Teenage-Proof Your Medicine Cabinet: Nonmedical Prescription Drug Use by Youth

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1 ][ Strengthening our community through increased awareness and accountability ][ Vol.3 Issue 1 March 2011 Inside the Report What does past research say? Question 1: How many Erie County youth are using prescription drugs? Question 2: How does the use of prescription drugs by Erie County youth compare to other drug use in the county? Question 3: Are youth who are using prescription drugs using from one, two, or all three categories? Questions 4 & 5: How does prescription drug use differ depending on gender and grade level? How does local use compare to state use? Warning Signs and Symptoms of Prescription Drug Use The purpose of the Mercyhurst Civic Institute Enhance and facilitate citizen participation in decision-making. Provide high-quality, objective information to assist local decision-making. Convene community forums that encourage reasoned reflection and free and open discussion of regional issues. Educate the Erie community and Commonwealth of Pennsylvania about various issues through Institute reports and publications. Foster human networks that enhance communication, link resources, strengthen community participation and build social capital. Promote research, learning, teaching and service opportunities for the Mercyhurst community. Teenage-Proof Your Medicine Cabinet: Nonmedical Prescription Drug Use by Youth By: Kristen Burillo, Senior Research Analyst While prescription drugs have many benefits when used as directed by a health care provider, they can be as dangerous as other drugs when not used as prescribed. Many individuals, however, do not recognize the dangers of misusing prescription drugs; this could be partially due to associating their original distribution with a medical professional and partially because the majority of their exposure to the drugs is connected to a helpful and healthy outcome. This seems to be especially true for youth. While families can have a strong influence on all types of adolescent substance use, parents are in a particularly unique position to intervene in terms of prescription drugs because many adolescents obtain the prescription drugs from their own homes. This report will highlight some of the findings from past research on prescription drug misuse by youth and then will introduce local data from the Pennsylvania Youth Survey. While reviewing this report, please keep in mind the information from the following notes section. Notes There are some differences in how prescription drug use was defined between varying sources. For example, the slight differences in wording such as asking about use without a doctor s orders versus use for a nonmedical reason may result in different interpretations of the question. Not all studies or surveys necessarily defined abuse or use in the same way. Not all studies asked about the motivation for the prescription drug use. It is possible to argue that borrowing prescription drugs from a friend in order to get high should be separated from borrowing prescription drugs for reasons such as self-medication (i.e. headache). Because respondents may not know that a particular drug fits into a certain category, the data obtained may have been limited by only listing certain examples of prescription drugs or not listing any examples at all. Some studies asked about specific types of prescription drugs, and the categories were not consistent across all studies cited in this article. The definition of a prescription drug was therefore broader or narrower depending on the source. Throughout the text of this article, any prescription drug use refers to the respondent having endorsed at least one of the three types of prescription drug categories included in the Pennsylvania Youth Survey. There were no separate questions about any prescription drug use.

2 What Does Past Research Say? National Prevalence In recent years, youth using prescription medications for nonmedical reasons has become a growing concern. The reported rates of prescription medication abuse range from about 3% to as high as 20%. According to results from the 2009 National Survey on Drug Use and Health, the rate of nonmedical use of prescription drugs for 12 to 17 year olds was 3.1% in 2009, which was slightly higher than the 2008 rate but lower than the 2002 rate 1. Data from the 2008 Partnership Attitude Tracking Study indicated that one in five teens (4.7 million) report abusing a prescription medication at least once in their lives, and one in ten teens (2.5 million) report abusing a prescription pain reliever in the past year 2. Teens are more likely to abuse prescription drugs as compared to any illicit drug besides marijuana 1. Prescription drugs were the most commonly used drug for 12 and 13 year olds 1. For all users over 12 years old, pain relievers are the most abused category of prescription drugs followed by stimulants and sedatives 1. According to a 2009 study, allergy drugs, narcotic pain relievers, antibiotics, acne medications, antidepressants, and anti-anxiety medications were the most commonly shared types of prescription medications 3. The prevalence of tranquilizer use is at recent peak levels with annual rates ranging from 2.8% in 8th grade to 5.6% in 12th grade 4. OxyContin use has increased in all grades between 2002 and 2010, with 2010 prevalence at 2.1% in 8th grade, 4.6% in 10th grade, and 5.1% in 12th grade 4. Vicodin use has remained fairly steady at somewhat higher levels since 2002, but use among 12th graders declined significantly in Annual prevalence rates are now 2.7% for 8th grade, 7.7% for 10th grade, and 8.0% for 12th grade 4. About 25% of teens know at least one friend or classmate who abuses prescription drugs, an increase from 2007 data 5. Females, as compared to males, had higher rates of nonmedical use of psychotherapeutic drugs (3.5% for females and 2.8% for males) and pain relievers (2.9% for females and 2.4% for males) 1. Availability and Accessibility Prescription medications are widely available to youth, and they are often obtained from family members or friends at no cost. Prescription medications have become more readily available to youth for nonmedical uses as the number of prescriptions for them have increased. The number of psychotropic prescriptions to adolescents increased from 1994 to 2001 (the year of the study), and particularly after In , 8.3% of office visits resulted in a psychotropic prescription as opposed to only 3.4% in Nonmedical stimulant use is associated with the number of prescription users in the students classroom or grade level, suggesting that use is higher when the substance is readily available. A 2001 study involving students in grades 7, 9, 10, and 12 in Nova Scotia, Newfoundland, and other areas found that of students with medical stimulant use in the year prior to the survey, almost 15% reported giving away medication, over 7% reported selling their medication, just over 4% had medication stolen, and 3% had been forced to give up some of their medication 7. In 2009, 16% of teens reported that prescription drugs were the easiest drug to buy (compared to cigarettes, marijuana, or beer); in 2010, 13% of teens reported that prescription drugs were easiest to get 5. In 2008, 61% of teens reported that prescription drugs are easier to get than illegal drugs 2. Over half of people age 12 or older who used prescription drugs nonmedically in the past twelve months got the medication from a friend or relative for free. Among those using pain relievers, another nearly 10% purchased them from a friend or relative, and 5% took them from a friend or relative without asking. Just over 5% got the pain relievers from a stranger or drug dealer, or through the internet 1. Another recent study concluded that about 20% of 12- to 17-year-olds reported either giving away their prescription drugs or obtaining prescription drugs from friends 3. Reasons for Use Not only do students turn to prescription drugs because they are accessible and often free, but they also utilize them for reasons such as focusing on schoolwork, partying and getting high, and relieving pain. College students reported using stimulant medication illicitly in order to increase alertness and energy in attempts to help manage their time. Twenty-seven percent of the students reported taking the drugs during finals week, 15% before tests, and 12% when they partied 8. Another study indicated that college students most common reasons for illicit use of prescription stimulants were to help with concentration, to increase alertness, and to provide a high 9.

3 A sample of 7th through 12th graders indicated that reasons for using prescription drugs included to improve sleep, to help with concentration or alertness, to get high, to relieve pain, or to decrease anxiety, with the motivation varying depending on the type of drug 10. A study on prescription opioid use by college students found that the three most common reasons for use were to relieve pain, to get high, and to experiment 11. Some youth may utilize prescription drugs because the effects are harder to detect and there are no smells or lingering effects as with other drugs 12. Prescription drugs have been utilized at pharming or bowling parties in which many types of pills are put into a container and a handful of pills are taken without knowing what is in the mixture or how it will affect the body 12. Misperceptions Additional reasons why youth utilize prescription drugs nonmedically relate to the misperceptions they have about their use namely, that prescription drugs are safe, especially compared to other drugs. They also tend to view prescription drugs as legal, and thus associate less of a stigma with their use. Forty-one percent of teens believe the abuse of prescription drugs would be less dangerous than the abuse of other drugs 2. Over half of teens report that they use prescription painkillers because the medications are not illegal. Over 30% believe that using prescription drugs is less shameful than using illicit drugs. About 20% reported that parents would show less concern if they caught their child using prescription drugs 13. Approximately one-third of teens believe that there is nothing wrong with using prescription medications without a prescription once in a while, that prescription drugs have fewer side effects than other drugs, and that prescription painkillers are not addictive 14. Parents Youth whose parents express strong disapproval of drug use are less likely to engage in substance use 14. Many parents, however, do not recognize the dangers of prescription drugs, which may contribute to why they do not often talk to their children about them. Parents could be a powerful influence in preventing abuse of prescription drugs because the medications are often found in the home. Over one-quarter of parents feel that prescription drugs are safer to abuse than street drugs 14. Only 24% of teens reported that their parents talked with them about the dangers of prescription drugs or use of medications outside of a doctor s supervision 2. Parents are much less likely to talk to their children about the dangers of prescription drug abuse than they are to talk to them about marijuana, heroin, or cocaine 14. Other Students who use prescription pain medication for nonmedical reasons were more likely to use other substances compared to students who do not use prescription drugs in this way. More specifically, they were five times more likely to drink alcohol and smoke marijuana, almost four times more likely to binge drink, and eight times more likely to have used other illicit drugs 15. Among people age 12 and older, the following were found to be risk factors for problem use of prescription drugs: female gender, older age, poor/fair health status, and daily drinking 16. Teens with weak family ties (poor parent-child bond; see source for full definition) are twice as likely to know a friend or classmate who abuses prescription drugs 5. Reasons for Nonmedical Use of Prescription Drugs Easily accessible (and often free) Viewed as safe Think parents are more accepting Easy to hide effects To increase alertness/energy To help focus on schoolwork To get high To relieve pain

4 The local information comes from the 2009 administration of the Pennsylvania Youth Survey (PAYS). The PAYS is a self-report measure administered every other year to 6th, 8th, 10th, and 12th grade students in Pennsylvania s public schools. The questions focus on attitudes and behaviors regarding alcohol, tobacco, and other drug use as well as antisocial behaviors and other special topics. The survey also examines a number of risk and protective factors that increase or decrease the likelihood that an individual would engage in problem behaviors. The questions regarding prescription drug use were new to the PAYS survey in Question 1: How many Erie County youth are using prescription drugs? Figure 1 illustrates how students responded to the following questions from the PAYS survey in 2009: On how many occasions (if any) have you: Used prescription pain relievers, such as Vicodin, OxyContin, or Tylox, without a doctor s orders, during the past-30-days? Used prescription pain relievers, such as Vicodin, OxyContin, or Tylox, without a doctor s orders, in your lifetime? Used prescription tranquilizers, such as Xanax, Valium, or Ambien, without a doctor s orders, during the past-30-days? Used prescription tranquilizers, such as Xanax, Valium, or Ambien, without a doctor s orders, in your lifetime? Used prescription stimulants, such as Ritalin or Adderall, without a doctor s orders, during the past-30-days? Used prescription stimulants, such as Ritalin or Adderall, without a doctor s orders, in your lifetime? Figure 1. Percentage of Erie County Students Reporting Past-30-Day and Lifetime Prescription Drug Use by Category and Frequency of Use Pain Relievers (n=4876) 30 Day Lifetime Tranquilizers (n=4874) Stimulants (n=4861) Pain Relievers (n=4827) Tranquilizers (n=4823) Stimulants (n=4820) 0 times 94.5% 98.2% 96.7% 92.1% 97.3% 94.9% 1 to 2 times 3.0% 0.9% 1.6% 2.5% 0.7% 1.5% 3 to 5 times 1.1% 0.4% 0.8% 1.6% 0.7% 0.9% 6 to 9 times 0.6% 0.2% 0.3% 1.1% 0.4% 0.7% 10 to 19 times 0.4% 0.2% 0.2% 0.6% 0.2% 0.7% 20 to 39 times 0.2% 0.1% 0.1% 0.9% 0.3% 0.5% 40 or more times 0.2% 0.1% 0.1% 1.1% 0.4% 0.9% The data indicates that most students are not using prescription pain relievers, tranquilizers, or stimulants without a doctor s orders. There are, however, between approximately 2% and 6% of students who have used at least one of these types of prescription drugs without a doctor s orders in the past-30-days as well as between approximately 3% and 11% of students who have used at least one of these types of prescription drugs without a doctor s orders in their lifetime. Pain relievers are the most common category of prescription drugs used by the respondents for both past-30-day and lifetime use. Figure 2 shows the number, rather than the percentage, of respondents who have used each of the categories of prescription drugs at least one time in the past-30-days and in their lifetime. While it is useful to know the breakdown of prescription drug use by type, it is also useful to know the prevalence of overall use. Figure 3 illustrates past-30-day and lifetime use of at least one of the types of prescription drugs on at least one occasion. Just over 93% of respondents indicated no prescription drug use without doctor s orders in the past-30-days, while almost 7% had used at least one type of prescription drug at least one time. In terms of lifetime use, just over 90% of respondents reported no history of prescription drug use without a doctor s orders, while just fewer than 10% reported using prescription drugs without doctor s orders at least one time in the past.

5 Figure 2. Number of Erie County Students Reporting Past-30-Day and Lifetime Prescription Drug Use by Category 30 Day Lifetime Rx Pain Reliever Rx Tranquilizer Rx Stimulant Any Rx Drug Figure 3. Percentage and Number of Erie County Students Reporting Past-30-Day and Lifetime Prescription Drug Use None 93.1% (n=4527) At least one, at least once 30 Day Lifetime 6.9% (n=337) 90.4% (n=4353) 9.6% (n=460) Question 2: How does the use of prescription drugs by Erie County youth compare to other drug use in the county? The occurrence of past-30-day and lifetime usage of various types of drugs is summarized in Figure 4 and shown as a bar graph in Figure 5. For past-30-day use, alcohol is by far the most commonly used substance, followed by cigarettes, marijuana, inhalants, and smokeless tobacco. Any prescription drug use, as well as each of the three individual categories of prescription drugs, ranked next, meaning that more youth used prescription drugs in the past-30-days than used any of the remaining illicit drugs (hallucinogens, ecstasy, steroids, cocaine, methamphetamines, heroin, or crack). The same pattern occurred for lifetime use with the exception of hallucinogens being slightly more commonly used than prescription tranquilizers; any prescription drug use remained more common than hallucinogen use, however. Figure 4. Drug Use by Type, Erie County 30 Day Lifetime Alcohol 21.8% 46.1% Cigarettes 10.2% 26.3% Marijuana 9.8% 17.3% Inhalants 7.2% 12.8% Any Rx Drug 6.9% 9.6% Smokeless Tobacco 6.8% 12.6% Rx Pain Reliever 5.5% 7.9% Rx Stimulant 3.3% 5.1% Rx Tranquilizer 1.8% 2.7% Hallucinogens 1.7% 2.9% Ecstasy 1.0% 1.9% Cocaine 0.8% 1.9% Steroids 0.8% 0.9% Methamphetamine 0.5% 0.5% Crack 0.3% 0.7% Heroin 0.3% 0.7% Figure 5. Drug Use by Type, Erie County

6 Question 3: Are youth who are using prescription drugs using from one, two, or all three categories? The majority of youth who are using prescription drugs in the past-30-days (Figure 6) and in their lifetime (Figure 7) have reported that they are only using pain relievers. Pain relievers are also commonly used with the other types of prescription drugs, with over 75% of respondents using prescription pain relievers either solely or in combination with other prescription drugs in the past-30-days. It is very rare (only four respondents for 30 day use and one respondent for lifetime use) for youth to use only prescription tranquilizers. If prescription tranquilizers are being used, they are typically used in conjunction with prescription pain relievers or both prescription pain relievers and prescription stimulants. About 14 percent of respondents have used all three types of prescription drugs in the past-30-days, and about 22% of respondents have used all three types of prescription drugs in their lifetime. Figure 6. Past-30-Day Prescription Drug Use by Category Figure 7. Lifetime Prescription Drug Use by Category 40.1% 41.4% 15.7% 7.7% 17.4% 7.4% 13.9% 21.6% 1.5% 0.9% 16.3% 1.2% 16.7% 0.2% Questions 4 & 5: How does prescription drug use differ depending on gender and grade level? How does local use compare to state use? Figure 8 once again shows the overall past-30-day use of each category of prescription drug in Erie County, but it also shows the breakdown for use by gender and grade within each category. Also shown are how the local percentages compare to state percentages, which are shown in parentheses. The state information also comes from the 2009 administration of the Pennsylvania Youth Survey. Total use Overall, youth in Erie County reported higher past-30-day use of prescription pain relievers and stimulants when compared to the amount of use reported across the state; local levels of prescription tranquilizer use in the past-30-days were similar to state levels.

7 Gender Locally, slightly more females than males used prescription pain relievers and stimulants in the past-30-days; there were no gender differences for prescription tranquilizer use. In contrast, males rather than females were more frequent users of prescription stimulants across the state. In a similar pattern to the total numbers, local past-30-day prescription pain reliever use for both males and females was higher than the state numbers. Local past-30-day prescription tranquilizer use was once again similar to state numbers, though local female use was slightly less than state female use. The largest difference between local and state numbers was for stimulant use by females, for which local use was one percentage point higher than state use. Grade In Erie County, a substantially lower percentage of sixth graders used each of the categories of prescription drugs in the past-30-days as compared to students in higher grade levels. Tenth graders were most likely to use each category of prescription drugs in the past-30-days, with as many as 9.6% of tenth graders using prescription pain relievers. The largest increase in prescription drug use in each category was between eighth and tenth grade. Local past-30-day use was higher than state use for each type of prescription drug in sixth, eighth, and tenth grade. For twelfth graders, local past-30-day prescription drug use was the same as the state rate for pain relievers, lower than the state rate for tranquilizers, and higher than the state rate for stimulants. The largest difference between local and state numbers was for stimulant use by 10th graders, with local use at 7.8% and state use at 3.2%. Figure 8. Erie County (Pennsylvania State) Past-30-Day Prescription Drug Use by Gender and Grade Pain Relievers Tranquilizers Stimulants Total 5.5% (5.0%) 1.8% (1.9%) 3.3% (2.8%) Gender Grade Male 5.2% (4.8%) 1.8% (1.8%) 3.2% (3.1%) Female 5.8% (5.3%) 1.8% (2.0%) 3.5% (2.5%) 6th 1.6% (1.0%) 0.5% (0.2%) 0.3% (0.2%) 8th 4.9% (3.6%) 1.1% (0.8%) 1.7% (1.2%) 10th 9.6% (6.1%) 4.0% (2.1%) 7.8% (3.2%) 12th 8.7% (8.7%) 3.2% (4.2%) 6.9% (6.0%) Figure 9. Erie County (Pennsylvania State) Lifetime Prescription Drug Use by Gender and Grade Pain Relievers Tranquilizers Stimulants Total 7.9% (7.4%) 2.7% (3.2%) 5.1% (4.2%) Gender Grade Male 7.4% (6.9%) 2.8% (3.1%) 5.2% (4.5%) Female 8.4% (7.9%) 2.6% (3.4%) 5.0% (4.0%) 6th 1.7% (1.6%) 0.3% (0.2%) 0.6% (0.4%) 8th 5.6% (3.7%) 1.1% (0.7%) 2.0% (1.5%) 10th 13.4% (8.3%) 5.3% (3.0%) 9.9% (4.3%) 12th 16.1% (14.8%) 7.1% (8.4%) 13.3% (10.1%) Figure 9 is similar to figure 8 but shows the data for lifetime use. Total use Overall, youth in Erie County reported higher lifetime use of prescription pain relievers and stimulants when compared to the amount of use reported across the state; local levels of lifetime prescription tranquilizer use were lower than state levels. Gender Locally, more females than males used pain relievers in their lifetime, while slightly more males than females used prescription tranquilizers and stimulants in their lifetime. In contrast, females rather than males were more frequent users of prescription tranquilizers across the state. In a similar pattern to the total numbers, local lifetime prescription pain reliever use and stimulant use for both males and females was higher than the state numbers and local lifetime prescription tranquilizer use was lower than state numbers. The largest difference between local and state numbers was for stimulant use by females, for which local use was one percentage point higher than state use. Grade In Erie County, the percentage of students reporting lifetime use in each of the categories of prescription drugs increased as grade level increased. By twelfth grade, as many as 16.1% of local students reported using prescription pain relievers and 13.3% reported using prescription stimulants in their lifetime. The largest increase in prescription drug use in each category was between eighth and tenth grade. Local lifetime use was only slightly higher than state use for each type of prescription drug in sixth grade, but became increasingly higher than state use in eighth and tenth grade. For twelfth graders, local lifetime prescription drug use was higher than the state rate for pain relievers and stimulants but lower than the state rate for tranquilizers. The largest difference between local and state numbers was for stimulant use by 10th graders, with local use at 9.9% and state use at 4.3%.

8 Warning Signs and Symptoms of Prescription Drug Abuse 16 Physical Signs and Symptoms Pain Relievers Constricted pupils Nausea or vomiting Dry or itchy skin Constant flu-like symptoms Slow, slurred speech Stimulants Increased alertness and energy Loss of appetite or weight loss Shaking or sweating Dilated pupils Paranoia or nervousness Increased heart rate and breathing Behavioral Signs Sudden mood changes including irritability Extreme changes in social behavior Forgetfulness or clumsiness Lying or avoiding eye contact Losing interest in personal appearance Losing interest in extracurricular activities Sudden changes in appetite Decline in school performance Borrowing money or having extra cash Sedatives Slurred speech Lack of coordination Slowed reflexes Slowed breathing REFERENCES 1. U.S. Department of Health and Human Services. (2010). Results from the 2009 national survey on drug use and health: volume I. summary of national findings. Retrieved January 18, 2011, from samhsa.gov/nsduh/2k9nsduh/2k9resultsp.pdf. 2. Partnership Attitude Tracking Study (PATS). (2009). Teens 2008 Report. Partnership for a Drug-Free America. Retrieved January 18, 2011, from 3. Goldsworthy, R. C., & Mayhorn, C. B. (2009). Prescription medication sharing among adolescents: Prevalence, risks, and outcomes. Journal of Adolescent Health, 45, Johnston, L.D., O Malley, P. M., Bachman, J. G., & Schulenberg, J.E. (2011). Monitoring the Future national results on adolescent drug use: Overview of key findings, Ann Arbor: Institute for Social Research, The University of Michigan. 5. National Center on Addiction and Substance Abuse at Columbia University. (2010, August). National survey of American attitudes on substance abuse XV: Teens and parents. Retrieved February 14, 2011, from 6. Thomas, C.P., Conrad, P., Casler, R., & Goodman, E. (2006). Trends in the use of psychotropic medications among adolescents. Psychiatric Services, 57, Poulin, C. (2001). Medical and nonmedical stimulant use among adolescents: from sanctioned to unsanctioned use. Canadian Medical Association Journal, 165, Hall, K.A., Irwin, M.M., Bowman, K.A., Frankenberger, W., & Jewett, D.C. (2005). Illicit use of prescribed stimulant medication among college students. Journal of American College Health, 53, Teter, C.J., McCabe, S.E., Cranford, J.A., Boyd, C.J., & Guthrie, S.K. (2005). Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. Journal of American College Health, 53, Boyd, C.J., McCabe, S.E., Cranford, J.A., & Young, A. (2006). Adolescents motivations to abuse prescription medications. Pediatrics, 118(6), McCabe, S.E., Cranford, J.A., Boyd, C.J., & Teter, C.J. (2007). Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addictive Behaviors, 32, National Council on Patient Information and Education. (2009). A troubling trend: why teens turn to prescription drugs. Retrieved January 18, 2011, from TAP2009_TroublingTrends.pdf 13. National Center for Mental Health Promotion and Youth Violence Prevention. (2011). Prescription drug abuse by adolescents. Retrieved January 18, 2011 from publications/prevention-briefs/prescription-drug-abuse-adolescents 14. Office of National Drug Control Policy. (2008). Prescription for danger: a report on the troubling trend of prescription and over-the-counter drug abuse among the nation s teens. Retrieved January 18, 2011, from Boyd, C.J., McCabe, S.E., & Teter, C.J. (2006). Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district. Drug and Alcohol Dependence, 81(1), Simoni-Wastila, L., & Strickler, G. (2004). Risk factors associated with problem use of prescription drugs. American Journal of Public Health, 94, National Council on Patient Information and Education. (2009). Warning signs & symptoms of prescription drug abuse. Retrieved January 18, 2011, from WarningSigns.pdf Contact Us (814) civicinstitute.org 501 East 38th St. Erie, PA ][ Strengthening our community through increased awareness and accountability ][