About 2,500 abused prescribed pain relievers every day (SAMHSA, 2007). Additionally, prescription drugs tended to be preferred drugs among 12 and 13-year-olds. The office of the National Drug Control Policy in 2008, reported that many teenagers were abusing prescription drugs more than illegal drugs apart from marijuana. Additionally, more than 2.1 adolescents abused prescription drugs (ONDCP, 2008). Adolescents are leaving street drugs and using prescription drugs to get high. This trend of users of prescription drugs has equaled with new users of marijuana (Kuehn, 2007). The mean age of the first non-prescribed use of sedatives and stimulants is 13 years. 60 % of adolescents who have abused prescription pain relievers first experienced them before age 15; additionally, about 18% used them at least weekly (SAMHSA, 2007).
These statistics indicate consistently hundreds and thousands of students are dependent on drugs. One does not need to be an impressionable teenager, or an addict or alcoholic to become dependent on prescription drugs. This problem can affect all; even those people who have never used street drugs, cigarettes, or alcohol are just as susceptible to prescription drug abuse as those who have. The abuse of prescription drugs usually starts with the abuser taking their problem as normal since a physician recommended the prescription. Overall, this is a hazardous assumption.
A tragic example of prescription drug abuse is the recovering alcoholic who fractures a bone or has surgery and is prescribed a potent narcotic pain reliever such as Vicodin or Demerol. Though the risks of addiction and abuse of these medications are well known, the prescribing doctor fails to determine whether the patient has a problem with drug abuse. The patient trustingly takes the drug intending to use it in the shortest period but gets hooked into the downward spiral of addiction and dependence. Physicians are all too willing to continue to give prescriptions for patients who insist they require the drugs for their suffering. Vicodin abuse, for instance, is a precise example of unexpected side effects linked with 48 cases of complete and sudden hearing loss (Joranson, 2006).
Drugs used by physicians to treat diseases have been controlled by law for many years. However, it is reported that there is excessive consumption of stimulants like amphetamines and Ritalin, together with tranquilizers such as Valium and Librium, and sedative-hypnotics especially Dalmane and Noludar. Intervention policies must be enhanced to reduce access to these drugs, particularly by students to reduce rates of dependency. Many patients have been provided drugs by well-meaning doctors only to discover that they have an addiction to their treatment. In some countries, drugs are not regulated as they are in America. Prescription drugs can be got in those countries merely by requesting pharmacists for them (CDC, 2007).
Causes of Prescription drugs abuse
Drugs prescribed by medical doctors are often regarded as safer. For this reason, four out of ten adolescents this to be factual, even when they are not prescribed by the physician (PAT, 2006). Furthermore, about one-third believe there is no fault with using prescription drugs without a prescription once in a while. The basic assumption is that people aged 12 and 17 find these drugs readily available and less dangerous than street drugs. It is estimated that 70% of individuals who abuse prescription pain relievers admit getting them from friends or relatives (NSDUH, 2007). Several studies have been carried out to reveal the causes of prescription drug abuse in schools and colleges.
In a survey by Partnership Attitude Tracking Survey (PATS) on 7,218 adolescents in 2005, self-administered measures identified several reasons for use of prescription pain relievers: 62% admitted getting these drugs easily from parents; 52% got them due to availability everywhere; 51% got them because they are not illegal; 50% admitted obtaining them as they easy to get through other people’s prescriptions; 43% for these drugs being cheap; 35% felt safer to use them than illicit drugs; 33% due to less shame attached to using them; 32% due to ease of purchase over the internet; 32% due to fewer side effects than street drugs; and 21% as a result of parent’s don’t care attitude if they get caught (PAT, 2006).
In addition, Partnership Attitude Tracking Study (PATS) also revealed that: 40% of adolescents in the US are in agreement that prescription drugs are much safer to use than illicit drugs, even when a physician has not prescribed them; 31% of teenagers find absolutely nothing wrong with using prescription drugs in some occasions; 29% of teens feel that prescription pain relievers are not addictive; three out of five adolescents admitted prescription pain killers are easy to obtain from medical cabinets of their parents; half admitted how easy it is to get these drugs through other people’s prescriptions; 52% of teens admitted how easy prescription pain killers are available everywhere. 56% of adolescents agree that it is easier to obtain prescription drugs than illegal drugs; only 36% of parents talk to their children about prescription drug abuse, while 70% of these same parents actively warn their children on the dangers of marijuana (PATS, 2006). These statistics reveal the real causes of the abuse of prescribed medications among students. These causes include: easy access to their parent’s medical prescriptions; availability of these drugs are not restrictive; prescription drugs are cheap and affordable; there is less stigma or shame in using them; non-concern by parents; internet explosion where students easy subscribe purchase these drugs through the internet; and other causes.
Counseling and Treatment of Prescription Drug Abuse in Schools and Colleges
Counseling is an important and necessary strategy of intervention by schools and colleges in curbing the problem of prescription drug abuse by students. It takes the concerted involvement of the school administration, parents and friends to get the affected students running. The purpose of this intervention is to get the drug dependent to recognize an abuse problem and accept to seek assistance. There is a wide range of intervention strategies. For instance, a teacher who has figured out that a particular student is always spending sleepless nights cramming for tests may speak to the student privately, praising the abilities of the student to perform well in class but expressing concern that the habit is undermining his grades. The teacher and the student may agree to find a counselor to assist the student fight off the addiction problem.
According to Joranson (2006), the Federation of State Medical Boards has introduced a model policy to regulate the use of controlled substances, some advocate for a public health approach to avoid opioid abuse and diversion. Joranson postulates that improved data collection resulting in more complete databases, information about the motivations for drug use, and more knowledge about the sources of abused prescription drugs are all necessary to reducing abuse and diversion, especially those that end up in the hands of the youth (Joranson, 2006). In 2004, nearly 13,000 incidents of prescription controlled drugs were diverted due to theft (Novak et al., 2004). There also exist non-medical sources of controlled substance diversion. These statistics are important as they send a vital message to providers of health care, and school administrators as well as anyone being prescribed scheduled medications. Getting a better understanding of the etiology of prescription drug abuse will inform fully future programs, particularly in schools aimed at curbing problems of prescription drug abuse.
Diversion is the most common method of getting medications for unintended purposes. Diversion involves some illicit activities such as selling, trading, or sharing drugs that have been prescribed legally by a physician. Adolescents, who endeavor to procure greater quantities than would ordinarily be prescribed by the doctor, may turn to doctor-shopping, falsely claiming a lost prescription, trying to escalate dosing from the provider, or forgery (NIDA, 2007). Given these, school administrations should design counseling programs aimed at sensitizing students on the dangers of using drugs that have not been recommended by the doctor.
Despite the rise in prescriptions for opioids, only about 14% of those used by adolescents are prescribed for them. Most teens who abuse prescription medications get them from peers or family members with legitimate prescriptions. About one-third of those who use prescription opioids rely on Internet No-Prescription Web sites (NPWs) or drug dealers. In a 2005 Web-based survey of 1,086 high school students, 49% had been prescribed a sleeping aid, sedative, stimulant, or pain medication at least once (NIDA, 2007). Among these students, 24% reported having lent their prescriptions or given them to other students. Having their medications stolen or being forced to give them away was often cited as significant problems (NIDA, 2007). From these statistics, it is inherent upon school and college administrators to liaise with government and other agencies in monitoring drug diversion; counsel the students on responsive use of the internet as well as the dangers.
Doctors can decrease effectively prescription drug abuse and diversion by screening the history of drug abuse before commencing treatment. Numerous measures for the assessment of chronic pain have been developed (Butler et al., 2007). The Prescription Drug Use Questionnaire (PDUQ) was designed to be applied in an interview format and has 42 items. This questionnaire has five criteria that make up an abuse checklist; patients who meet three of the five criteria are considered to be opiate abusers (Chabal et al., 1997). According to Maxwell (2006), “Other screening measures include the Current Opioid Misuse Measure (COMM); the Screening Instrument for Substance Abuse Potential (SISAP); the Pain Assessment and Documentation Tool (PADT); and the Pain Medical Questionnaire (PMQ)”.
Prevention of prescription drug abuse can also be done through elaborate media campaigns. The Office of National Drug Control Policy (ONDCP) started a media campaign in 2008 aimed at parents regarding prescription drug abuse (ONDCP, 2008). For instance, a drug dealer in one of the television advertisements is portrayed as being out of work and not the one selling kid drugs. This seems to suggest that teens get these drugs from their medical cabinets, friends, and doctors. The advertisement was meant to enlighten parents of the dangers posed by prescription drugs (ONDCP, 2008). Due to the increase in abuse rates in prescription drug abuse, institutions have started national campaigns that involve students to raise awareness about the dangers of illicit drugs.
Illicit drug use may be declining among US teenagers, but prescription drug abuse has risen sharply, with prescription pain relievers leading the list of misused, misappropriated, or diverted substances. Emergency medicine providers and other clinicians must reverse this dangerous trend. Prescription drugs abuse has been a national problem for decades, but recently the number of young people using prescription drugs for non-medical purposes has been increasing at an alarming rate. For the period 1999 and 2006, the US Department of Health and Human Services reports, the number of surveyed 12 to 17-year-olds who reported non-medical use of a psychotherapeutic medication within the previous year rose by more than 60% (ONDCP, 2008).
NSDUH survey of 2005 revealed that about 1.4 million Emergency Department (ED) admissions were prescription drug abuse cases; in 37% of cases, involved abuse of prescription drugs. Prescription drug overdose is common among 12- to 17-year-olds, with more than 13,000 Emergency Department visits per year attributed to overmedication (NSDUH, 2007). It is imperative for physicians, especially emergency medicine providers (EMPs), to appreciate the magnitude of prescription drug abuse among adolescents so that overdoses or chronic abuse can be identified appropriately, and treatment and prevention strategies can be implemented (PATS, 2006).
Awareness of the current trends and demographics of prescription drug abuse will enable Emergency Medicine Providers to reevaluate their prescribing practices. The challenge is to maximize safe and effective treatment while minimizing the diversion of prescription drugs and the development of substance abuse disorders (PAT, 2006.)
Private training and technical assistance can also enhance the fight against prescription drug abuse in schools and colleges. For instance, ONDCP and Community Anti-Drug Coalitions of America (CADCA) have been contracted by Non-Governmental Organizations to offer training and technical aid through National Coalition Institute (NCI) (ONDCP, 2008) to schools, colleges, and other national institutions. CADCA and ONDCP are working hand in hand with community members to form a network of leaders who will tackle the spread of prescription drug abuse within their communities (ONDCP, 2008).
Random drug testing and counseling in schools is an important program that seems to be effective. A randomized control study done in Oregon showed that, after two full school years, schools that had random drug and alcohol testing in practice reported significantly less drug use compared to learners at the control schools without random drug testing (Goldberg et al., 2007). On an occasion a student tested positive for drug use, their parents were informed and mandatory counseling followed (Goldberg et al., 2007).
Random drug testing in schools promotes the prevention of youth from initiating drug use for intervention before dependency commences, and intensifies students with dependency issues to refer them to appropriate treatment facilities (ONDCP, 2008).
School and college administrations together with parents should direct prescription drug abusers to the best available treatments; and enhance their proximity to recovery. The “Access to Recovery” (ATR) initiative is intended to narrow the treatment gap to ensure health providers have the necessary knowledge and tools mandatory to conduct proper treatment. Nationally, policies on prescription drugs can also be directed to help in the prevention of prescription drug abuse. The White House Office of National Drug Control policy released new guidelines for the disposal of unused, not required, or expired drugs by the White House Office of National Drug Control Policy (ONDCP) in 2007. The Environmental Protection Agency, apart from ensuring that prevention of diversion of prescriptions is achieved; is also mandated to apply guidelines to protect waterways. In addition, it ensures that pharmaceuticals are kept safe from potential abusers (ONDCP, 2008).
In sum, the abuse of prescription drugs in the United States is on the rise. Many of these drugs are prescribed narcotics meant to relieve chronic and acute pain. Moreover, the abuse of prescription drugs leads to abuse and dependency. According to Medline Plus (2008) “prescription or over-the-counter drugs may be abused if one takes more than the normal amount of the drug, or when one uses them for illegal purposes”. Again, drugs used by physicians to treat diseases have been controlled by law for many years. However, it is reported that there is excessive consumption of stimulants like amphetamines and Ritalin, together with tranquilizers such as Valium and Librium, and sedative-hypnotics especially Dalmane and Noludar. This calls for improved data collection resulting in more complete databases, information about the motivations for drug use in schools and colleges, and more knowledge about the sources of abused prescriptions drugs. This is particularly necessary to reduce prescription abuse and diversion. This paper has reviewed the literature on; the prevalence of prescription drug abuse among adolescents where, NSDUH data estimates of 2006, were that 15.6% of young adults of ages 18 to 25, equivalent of about 5.1 million people across the US, abused prescription drugs annually during the period; dependency on prescription drug among adolescents; causes of prescription drugs abuse; and prevention of prescription drug abuse.
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