From potent painkillers to humble cough syrups, the same medicines that help patients misused by teens

Jul 1 2004

The medicine cabinet may seem like a strange place to look for a way to get high. But a growing number of teenagers are doing just that, raiding their parents’ pill bottles or buying prescription drugs illegally through Internet pharmacies and dealers.

From potent painkillers to humble cough syrups, the same medicines that can help patients can also be misused to produce a high feeling. And they can hurt teens or hook them into addiction just as easily as other illicit drugs.

Parents need to wake up to this growing trend, and watch out for signs that their son or daughter might be using medicines to get high, warns a University of Michigan Health System expert who has treated teens for prescription drug abuse problems.

“Prescription drug use is becoming more of a problem among teens, and the trend has been increasing in the last three to four years,” says Maher Karam-Hage, M.D., medical director of the Chelsea Arbor Treatment Center, which U-M operates in conjunction with Chelsea Community Hospital. “These drugs can be highly addictive if they’re used on an ongoing basis, and the person can become physically, psychologically and behaviorally addicted to them.”

Parents might not realize it, but far more teens use prescription or over-the-counter drugs to get high than use “harder” drugs like heroin, cocaine or Ecstasy.

Recent anonymous survey results show that one in every 10 high school seniors had used the painkiller Vicodin in the last year without a doctor’s orders. Roughly the same number had used the stimulant Ritalin in the last year, about 6 percent had used tranquilizers, and 4.5 percent had used the super-potent painkiller OxyContin.

Those figures, which came from the 2003 Monitoring the Future survey of 48,500 students across the country conducted by the U-M Institute for Social Research, hint at how big the problem really is, says Karam-Hage. Other data, from the National Survey on Drug Use and Health, indicate that the sharpest increases in new users of prescription drugs for non-medical purposes have been in 12-to-25 year-olds.

Although alcohol and marijuana still account for most teen substance use, the recent increases in use of inhalants, stimulants, painkillers and tranquilizers mean more kids are putting themselves at risk — possibly thinking that medicines are “safe.”

But it’s never safe to use drugs that a doctor prescribed for someone else, to use prescription drugs in a different way or higher dose than a doctor prescribed, or to obtain a prescription drug without a real medical reason, Karam-Hage says. Not only can drugs interact with other drugs a person is taking, they can also cause serious side effects, become addictive, or kill.

The broad range of medications that teens and young adults are using makes the problem even tougher to spot and treat, Karam-Hage warns. “Boys seem to like more stimulants, like Ritalin and amphetamines, as well as steroids, while girls tend to use ‘hypnotics’ – benzodiazepines like Valium, Xanax, and Ativan,” he explains. “Also commonly abused, among both boys and girls, are drugs we call opioids, which are the famous OxyContin and Vicodin.”

Each of these drugs affects the brain in different ways, but teens use them to try to achieve a high feeling that can range from euphoria or intoxication to super-calm. Their chemical formulas are often related to those of “hard” drugs, which means their effects can be just as bad, says Karam-Hage, who is a clinical assistant professor in the U-M Medical School Department of Psychiatry.

Opioids: OxyContin and Vicodin, as well as their generic cousins oxycodone and hydrocodone, are from the same family of drugs as heroin. Used correctly, they ease the pain of people recovering from surgery or coping with terrible back pain. But crushed and snorted or swallowed, they become powerfully addictive drugs that users need more and more of to get high. Before long, many users live for their next pill and will do anything to get it — just like heroin addicts. And if painkiller abusers are also drinking alcohol or taking allergy medications, they can wind up shutting down their lungs. A recent U.S. General Accounting Office report showed that it was relatively easy to get Vicodin and hydrocodone without a prescription from Internet pharmacies, many of them located overseas.

Stimulants: Ritalin, Dexedrine and other stimulants help children with attention deficit disorder, and people with asthma or narcolepsy. When used correctly, they’re safe and non-addictive. But when abused, especially in large doses or after crushing the pills, these substances can produce a similar high — and cause the same harm — as methamphetamine and other illegal drugs. In addition to becoming addictive, they can make the heart beat erratically, drive body temperatures dangerously high, or even cause lethal seizures. People on antidepressants or decongestants when they take high doses of Ritalin have an especially high risk of heart problems.

Depressants: Barbiturates and tranquilizers/sedatives calm the nerves of millions of people with anxiety disorders and are used for short-term use by people with insomnia problems — but they also attract high-seeking teens, says Karam-Hage. These drugs, which slow down the brain’s activity, together are called central nervous system depressants, and include benzodiazepines (Valium, Klonopin, Xanax, etc.), barbiturates (phenobarbital, Mebaral, Fiorinal, etc.) and sedatives/hypnotics (Halcion, Ambien, ProSom, etc.). They can also become addictive, or slow down the heart and lungs to dangerously low levels. If someone stops taking them suddenly after abusing them, he or she can go into withdrawal, including seizures. Also abusable and unsafe when taken in large doses is diphenhydramine, commonly found in drugstore remedies such as over-the-counter allergy medicines (Benadryl, etc.) and over-the-counter sleep aids (Sominex, Unisom).

Cough medicine/DXM: Nearly all of the drugs listed above require a prescription, but even some over-the-counter medications available at any drugstore can endanger a teen if abused. “Dextromethorphan, which is an active ingredient in most cough remedies and is often called DXM, can be a dangerous thing,” says Karam-Hage. “Because it’s over-the-counter, teenagers or even adults think they can use as much as they want without any problem. But that can be very, very dangerous and can become a major addiction by itself.” Teens can also order DXM in powder form on the Internet, and follow “recipes” from Internet sites to get high with it. And if they abuse it, they can set themselves up for problems with thinking and decision-making, and physical effects too.

So what’s a parent to do?

If someone in your household has a valid reason for taking any of these drugs, make sure that others can’t get them. Know what’s in your medicine cabinet, and how much is left. Keep drugs that can be abused out of the medicine cabinet. For a short-term prescription, or a temporary cough medicine, throw it out if there’s some left after symptoms are gone. If you notice your teen is taking cough medicine when he or she doesn’t have a cough, ask him or her about it.

But teens can get these substances from other sources, Karam-Hage warns. “They trade them among each other, and buy them in the street,” he says. “And another major variable, whose impact I don’t think we account for enough yet, is the Internet.”

Teens are ordering pills from web sites that sell prescription drugs without a prescription, no questions asked — which means parents should monitor their child’s Internet access, credit card use and mail deliveries. Authorities are stepping up efforts to shut down the online sites and illegal pharmacies that offer these drugs, but that’s a difficult, maybe impossible, task.

Other things parents can look for include drops in their children’s grades at school, sudden behavior changes or shifts in the kinds of friends they hang out with. “If there’s a change in their relationship with their parents, or they all of a sudden become isolated or not talkative, or if they choose different friends and groups at school, these are things that can signal a problem,” Karam-Hage says.

If you discover or even suspect that your teen is abusing prescription medications, talk to his or her doctor or seek other professional help. Treatment programs can help, but breaking an addiction or dependence on a prescription drug is often difficult and requires expert guidance.

Even if you don’t suspect your child is using medications to get high, take time to talk about the issue. “The best way to prevent it from happening is to educate your teen and be very clear about the inappropriateness of using other people’s prescriptions, and the importance of understanding how much to use of an over-the-counter medication and what for,” Karam-Hage advises. “You can start creating that dialogue, and start drawing the lines, of what is appropriate and what is not.” And maybe you can keep your child from joining the teens who are following a prescription for danger.

Facts about prescription drug and over-the-counter medicine abuse:

• Use and abuse of medicines to get high is a common and growing practice among teenagers and young adults. Only alcohol and marijuana are more popular. Teens may use painkillers, ADD drugs, tranquilizers, anxiety drugs and even cough syrup to get high.
• Even though prescription drugs and drugstore remedies seem “safe”, they can be addictive or harmful if used incorrectly, taken in high doses, or used by people with no medical reason.
• Never take a prescription drug that wasn’t prescribed to you, and when you have a prescription, follow instructions for use of both prescription and over-the-counter medicines.
• Parents should talk to their teens and pre-teens about the dangers of abusing medicines to get high, keep an eye on teens’ Internet use and mail, keep prescription drugs out of reach, and watch for changes in behavior and grades that can signal many forms of drug abuse.
• If you discover or strongly suspect that your teen is abusing medications, seek help.

For more information, visit these web sites:

National Clearinghouse for Alcohol and Drug Information:
http://www.health.org

Nat’l Inst. on Drug Abuse - Prescription Drugs:
http://www.drugabuse.gov/ResearchReports/Prescription

Prescription drug abuse (National Inst. on Drug Abuse): http://www.drugabuse.gov/Infofax/PainMed.html

Chelsea Arbor Treatment Center (U-M/Chelsea Community Hospital): http://www.chelseaarbor.org