How can something that is prescribed by a doctor, or available for purchase without a prescription at Wal-Mart and Walgreens, be so bad or cause such devastating problems for teenagers? Unfortunately, Corey Suazo, a 17-year-old high school student had been to a “pharm” party before he died. Cocaine and the painkiller OxyContin were found in his system. A pharm party is similar to a bring-your-own-bottle party, except kids substitute pills for bottles. Kids bring whatever they can get their hands on and they may not be sure about what they have. The pills are thrown into a communal bowl and the participants grab handfuls to consume, often washing them down with alcohol. They wait for what's next, which may be death. One could call it prescription roulette.1
Unauthorized use of pharmaceutical and over-the-counter (OTC) drugs by teenagers is a growing national problem.2 This latest trend in drug abuse by adolescents is called pharming, or the nonmedical use of prescription and OTC cough and cold medications.3 It is a concerning risky behavior that allows for the ability to get high with disregard for the type of drug that is being ingested, often along with alcohol.4
Pharming parties may also be referred to as "Skittles parties” or “skittling" by comparing the pill-popping behavior with the small hard candies that come in multiple colors and flavors.4 "Robo-tripping," referencing the cough suppressant Robitussin, is the abuse of cough medications containing dextromethorphan, in which the cough syrup, often left over from earlier illnesses, is drunk alone or in combination with other substances to obtain a high.
The purpose of this article is to explore the risk-taking behaviors of adolescents who engage in pharming parties; the effects that pharming parties, with indiscriminate use of prescription and nonprescription drugs, have on children and teenagers; and the approaches that healthcare providers (HCPs) can employ to guide young persons and their families to prevent negative outcomes from this growing epidemic.
Surge in prescription and nonprescription drug use
Nearly 50% of all Americans take at least 1 prescription medication.5 The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices quadrupled in a little over a decade, from 1999 to 2010.6 In 2010, enough prescription analgesics were prescribed to medicate every American adult around the clock for 1 month. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reports that after marijuana, prescription medications are the drugs most commonly abused by the adolescent population with the biggest growth of abuse among persons aged 12 to 24 years.5 Alarmingly, the abuse of prescription and OTC medications has surpassed the use of illegal drugs such as crack, cocaine, ecstasy, and heroin. An estimated 14% of high school seniors have used prescription drugs for nonmedical reasons at least once.
Students report that prescription pills often can be bought for less than other drugs such as marijuana and cocaine. However, costs can increase when these medications are in high demand, such as when students use them to cram before midterm and final exams.5 One study of intentional drug abuse in teenagers and children aged 6 to 19 years revealed that 38% of intentional drug abuse involved nonprescription drugs, with dextromethorphan, caffeine, antihistamines, and nonprescription stimulants identified as the most commonly abused nonprescription drugs (Table6).8 The Partnership for Drug-Free Kids estimates that 15% of teenagers have abused nonprescription cough or cold medications to get high.9
Teenaged girls, in particular, see prescription pills as “cleaner” than other drugs and equal their male counterparts in prescription drug use, but girls are less likely to use marijuana or cocaine compared with boys.5 Student athletes may see pills as a way to enhance sports performance or may self-medicate with opiates for pain related to sports injuries. Seventy percent of all persons who abused prescription pain relievers obtained them from friends or relatives, often without permission.9 Parents are advised to watch out for their own children as well as for their children’s friends who may be searching through the medicine cabinets when visiting the home.7
A national effort to reduce illicit drugs such as heroin and cocaine has seen a slight decline in overall drug use among young adults in recent years.5 However, as prescription drug sales continue to soar, pharming or prescription drug abuse is on the rise, with adolescents now dubbed the “Ritalin generation.” Pills are available to sell or share more than ever before, with more prescriptions written every year for antianxiety drugs, sleeping pills, and stimulants such as Ritalin, which is used to treat attention-deficit/hyperactivity disorder.
Skittling or pharming is a party game in which teenagers indiscriminately mix drugs together, putting themselves at risk for stroke, heart attack, or irreversible brain damage.9 Children have easy access to medications from medicine cabinets in their own homes and homes of their families and friends (Figure6). Gathering unused or expired medications often goes unnoticed by family members and does not cost the child anything. Emergency departments (EDs) may have difficulty discerning the combination of medications that an individual has ingested, resulting in delay and uncertainty of treatment.8 Experts report that it is difficult to identify a teenager who abuses prescription drugs because these medications are odorless and can be easily hidden, and the abuser may not manifest with unusual behavior such as stumbling or slurred speech.10