Senate Subcommittee on Crime and Drugs
Senate Caucus on International Narcotics

United States Senate, March 12, 2008

Chairman Biden, Senator Grassley, members of the Subcommittee and the Caucus, thank you for inviting me to testify about a serious health risk facing America’s families. I’m Steve Pasierb, President of the Partnership for a Drug-Free America.

As the representative a nonprofit organization that unites communications professionals, renowned scientists and parents, I’d like to begin by thanking you for your steadfast leadership on all substance abuse issues including DXM legislation and your support for local groups the Face-It Together Coalition and Partnership for a Drug-Free Iowa. Putting a focus on the public health threat posed by the behavior of intentionally abusing prescription and OTC medicines is of tremendous value to parents, healthcare professionals, the prevention and treatment communities, and ultimately, of course, to our children.

I submit to you that the abuse of prescription and OTC medications – legal substances of benefit if used appropriately – is the single most troubling phenomenon on today’s drug abuse landscape. The Partnership has devoted a significant measure of our research, focus and voice to this issue over the past four years. Yet much more needs to be done.

The 2007 Partnership Annual Tracking Study of over 6500 teens in grades 7 through 12 shows that 19%, or one in five, teens report having tried a prescription drug without having a prescription. About one in ten report having used over-the-counter cough medicine “to get high.” Only alcohol, cigarettes and marijuana are abused by teenagers at higher rates than prescription drugs. Cocaine, Ecstasy and methamphetamine are each roughly half as prevalent as prescription drug abuse.

While it’s true that the prevalence of medicine abuse has not increased over the past three years, it’s troubling to realize that with just one or two exceptions, teen use of virtually all other substances of abuse –alcohol, tobacco, marijuana, methamphetamine – has declined over the same period, and in fact has been in steady decline over the past decade.

Why has this trend proved resistant thus far to our nation’s education and prevention efforts? There are several reasons:

1. These substances are readily available to teens – in their home medicine cabinets and the medicine cabinets of friends — for free. Our data are very much in line with the findings of the National Survey on Drug Use and Health, which shows over 75% of teenage prescription drug abusers saying they got those drugs from immediate friends or family. (Less than 1% of teens – in both the NSDUH and in the Partnership’s research – claim to have ordered their drugs over the internet.)

2. Teens’ perception of the risks of abuse is low. Our PATS research shows that less than half of teens see “great risk” in experimenting with prescription pain relievers such as Vicodin or Oxycontin. Even more alarming, over one quarter of teens believe prescription pain relievers are not addictive. The University of Michigan’s Monitoring the Future survey going back over thirty years demonstrates that teens’ perception of the risk associated with any substance of abuse, along with their perceptions of “social disapproval”, correlates significantly with actual teen abuse of that substance. So low perception of risk, low disapproval, coupled with easy availability, is a recipe for ongoing problems.

3. Research conducted by the Partnership in 2007, with support from Abbott Pharmaceutical, cast new light on the motivations of teens to abuse prescription drugs. Traditionally, abusing illegal drugs and alcohol was thought of as either to “party” escape or, “get a buzz.” But our 2007 research, like the research done among college students by Carol Boyd and Sean McCabe, suggests a wider range of motivations for young people’s abuse of prescription drugs beyond getting high, including an emerging set of “life management” or “regulation” objectives. Teens appear to be abusing these drugs in a utilitarian way, using stimulants to help them cram for a test or lose weight, pain relievers to escape some of the pressure they feel to perform academically and socially, tranquilizers to wind down at the end of a stressful day. Once these substances have been integrated into teens’ regular lives and abused as study or management or relaxation aids, it may become increasingly difficult to persuade teens that these drugs are unnecessary and unsafe when taken without a prescription.

4. Parents – who are typically our most valuable ally in preventing teen drug use – are generally ill equipped to deal with teens’ abuse of prescription drugs. We have the most drug-experienced generation of parents in history, but this behavior was not at the fore when they were teenagers. Parents find it hard to understand the scale and purposefulness with which today’s teens are abusing medications, and it’s not clear to them that the prime source of supply is likely to be their very own medicine cabinet. Further, many parents themselves are misusing prescription drugs. In our study with Abbott, 28% of parents said they had used a prescription drug without having a prescription for it, and 8% of parents said they had given their teenage child a prescription drug that was not prescribed for the teen.

In our other studies, parents tend to underestimate the danger of abusing medicines, some actually expressed relief and saw less social stigma in teens abusing “safe” prescription drugs versus illegal street drugs. When considering the dangers associated with overall drug abuse, parents give medicine abuse less weight and are less likely to include these substances in drug talks with their kids.

5. And finally, the reason we are not seeing declines in teen abuse of medications is that America’s efforts – to date at least – have been inadequate. There has simply not been the public attention or resources devoted to this issue that we have seen for other emerging drug threats. That’s now turning. ONDCP’s National Youth Anti-Drug Media Campaign is to be applauded for its new $14 million campaign (then doubled in scale thanks to the media match), targeting parents and providing them with information on how to safeguard their prescriptions and prevent their teenage children from abusing them. In some quarters of the pharmaceutical and OTC industries, there have been concern, action and support for prevention and education efforts from associations like PhRMA and CHPA – and select companies that have stepped forward and should be commended for their proactive approach. Federal agencies, NIDA in particular and others have been in the vanguard of those taking action.

But reducing abuse of prescription and OTC drugs will require much more across all facets of society. The tragic death of Heath Ledger cast a sudden spotlight on this issue –much as Len Bias’s death in 1987 focused attention on the risks of cocaine abuse, which had been underestimated until that point. We must build on growing understanding, and devote necessary, sustained resources to prevention, education, and treatment – programs addressing the behavior of intentional abuse of these products.

On behalf of the Partnership, Mr. Chairman, let me thank the Subcommittee again for your willingness to take on this important issue.