According to a recent survey, prescription drugs are quickly becoming one of the most commonly misused substances among high school seniors in the United States. The most frequently abused types of prescription drugs are narcotics such as oxycodone (OxyContin) and hydrocodone (Vicodin). In fact, studies show that nearly one in 10 high school seniors have used prescription painkillers to get high. Teen abuse of over-the-counter (OTC) medications is growing as well. About one in 14 high school seniors has admitted to using OTC cough or cold medicines for non-medicinal purposes. These drugs usually contain dextromethorphan, which can cause euphoria and hallucinations when taken in high doses.
Experts cite several reasons for the recent increase in prescription and OTC drug abuse. First, they're easily accessible; many teenagers get them from friends or take them from someone's medicine cabinet. Second, many teens think these drugs are safer than street drugs and think they carry little or no risk. Sharon Levy, MD, MPH, director of the Adolescent Substance Abuse Program (ASAP) at Children's Hospital Boston, is concerned about this perception of safety. "These medicines cause dependence, addiction and even death when misused," she says. "Kids can become addicted just as easily as they can to street drugs."
Primary care providers play an important role in preventing and detecting drug and alcohol use by adolescents. Dr. Levy suggests that clinicians screen teens at each yearly health maintenance visit for high-risk behaviors, including substance abuse, as part of routine care.
She recommends a six-item screening called CRAFFT that was developed at Children's Center for Adolescent Substance Abuse Research to detect high risk drug or alcohol use by adolescents. (See sidebar for CRAFFT definition.) The test is simple: If the teen answers "yes" to two out of six questions, he scores positive, and has about a 50 percent chance of having a substance use disorder, such as abuse or dependence.
Dr. Levy recommends that patients be questioned without the parents present to help assure the teens that their responses will be kept confidential—unless safety is at risk. In that case, the clinician should alert the parents, deciding carefully which information to share. There is almost never a need to provide parents with detailed information about their child's substance abuse, though in some cases a diagnosis may need to be revealed.
Have you ever ridden in a CAR driven by someone (including
yourself) who was "high" or had been using alcohol or drugs?
Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
Do you ever use alcohol/drugs while you are by yourself, ALONE?
Do you ever FORGET things you did while using alcohol or drugs?
Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
Have you gotten into TROUBLE while you were using alcohol or drugs?
Teens with a positive CRAFFT screen need further assessment, which may be addressed in a follow-up appointment if time is limited. The clinician should ask which drugs have been used, the pattern of drug use and whether the teen has experienced associated problems (such as arrests, school suspensions, problems with parents, fights with friends or medical problems). A physical exam to look for signs of acute intoxication or chronic drug use should also be completed. These findings are rare in adolescents, but should be noted if present. Teens who have had serious problems associated with drug use should be referred for treatment.
If a clinician doesn't have the time to elicit a complete picture of the teen's alcohol or drug involvement, Dr. Levy recommends referral to ASAP for further evaluation.
ASAP offers a full spectrum of services to adolescents and their families, including comprehensive diagnostic assessments; drug testing; individual counseling; individualized parent support; group therapy; psychopharmacology; and a program for opioid-addicted adolescents, where patients are treated on an outpatient basis with Suboxone, a sublingual preparation of buprenorphine that helps stabilize their chemical dependency. Because
buprenorphine is a partial agonist for the opioid receptor, patients taking it don't get high, nor do they experience the lows associated with stopping opioid use. They also
experience fewer side effects, such as constipation, than they would with other drugs in this class, such as methadone.
The Suboxone program also offers psychosocial services, including individual
counseling to help patients manage stress and anxiety and recognize triggers that prompt their drug use. A parent support component to the program educates parents about how to avoid "enabling" behavior.
To refer a patient to ASAP, call (617) 355-2727 or visit www.childrenshospital.org/asap.