Adolescent abuse of prescription, OTC drugs remains an issue

Prescription and over-the-counter medications were the second most abused drugs among high school students, according to survey results published by the National Institute on Drug Abuse.

In the Monitoring the Future 2014 survey, conducted by researchers at the University of Michigan, 6.8% of high school seniors reported nonmedical use of the amphetamine Adderall, 4.8% used Vicodin (acetaminophen and hydrocodone bitartrate, Abbott Laboratories), and 3.3% used OxyContin (oxycodone hydrochloride, Purdue Pharma).

“We know from state statistics that 13% of high school-aged children have abused opioid pain relievers, 6% tranquilizers and 12% amphetamines such as Adderall and Ritalin,” Denise A. Salerno, MD, FAAP, vice president of the Pennsylvania chapter of the AAP, said in a press release. “Every effort to address this abuse, including families disposing of medications no longer in use, helps in our battle against prescription drug abuse and protecting our communities.”

Clean out medicine cabinets

Several medical associations addressed the increasing epidemic and urged families to clean out their medicine cabinets to reduce the risk of adolescents abusing expired and unused medications, according to a press release issued by the Pennsylvania Medical Society.

Karen Rizzo, MD

Karen A. Rizzo

“It’s a situation that I think is more common than we realize, where family members have prescription medications in the medicine cabinet that may be old or utilized for a problem that is no longer current and yet they forget to discard the medication,” Karen A. Rizzo, MD, president of the Pennsylvania Medical Society, told Infectious Diseases in Children. “That can be a major area of concern, especially when you have adolescents in the household.”

Spring is a good time to clean out the cabinets, Rizzo noted, as it satisfies the need to reorganize a medicine cabinet and also provides an annual check of expired or leftover medication.

“At this time of the year, everyone thinks about spring cleaning so this is an opportunity [for pediatricians] to remind families about looking in their medicine cabinets,” she said. “But, it’s not just for the springtime. This is an issue that I think should be discussed with families throughout the year.”

Although many families want to prepare for imminent illnesses by stocking up medications, Salerno told Infectious Diseases in Children this could be harmful to adolescents.

“Making sure that we are only buying medications as needed and not keeping an abundance of them around would decrease the risk of children and adolescents getting into medications and overdosing or experiencing adverse effects,” she said.

Warning signs of abuse

General warning signs of adolescents abusing OTC or prescription drugs that pediatricians can share with parents include changes in mood, increased irritability and a lack of interest, according to Rizzo.

“Usually what we look for would be sudden changes in behavior, Michael A. Bohrn, MD, FACEP, president of the Pennsylvania College of Emergency Physicians, said in an interview. “For example, how children take care of themselves, changes in sleep patterns, drastic changes in mood where they may go from very angry and agitated to an almost depressed state, and not following through — not completing homework, being involved in school or participating in activities that they did previously.”

Michael Bohrn, MD, FACEP

Michael A. Bohrn

Conversely, behavioral changes might not be easy to ascertain.

“Adolescence is a developmental period in time where at that age they are really becoming more independent and tend to spend less time with their family and more time with their friends and people at school,” Salerno said. “Behavioral changes often can be something that goes undetected for quite some time until they experience an overdose or some significant side effects that cause them to wind up in an emergency room.”

Provider advice

Since common OTC medications — such as cough and cold remedies — can be misconstrued as innocuous, Bohrn stresses that it is vital for pediatricians to discuss the harms with patients and parents during routine examinations.

According to the Commonwealth of Pennsylvania Department of Drug and Alcohol Programs (DDAP), a 2011 survey found that 14% of youths claimed to have taken prescription drugs that did not belong to them. Among them, 18% felt the drugs were harmless.

“It’s definitely something pediatricians should address. The key is to start early, especially as children get closer to the adolescent age group where this really begins to be a problem,” Bohrn said.

Leaders of medical organizations in Pennsylvania recommend pediatricians advise parents to engage in an open communication with their children.

“One of the key things is to be aware of the changes that are going on in their child’s life and continue to be a part of their life by spending family time and eating meals together,” Salerno said.

While some adolescents may feel uncomfortable discussing drug abuse with their parents, a one-on-one conversation between the pediatrician and patient can be beneficial, according to Salerno.

“It’s tough. There’s so much to cover in an adolescent visit that it might often get overlooked or not addressed, but I think that’s part of what we’re trained as pediatricians to do … to get an overall assessment of the patient,” she said.

Turn in prescription drugs

The Pennsylvania Health News Service Project, an organization that consists of 20 medical associations, requests that families take unused medications to prescription drug take-back locations, according to a press release. Sites in Pennsylvania are sponsored by the DDAP and a list of locations is available on the organization’s website.

Take-back sites accept tablets, capsules, inhalers, creams, ointments, nasal sprays and liquid medications. Intravenous solutions, injectables or needles are not returnable.

Take-back programs also are available in other states, including Arkansas, Colorado, Idaho, North Dakota, Rhode Island and Tennessee. To find a take-back site, contact a local county’s trash and recycling service or a local pharmacist, according to the FDA. Information is also available on the U.S. Drug Enforcement Administration’s website. 

For more information:

Michael A. Bohrn, MD, FACEP, can be reached at WellSpan York Hospital, Department of Emergency Medicine, 1001 S. George St., York, PA 17405; email: mbohrn@wellspan.org.

Karen A. Rizzo, MD, can be reached at P.O. Box 8820, Harrisburg, PA 17105-8820; email: stat@pamedsoc.org.

Denise A. Salerno, MD, FAAP, can be reached at Temple University Hospital, 3509 N. Broad St., Philadelphia, PA 19140; email: DeniseSalerno@tuhs.temple.edu.

Disclosure: The researchers report no relevant financial disclosures.