Join Together: You have done quite a bit of research on drug use among 12 to 17 year olds. Why do you believe it is important to focus on that age group when it comes to Rx abuse?
Carol: Substance use disproportionately starts between the ages of 12 to 25. When we look at National Survey on Drug Use and Health (NSDUH) data, about 75 percent of the new users of prescription pain killers are under the age of 25 and about 38 percent are under the age of 18. Adolescents are prescribed controlled medications and yet, are not taught about the risk associated with their use – including the risks associated with diversion. Thus, the highest risk groups for nonmedical use of controlled medications are young adults, followed by adolescents.
Join Together: Why has Rx drug use has become such a major part of teens´ repertoire?
Carol: It is not entirely clear why prescription medication misuse and abuse has increased, while other forms of drug use have decreased. However, several issues appear to be interacting to create this problem. These include: increased availability due to increases in prescribing controlled medications to adolescents; perceptions that prescription drugs generally are safer than street drugs; changing attitudes toward the use of medications because of direct-to-consumer marketing (DTC) and the Internet, where adolescents can quickly learn about medications and how to use them to self-treat and get high.
Join Together: Can you tell us a little bit about diversion of prescription drugs among adolescents – who is most likely to divert medications and what their likely motive is for diversion?
Carol: National and regional data show that most nonmedical users get their pills from peers and/or parents and siblings. Our data show that although most adolescents use their medications correctly, some adolescents divert their own medications to friends and family members and if they divert, they are also more likely to use marijuana and other drugs. Approximately 10 percent of adolescents have diverted pain medications and 15 percent stimulant medications. Like other researchers, we found that girls, when compared to boys, reported higher lifetime rates for giving or loaning medications (27.5 percent vs. 17.4 percent) and they were significantly more likely to divert to their girlfriends (64.0 percent vs. 21.2 percent). In contrast, boys were more likely to divert their controlled medications to their male friends (45.5 percent vs. 25.6 percent. Approximately 10 percent divert their pills to their parents. Overall, 13 percent of adolescents in our most current studies divert their controlled medicines and approximately 16 percent of adolescents with legal prescriptions are asked to divert, it is usually stimulants that are requested.
Join Together: The research that you presented at the recent Surgeon General’s meeting touched on the role of parental monitoring in preventing drug use. How important do you think parental monitoring is and is it equally effective when it comes to Rx abuse as it is with other drugs?
Carol: I believe that parental monitoring is the “key” to reducing the nonmedical use of prescription medications in ages 12 to 17 years. Our data show that general parental supervision is associated with lower rates of marijuana, alcohol and tobacco use; however this is not true for the nonmedical use of prescription medication. We speculate reasons for this: (1) parents are unaware of the potential problem and do not supervise the storage of controlled medications (and thus, they are available to household members) and (2) parents engage in nonmedical use and do not consider it a problem.
Join Together: You have said that you believe that preventing Rx abuse is much more complicated than preventing use of street drugs. Can you explain why you feel that way?
Carol: This question is difficult to answer because of a lack of prospective data. It is well established that illicit drug use moves in social and behavioral patterns, with individual drugs gaining and losing popularity among adolescents. However, this ebb and flow is not true for alcohol, which remains a very popular substance.
Because prescription medications share social characteristics with alcohol (e.g. legal for certain groups, relatively safe in small doses, etc.), nonmedical use may be more similar to alcohol misuse/abuse. Our society promotes the legal use of both alcohol and controlled medications; we are one of a very few countries that allow the television marketing of controlled medications.
Like the abuse of alcohol, the nonmedical use of controlled medications is increasing in several age groups, including those over 50 years of age. This nonmedical phenomenon — among all age groups — is most likely a product of our social mores as well as attitudes about our bodies, medications and self-treatment. Historically young adults and adolescents (illegally) use many different substances (including controlled medications) at higher rates than their older counterparts; fortunately, most curtail these behaviors as they advance to middle adulthood. There are some young substance users who do not stop; it is for this reason that drug prevention and early intervention is so very important.
Join Together: What kind of different tactics do you think we need to employ to prevent abuse of Rx drugs?
Carol: Marketers know that before you send a message, one must know who is intended to receive the message – this goes for drug prevention messages as well. Prevention content must be age, gender and culturally appropriate. In general, adolescent girls are less likely to be risk takers and more likely to endorse high levels of social connection when compared to boys. For this reason, I suggest that prevention experts take advantage of girls’ desire to help friends and craft gender specific messages that highlight the harm that comes from sharing medications – even when the goal is to help a friend.
If all it took was symbols on bottles or lecturing adolescents, the problems of nonmedical use and diversion could be solved. However, educating adolescents about the dangers of these medications is unlikely to be effective because they see too many of their friends with prescription medications. The solution to this problem lies in the recognition that it is far more complex than street drug use and involves all aspects of our society – our pharmaceutical companies, our health care providers, our families, our young people and equally as important, our policy makers.
Carol J Boyd, PhD, MSN, FAAN, is Research Professor at the University of Michigan Substance Abuse Research Center in Ann Arbor. She is also Director of the Institute for Research on Women and Gender.