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Adolescents and Prescription Drug Abuse. Rodgers M. Wilson, M.D.,CHCQM Arizona Department of Health Service Division of Behavioral Health Services. Prescription Drugs in Adolescence.

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Adolescents and Prescription Drug Abuse

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Adolescents and Prescription Drug Abuse

Rodgers M. Wilson, M.D.,CHCQM

Arizona Department of Health Service Division of Behavioral Health Services


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Prescription Drugs in Adolescence

  • Adolescence is a developmental period characterized by suboptimal decisions and actions that are associated with an increased incidence of unintentional injuries ,violence, substance abuse, unintended pregnancy, and sexually transmitted diseases.

    ( Ann.N.Y.Acad.Sci.,2008)

  • Research suggests that areas in the brain associated with higher order functions such as impulse control develop in the 20s

    ( Giedd,2004)


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Prescription abuse?

  • Non-medical use, misuse, and abuse of prescription drugs are defined as the use of prescription medications without medical supervision for the intentional purpose of getting high, or for some reason other than what the medication was intended (Office of National Drug Control Policy Executive Office of the President,2007)


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Non-Medical Use of Pain Relievers in the Past Year: Person aged 12>


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Last Decade


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National Issue

  • 48 million(20% of the U.S .population) aged 12 or older had used prescription drugs for non-medical reasons in their lifetime. (NIDA 2005)


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Accessibility and Availability


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Availability and Accessibility

  • 2005 National Survey on Drug Use and Health(SAMSHA,2006)

    • 47.3% obtain from friends for free

    • 18.3% from one doctor

    • 10.2% took from a friend or relative without asking

    • 10.0% bought from friend or relative

    • 4.5% bought from a dealer or other stranger


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Availability and Accessibility

Creative Possession:

  • 2.6% from more than one doctor

  • .1% bought on the internet

  • .1% wrote a fake prescription

  • .5% stole from doctor’s office, clinic, hospital pharmacy

    (2006, SAMHSA)


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Prescription Drugs Commonly abused by Adolescents

  • Opiates

    • Morphine, codeine, oxycodone (oxycontin),

    • Hydrocodone (vicodin), and demerol

  • Depressants

    • Diazepam (valium), Alprazolam (xanax)

  • Stimulants

    • methylphenidate (ritalin), dextroamphetamine(dexedrine)

  • Anabolic Steriods

    • testosterone


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Top Five Drugs Used by12th graders in the Past Year

  • Cannabis: 31.5%

  • Vicodin: 9.7%

  • Amphetamines: 8.1%

  • Cough Medicine: 6.9%

  • Sedative and Tranquilizers: 6.6%

    (Monitoring the Future Study, The University of Michigan,2006)


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National Survey on Drug Use and Health(2005)

Sample of 18,678 with focus on ages 12-17

Opioids were the most frequently misused class

(Schepis,2008)


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Types of Prescription Drugs abused by Adolescents

  • Pain relievers are currently the most abused type of prescription drugs by 12-17 year olds followed by stimulants, tranquilizers and sedatives( NSDUH, 2006)

  • In 2005, past year use of vicodin is high among 8th, 10th and 12th graders with 1/10 school seniors using it in the past year (MTF,2006)

  • On average, almost for 3.5% of 8th-12 graders reported using OxyContin and 6% reported using Vicodin in the past year. (MTF,2006)


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2007 Monitoring the Future Study


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Gender Differences

  • Girls are more likely than boys to intentionally abuse prescription drugs to get high.12-17: 9.9% vs. 8.2%

  • Pain relievers: 8.1% vs. 7%

  • Tranquilizers: 2.6% vs. 1.9%

  • Stimulants: 2.6% vs. 1.9%

  • Dependency is higher in girls across the categories( SAMSHA, 2006)


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Age


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Outcomes of Prescription Drug Abuse

  • In 2004, more than 29% of teens in treatment were dependent on tranquilizers, sedatives, amphetamines and other stimulants (TEDS,2004)

  • More 12-17 year old than young adults (18-25) became dependent on or abused prescription drugs in the past year (SAMHSA, 2006)

  • Abusing prescription drugs for the first time before age 16 leads to a greater risk of dependence later in life( SAMHSA,2006)

  • In the last 10 years the number of teens going into treatment for pain killer addiction increased by 300% (TEDS,2006)


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Outcomes of Prescription Drug Abuse

  • Prescription drug misuse was significantly linked to poor academic performance, a major depressive episode in the last year, history mental health treatment in the last year and concurrent use of cigarettes, alcohol, marijuana, or inhalants

  • 33% of the surveyed adolescents were developing symptoms of dependency

    (Schepis, and Krishnan-Sarin,2008)


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Outcomes of Prescription Drug Abuse

  • In 2005,2.1 million adolescents abused prescription drugs( NSDUH,2006)

  • The gap between cannabis abuse and prescription drug abuse is narrowing .The gap closed to 5.9% between 2003-2005.(SAMSHA,2006)

  • CDC(2007): Most common poisonings result from the abuse of prescription drugs.

  • Number of deaths increased from 12,186 in 1999 to 20,950 in 2004---62.5% increase over five years.


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Deaths in Arizona:2006


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Deaths in Arizona:2006


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Holistic Treatment Approaches required in Adolescence

1. Understanding Family Dynamics and Culture

2. Understanding Growth and Development

3. Understanding Sexual and Physical Abuse

4. Assessing co-morbid diagnoses

5. Psychopharmacological Interventions

6. Cognitive and Learning Disorders

7. Legal matters and issues of consent

8. Use of Community Resources


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Holistic Treatment Approaches required in Adolescence

9. SES

10. Intelligence

11.Living Environment (rural vs. urban)

12. Pattern of use and Relapse Prevention

13. Medical and Detoxification Needs


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Use of Medications to Treat Prescription Drug Usage

Opiate Addiction:

  • The use of buprenorphine in adolescents has not been systemically studied.

  • Many experts believe buprenorphine should be the treatment of choice for adolescents with short addiction histories or adolescents who have had multiple relapses

    http://www.kap.samhsa.gov/general/order.html


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Opioid Addiction Treatment: Clonidine vs. Buprenorphine

  • Buprenorphine (partial opioid agonist) and Clonidine (alpha adnergeric blocker)

  • Ages 13-18 with a opioid dependency diagnosis

  • Behavioral therapy augmented buprenorphine and clonidine therapy

  • Buprenorphine =increased abstinence

    • ( Marsch et al,2005)


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Risk/ Protective Factors


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Prevention Principles

1. Prevention programs should enhance protective factors and reverse or reduce risk factors.

2. Prevention should address all forms of drug abuse, alone, or in combination.

3. Prevention should address the type of abuse in the local community.

4. Prevention should address the specific population.

  • NIDA,2008


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Prevention Principles(cont.)

5. Prevention should address family bonding and parenting

6. Prevention should be design to address early risk factors (i.e., aggression, poor social skills, academic difficulties)

7. Prevention should work with educational systems with a focus on skill development (i.e.,self-control,emotional awareness, communication, problem-solving, academic support)

NIDA,2008


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Prevention Principles(cont.)

8. Middle and high school intervention to increase academic and social competence.

9. Prevention should be aimed at general populations at key transition points( e.g., middle school)

10.Prevention should seek to combine effective programs (i.e., family-based and school-based programs)

  • NIDA,2008


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Prevention Principles(cont.)

11. Prevention should focus on reaching populations in multiple settings

12. Research-based elements of prevention must be maintained during cultural adaptation.

13. Prevention should be long-term with repeated interventions

14. Prevention should involve teacher training

15. Prevention should be interactive( i.e., peer discussion, parent role playing)

  • NIDA,2008


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Educating Parents on Prescription Drug Usage

1. Monitor adolescents on-line

www.TheAntiDrug.com/E-Monitoring/index/asp

2. Be Observant of over-the-counter drug usage in Adolescents

3. Discard old and unused medications

4. Keep track of the quantities of prescription drugs in the Medicine Cabinet

5. Educate Parents on Talking to Teens


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Physicians and Prescribing


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FDA and Required Training

  • Due to increasing the deaths and complications, the FDA is considering mandating education for narcotic prescribers. A decision is pending in 2009.

  • There is a concern that this will reduce the availability of pain treatment providers.

  • This may have implications on the disparity in pain treatment. Only 45% of Hispanics and 39% of Blacks receive treatment for severe pain in contrasts to White(52%)

    (Pletcher,2008)


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Arizona Prescription Monitoring Program

17% of substance abusers obtain drugs by presenting pain to multiple physicians(SAMSHA,2006)

Strategy:

A. Individuals who refill five prescriptions with five or more pharmacists in one month( schedules II, III, IV). APMP will notify the prescriber.

B. Doctors will be able to query the databank with a username and password.

Initial implementation September ‘08 with full implementation by March 2009.


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Arizona’s Next Steps…….

1. Prevention education with School Systems on the use of prescription drugs.

2. Increasing emphasis on coordination care between PCPs and Behavioral Health

Medical Providers related to opiates.

3. Prescription Monitoring Program and participation by providers

4. Evidence-Based Practice Detoxification Protocols for Adolescents

5. Arizona Substance Abuse Partnership Collaboration


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Informational Linkages

  • http://www.couragetospeak.org/

  • National Youth Anti-Drug Media Campaign, http://www.theantidrug.com/

  • Office of National Drug Control Policy, http://www.whitehousedrugpolicy.gov/


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The End


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