Children who are open to experimenting with herbal products may be more open to trying illicit drugs

Adolescents who have ever used herbal products are six times more likely to have tried cocaine and almost 15 times more likely to have used anabolic steroids than teens who have never used herbal products, according to a University of Rochester Medical Center study to be published March 23 in the Journal of Adolescent Health.

More than a quarter of the Monroe County high school students in the sample reported having ever used herbal remedies and of those, the heaviest herbal users were more likely to use illicit drugs. Teen responders decided for themselves what would be considered "herbal or other natural products, either to make you feel better, or to help you perform better at sports or school," as asked in the survey. Herbal remedies could include products from dietary supplements such as vitamins or St. John's wort to natural performance enhancers, such as creatine.

"The study points to the need for parents and health care providers to ask if teens are using herbal remedies and from there probe deeper for possible drug use," said study author, Susan Yussman, M.D., M.P.H., assistant professor of pediatrics in the Division of Adolescent Medicine at the university's Golisano Children's Hospital at Strong. "Children who are open to experimenting with herbal products may be more open to trying illicit drugs."

However, Yussman cautioned against directly linking herbal product use with drug use: "This was a cross-sectional study that examines an association, not a causal link. Health care providers should ask all adolescents about potential substance use, regardless of herbal product use." Yussman added that counseling should be provided to those teens found to have a substance abuse problem and to all patients regarding proper use of any type of medication, including herbal products. For more information on the safety and effectiveness of herbal products, please visit http://nccam.nih.gov/health/supplements.htm.

The study found that teens who have ever used herbal products are:

• 4.4 times more likely to have ever used inhalants
• 4.4 times more likely to have ever used LSD, PCP, ecstasy, mushrooms, and other illegal drugs
• 5.9 times more likely to have ever used cocaine
• 6.8 times more likely to have ever used methamphetamines
• 8.1 times more likely to have ever used IV drugs
• 8.8 times more likely to have ever used heroin
• 14.5 times more likely to have ever used steroids

than teens who have never used herbal products.

"Those numbers could go higher with a survey that includes students who don't attend school regularly or who have dropped out. Those teens are considered at higher risk for drug use," Yussman said.

The study was based on the 1999 Monroe County, N.Y., Youth Risk Behavior Survey which provided data on a random sample of 2,006 high school students. Herbal product use was defined by lifetime use of "herbal or other natural products--to feel better, or perform better in sports or school."

Overall, 28.6 percent of teens reported using herbal products. Herbal product use increased with age (25 percent of 9th graders to 30 percent of 12th graders) and varied by ethnicity (33 percent of Hispanics, 31 percent of Caucasians, 29 percent of Asians, Native Americans, or Pacific Islanders, and 12 percent of African Americans), but not by gender.

Yussman said further studies are needed to determine which herbal products may be associated with use of which specific drugs.

"A teen using a sports-enhancing product probably has a very different substance use pattern than a teen taking echinacea for a cold," she said.