By Bessie Oster and Julie Rosenbluth, MPH, CHES for American Council For Drug Education
Most people are aware that using illicit drugs is dangerous. But what many don’t know is that even prescription drugs or medicines you can buy over the counter at your nearest pharmacy can be just as dangerous. Prescription medications save many lives and can be wonderful in maintaining health when used correctly, but when used incorrectly, or not as prescribed by your doctor, the results can be devastating. Non-medical use occurs whenever a prescription or over the counter medication is used for anything other than its intended purpose, by someone other than the intended recipient, or in a dosage other than prescribed.
Prescription drugs are among the substances most commonly abused by young people in the U.S. and the rates are steadily increasing. Nearly one in five teens (19 percent, or 4.5 million) report abusing prescription medications to get high and 10 percent (2.4 million) report abusing cough medicine to get high.
Teen drug use is nothing new, but lately kids are realizing that the easiest drugs to get can be found at home -- including prescription stimulants such as Ritalin and Adderall, pain killers such as Vicodin and OxyContin, anti-anxiety meds such as Valium and over-the-counter medications such as cold medicine containing dextromethoraphan (DXM).
Today’s teens do not perceive the non-medical use of prescription and over-the-counter (OTC) drugs to be risky. However, when used not as prescribed they can be just as dangerous as illicit drugs. In addition they are easily accessible to many teens with most reporting that they get them from friends, the Internet, or their parents medicine cabinets. According to 2005 data from the Partnership for Drug Free America (PATS 2005), nearly one-third of teens (31 percent, or 7.3 million) believe there’s “nothing wrong” with using prescription medications without a prescription “once in a while.” Forty percent, of teens (9.4 million) agree that prescription drugs, even if they are not prescribed by a doctor, are much safer to use than illegal drugs, such as marijuana or cocaine. And frighteningly enough, nearly three out of 10 teens (29 percent or 6.8 million) believe prescription pain relievers are not addictive. At the same time, more then half of teens (56 percent, or 13.4 million) agree that prescription drugs are easier to get than illegal drugs.
As counselors there is a lot you can do at the school level to educate and intervene with students who may have a problem. The first step is simply to educate your self about the problem. Armed with information, you can educate your school community and help to initiate policies and practices to minimize abuse.
Startling Statistics
According to startling data recently released from the Partnership for a Drug-Free America’s Partnership Attitude Tracking Study, also called PATS:
- Approximately one in five teenagers (18 percent), or 4.3 million teenagers nationally, report abusing Vicodin®; one in 10 teenagers (10 percent), or 2.3 million teenagers nationally, report abusing OxyContin®. (Both are prescription painkillers.)
- One in 10 teenagers (10 percent), or 2.3 million young people, has tried prescription stimulants Ritalin® and/or Adderall® without a doctor’s order.
- One in 11 teenagers (9 percent), or 2.2 million young people, has abused OTC cough medications intentionally to get high. Such products contain the active ingredient dextromethorphan.
- Teen abuse of prescription and OTC medications is higher or on par with teen abuse of a variety of illicit drugs – i.e., cocaine / crack (9 percent), Ecstasy (9 percent), methamphetamine (8 percent), LSD (6 percent), ketamine (5 percent), heroin (4 percent) and GHB (4 percent).
- Abuse of medications has penetrated teen culture: 37 percent of teens say they have close friends who have abused prescription painkillers like Vicodin®, OxyContin® and Tylox®. Some 29 percent say the same about prescription stimulants Ritalin® and Adderall®. (Teens often overstate friends’ use; however, this measure underscores awareness and normalization of this type of substance abuse among teenagers.)
- Teens who abuse or have abused a prescription or OTC medication are, more often than not, likely to report having abused drugs such as Ecstasy and marijuana.
Availability
Students get prescription drugs from friends with prescriptions that are willing to share or sell their medications. Often students steal pills from friends or the family medicine cabinet. Few people actually keep track of exactly how many pills they have left in a bottle and will not likely notice if a few a missing -- especially unused pain medications left over from injury or surgery. Some students get prescription drugs off the Internet or buy them on the black market, similar to how marijuana or other illicit drugs are purchased.
Signs and Symptoms
The first step in reducing the problem is recognizing the signs and symptoms of misuse. You might suspect that there is a problem but might be unclear exactly what’s going on. Because prescription and over-the-counter medications encompass such a broad category, it’s difficult to rely on any one set of signs and symptoms. However, you should note any marked physical or behavioral changes. The best advice is to trust your gut instinct and investigate any situation that does not seem as it should.
Physical Signs
- Loss of or increase in appetite, changes in eating habits, unexplained weight loss or gain
- Slowed or staggering walk
- Poor physical coordination
- Inability to sleep, awake at unusual times, unusual laziness
- Red, watery eyes
- Pupils larger or smaller than usual
- Blank stare
- Cold, sweaty palms
- Shaking hands
- Puffy face, blushing or paleness
- Extreme hyperactivity
- Excessive talkativeness
- Nausea, vomiting or excessive sweating
- Tremors or shakes of hands, feet or head
- Irregular heartbeat
Behavioral Signs
- Change in overall attitude/personality with no other identifiable cause; generally erratic behavior
- Dramatic drop or increase in grades at school; skips school or is late for school
- Difficulty in paying attention or excessively attentive; forgetfulness
- Sudden oversensitivity, temper tantrums, or resentful behavior
- Moodiness, irritability, or nervousness
- Silliness or giddiness
- Paranoia
- Excessive need for privacy; unreachable
- Secretive or suspicious behavior
So What Can You Do?
Raise awareness in your school community. Be sure to include faculty, staff, students, parents and medical professionals in your community in discussing the problem. Consider sending letters, creating posters or ads in student newspapers and adding information about the dangers of prescription and OTC drug abuse in health education courses for students in middle school and high school.
At the Individual Level
Strategies to prevent non-medical use of prescription drugs at the individual level are designed to engage individual students. Students should be advised about individual risks of non-medical use of prescription drugs. Here are some specific tips to address individual students.
- Inform new students and parents about alcohol policies and penalties.
- Discuss negative consequences of non-medical use of prescription and OTC drugs.
- Discuss healthier coping strategies to deal with academic anxiety.
- Enhance awareness of personal liability. Help students recognize how drugs affect them and others.
- Ask students and parents to disclose medications that students bring to school, so that the school can be aware of students with supply of meds with abuse potential.
- Teach students how to protect their medications – e.g. distribute through the school nurse or count pills.
- Get a proper assessment if needed and refer for treatment if needed. Remember that most prescription drugs with a potential for abuse are also addictive. Treatment is necessary in some cases and should always be considered as an option.
At the School Level
It’s important to address the behavior of the general student population. Research has demonstrated that education alone is not effective in changing student behavior (e.g. just using posters or brochures). Therefore, school-wide education campaigns should correct student misconceptions about the safety of OTC and prescription drugs, help students understand healthier ways to deal with the underlying root cause for use whether that’s teaching stress management skills, resistance to peer pressure, or getting a diagnosis for an undiagnosed medical condition.
Update and Clarify Policy
Your school or school district should have a clear, written policy on medication which is distributed to all school personnel, parents, and students. The policy might specify what responsibility for medication the school or district is willing to assume and which school personnel will administer medications.
It might also address the responsibilities of parents, such as providing medication in original containers with the name of the prescribing doctor, a written order for the medication, and the patient for whom the drug is prescribed.
In addition, policies around over-the-counter medications, whether kept at school or carried by students should be clearly defined. It might also state the school or district`s rules on self-medication by students.
The school should have clear-cut procedures on what to do when students are found abusing -- taking medications not prescribed to them, taking medication other than as intended or sharing medications. Sanctions should be clearly stated and consistently imposed.
Policy is ineffective unless it is enforced. School personnel, students, and parents need to know the school’s policies and understand consequences if policies are not followed.
Once the policy is in place, inform students and parents about the Alcohol and Other Drug Policy. Use handbooks, letters, posters, e-mails, student newspapers and student forums to clarify alcohol and other drug policy.
Adopt School-based Programs
1. Student programs
- Engage peer leaders in education campaigns
2. Involve Parents
- Raise awareness among parents—let them know that misuse of prescription drugs is a growing problem among teenagers.
- Let parents know that the school health staff can keep self-administered medication under lock and key so that students are not pressured by other students to share their medications.
- Tell parents to consider counting medications daily -- both student medications and any medications in the home which a potential for abuse (such as left over pain killers, sleep aids and even over-the-counter cold medication).
- Ask parents to notify the school about any changes in medication, doses or routine.
3. Train school health staff, as well as faculty.
- Keep all medications held in the school under lock and key.
- Health staff should communicate with other school staff about students on medications, as appropriate so they can monitor behavior changes, or be aware of students taking medication without a prescription. Don’t forget to consider student privacy as defined by FERPA regulations.
- Communicate with medical professionals. The issues outlined above are difficult for schools, since the primary mission of a school is education, not medical care. This makes it important that schools reach out to medical professionals in their communities for advice and assistance.
At the Community Level
Prevention works that involves both the school and the surrounding community can change the broader environment and reduce problems over the long term. School and community alliances typically involve a range of groups such as student affairs offices, local police, retail alcohol outlets, and the court system to work cooperatively in resolving issues involving students.
Prescription drug abuse is a community issue because many students get prescriptions from the local medical community. A single student might get medications from a variety of sources, such as a local dentist, or a hospital emergency room or a psychiatrist. It is essential for the school to work with community to limit access to prescription drugs.
Environmental management strategies can limit access to prescription drugs, strengthen policies to address prescription drugs, and improve detection of the problem. Specific activities aimed at limiting access might include instituting an anonymous reporting program for students and community members concerned about other students’ non-medical use of prescription drug.
Non-medical use of prescription and over-the counter medication is a growing problem among students. It’s an issue which schools need to address. Education, prevention, and intervention are the key to stopping this widespread problem and keeping our students healthy and ripe for growing and learning.
For more information, please visit Children of Alcoholics Foundation at www.coaf.org; the American Council for Drug Education at www.acde.org or Phoenix House at www.phoenixhouse.org. For specific program information geared toward older adolescents and college students visit the Facts on Tap Web site at www.factsontap.org.
The National Family Partnership's Red Ribbon Campaign, October 23-31, is a time to bring people together and make the drug-free message visible. The Red Ribbon Campaign, conducted annually since 1985 through local and nationwide volunteers, has made October a time to reinforce and introduce students throughout the country to the simple realization that they can choose to grow up drug-free. 
