Your role in curbing prescription and OTC drug abuse by adolescents

October 1, 2006

Awareness of over-the-counter and prescription drug abuse among adolescents is a first step you can take toward curtailing this worrisome trend. Take care, however, not to risk interfering when patients need these medications.

The source of the next wave of adolescent drug abuse is found in the home medicine cabinet and on supermarket and pharmacy shelves. An adolescent can also obtain these drugs from a friend or even a parent. Because the drugs are not, like heroin or cocaine, illegal, they do not have to be hidden or purchased from drug dealers. These are some of the worrisome trends confirmed by three national surveys of drug use among adolescents.

Although overall drug use is down among adolescents, abuse of prescription medications and over-the-counter cough remedies appears to be on the rise.

What are they using?

Another national survey on drug use, the 2004 National Survey on Drug Use and Health (NSDUH) estimates that 980,000 12- to 17-year-olds engaged in nonmedical use of prescription pyschotherapeutic drugs for the first time in 2004. This statistic represents approximately 2,700 new users every day-a number that, because the survey is administered in the home where a parent may be present, is likely to be an underestimation.

Abuse of prescription medications and OTC cough preparations by adolescents is more common than abuse of crack-cocaine, Ecstasy, methamphetamine, LSD, ketamine, heroin, and gamma-hydroxybutyrate; only marijuana and inhalants are abused more frequently by adolescents, according to the 2005 Partnership Attitude Tracking Study, conducted by the non-profit Partnership for a Drug-Free America.

One in three adolescents reports having a close friend who abuses prescription pain relievers to get high, and one in four has a close friend who abuses cough medicine to get high. The active ingredient in many cough medications, dextromethorphan, is a synthetic opioid, the dextro-isomer of the codeine analogue levorphanol. Whereas the recommended dosage for cough suppression affects the cough center in the brain to the same degree as codeine, higher doses have dissociative effects. Dextromethorphan ingested in large quantities is converted to dextrophan, a substance that has an effect similar to phencyclidine and ketamine. High doses can be achieved by consuming four to eight ounces of cough medication, or pills, which contain twice the amount of dextromethorphan as the liquid preparations.

Results of a forthcoming study to be published in the Archives of Pediatrics and Adolescent Medicine demonstrate that dextromethorphan abuse is most common among 15- to 17-year-olds. The rate of calls related to dextromethorphan use to the California Poison Control System among all calls from 9- to 17-year-olds increased from 0.11/1,000 calls in 1999 to 1.71/1,000 calls in 2004. The mean age of the subject of the calls fell from 21.5 years to 16.6 years over the same period. The rise of dextromethorphan-related calls among adolescents in California parallels trends seen in national poison control call systems.

Why the rise in abuse of prescription drugs?

There is much we need to learn about this relatively new phenomenon of adolescents' abuse of OTC and prescription drugs before we can understand its rise, but several explanations seem plausible.