Editorial:Generation Rx: Adolescent Prescription Drug Abuse

Surveys show that “pharming” - the popular term for abuse of prescription drugs - is a widespread problem. For example, a recent SAMHSA survey reports that during the past year over 2.6 million US inhabitants of 12 years and older have used psychoactive medication nonmedical for the first time [1]. This issue of CURRENT DRUG ABUSE REVIEWS features a review by Dr Barrett and colleagues on operational definitions of prescription drug misuse. Dr Barrett warns us that definitions and conceptualization of prescription drug abuse and misuse are diverse and consensus is essential to integrate and interpret future research results on this important topic. Reasons for prescription drug abuse vary greatly from getting high (i.e. painkillers and inhalants), increasing alertness and concentration, or to control weight by reducing appetite (i.e. stimulant drugs). In contrast to street drugs, access to prescription drugs is much easier. Teens can find them unprotected in their own home or steal them from the medicine cabinet in their friends' homes. Parents often do not keep track of the quantity of pills in their medicine cabinet, nor do they destroy unused medication. In addition, prescription drugs can be bought on the streets and it has been reported that even patients have been selling their own drugs to profit from high street prices [2, 3]. Also, the internet plays an important role in selling controlled substances without the normally required prescription. In order to accomplish the wanted “high”, drugs are often used in a different way than prescribed. Slow release tablets are crushed and then swallowed, snorted or dissolved in water and injected to give an immediate effect that's much more intense than when used as prescribed. The pharmacokinetic and pharmacodynamic properties of a drug change dramatically when used in this unintended way. Active compounds manufactured for slow release enter the bloodstream immediately producing much higher blood drug concentrations than intended. Two classes of prescription drugs that are often abused by adolescents and students are stimulants and painkillers. Anxiolytics, sedatives and inhalants are also abused, but to a lesser extend. According to the 2006 National Survey on Drug Use and Health two percent of US adolescents between 12 and 17 years old (about half a million kids) acknowledged abusing prescription stimulants during the past year [1]. The abuse of prescription stimulants is popular among adolescents and young adults (12-26 years old) and twice as high as among adults aged 26 or older. A recent review concluded that prescription stimulants used for the treatment of ADHD are abused by 5-9% of adolescents and 5-35% of students [4]. Ritalin (methylphenidate) is among the most frequently abused prescription stimulants. Ritalin seems safe because this stimulant drug is prescribed also to children who suffer from Attention Deficit Hyperactivity Disorder (ADHD). However, when used as prescribed it comes in tablet form and the dose is adjusted to the individual patient. Moreover, the use of Ritalin and possible side effects are carefully monitored. In contrast, those who abuse Ritalin often do so by crushing and swallowing or snorting the powder. This produces the wanted “high”, but also increases the risk of heart failure, seizures, high body temperature, aggression and confusion. Consequences of prescription stimulant abuse are serious and well documented. The 2006 National Survey on Drug Use and Health reports that 12 to 17 year olds who abuse prescription stimulants are more than twice more likely to be engaged in delinquent behavior [1]. Also, they are about 3 times more likely to develop a major depression episode when compared to youth that does not abuse prescription stimulants (22.8% versus 8.1%). OxyContin (oxycodone) and Vicodin (hydrocodone) are popular prescription painkillers. Each year, about half a million Americans use OxyContin for the first time for recreational purposes. Tablets are chewed or the powder from crushed tablets is snorted to produce a high similar as experienced after taking heroin. Unfortunately, extensive US media attention - enhanced by the increasing number of overdose related deaths and hospitalizations during the past decade - contributed to the popularity and abuse of OxyContin and other painkillers [5]. In 2006, the total number of abusers of prescription painkillers in the USA was about 33 million, of which about 4 million abused OxyContin [1]. Data from the Partnership Attitude and Tracking Study [6] revealed that approximately 18% of US teenagers (4.3 million) use Vicodin to get high and 10% (2.3 million) use OxyContin. Abuse of painkillers seems part of the current teen culture: about 37% of teens report to have friends who use Vicodin and OxyContin [6].