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Let's Get Real About Prescription Pills

Abuse of meds by America's teens has reached epidemic proportions. But if we're serious about keeping kids away from Oxy and Adderall, we need to get honest with them.

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Fear-based Rx drug ed will not benefit our kids. photo via

By Maia Szalavitz

03/07/12

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Over the years, people trying to prevent addiction have learned some hard lessons. One of the most important is that lying to teens about drugs is not effective. Indeed, it often backfires as they lose trust in educators as reliable sources and turn instead to friends on the street. 

So why then do we now hear over and over again that “prescription drugs are as dangerous as street drugs”? For example, when Whitney Houston died of an apparent overdose of alcohol and Rx drugs, drug czar Gil Kerlikowske told CBS News, "They're coming right out of our medicine cabinets, and yet these drugs are as addictive and dangerous as any other [street] drug." Or check out this warning on the New York State Department of Health site: "Kids need to hear from parents that getting high on lethal prescription and OTC drugs is just as dangerous as getting high on illegal street drugs."

This is not to say, of course, that OxyContin can’t be as addictive and deadly as heroin when misused. But if we pretend that having a known dose and lack of contaminants doesn’t matter, we risk losing all credibility. Teenagers aren’t stupid. They see their parents taking prescription medication—hopefully, as prescribed—and they typically don’t see them using street drugs. They themselves may be on medication for depression or ADHD. They are perfectly aware that many people are safely using the very same drugs we are demonizing.

We shouldn't be surprised, then, when they ask, "If street drugs and medications are equally dangerous, what's the point of having the FDA?" 

If we want to fight misuse of prescription drugs, we need a more honest message. Most teens are not introduced to recreational use by doctors: 87% of Rx drug abusers say the source of their drugs was a friend, family member or dealer (though many later point to medical exposure as an early experience of liking a drug).

Teens are also growing up in a culture of ubiquitous direct-to-consumer prescription drug advertising, whose general message suggests that there’s a pill for any ill. Even in the absence of such promotion, every human society has cultivated some form of intoxicant. The popularity of risky nondrug highs—like the “choking game” that alters consciousness through asphyxia—indicates that supply side efforts will never defeat the human drive to get high. In one study, one in seven teens reported having tried getting high through oxygen deprivation.

But while some drug use is inevitable, drug-related harm can be dramatically reduced. For example, research on effective drug prevention shows that the best programs actually don’t focus primarily on drugs themselves, instead teaching kids how to regulate their emotions and impulses, empathize with others and navigate the social world without feeling like chemicals are their only option when everything is overwhelming. High-quality preschool and support for new mothers in poor neighborhoods are also good drug prevention

But if we pretend that having a known dose and lack of contaminants doesn’t matter, we risk losing all credibility. Teenagers aren’t stupid. So we shouldn't be surprised when they ask, "If street drugs and mediations are equally dangerous, what's the point of having the FDA?" 

Getting rid of the outdated DARE and replacing it with evidence-based programs—which also fight problems like violence and risky sex—is a good place to start. DARE, which is still used by a majority of American schools and which involves having police officers teach drug ed, has repeatedly been shown to be ineffective and sometimes to even backfire.

All this, however, will not be enough in a world where 80% of teens drink alcohol before they are legal, 56% of adults age 28 and under have tried marijuana, 19% have misused prescription painkillers like OxyContin, and 15% have misused prescription stimulants like Adderall.

Teens need to know not just that drug misuse can be dangerous but that certain drugs are far more risky than the rest. It’s precisely because prescription drugs are familiar and generally used without harm that there’s a human tendency to underestimate their risk.

Nonetheless, the reality is that their risk is nowhere near as great as that of street heroin, which varies enormously in dose and purity. This alone makes heroin riskier than OxyContin—in part because the danger of overdose is controlled by knowing the actual dose and in part because the FDA does its best to guarantee that there’s little risk of being poisoned by a drug obtained from a pharmacy. The agency, for all its flaws, came into existence because before drug regulation, all sorts of counterfeits, snake oils and even poisons were sold as medicine—a practice that continues in countries with poor or corrupt oversight over manufacturing such as China. Before the FDA, in fact, many medications contained addictive opiates, without revealing that fact on their labels.

Of course, this doesn’t make OxyContin safe to take nonmedically—or less addictive than heroin, when injected or snorted. (When taken as directly orally, it is less addictive because addiction potential is related to intense highs and lows and long-acting oral opioids produce a steadier state with fewer of them). However, it does mean that maintenance drugs like buprenorphine, methadone and (in some countries) heroin itself are safer than their street brethren because of regulation. (The reason that research into using heroin as maintenance universally shows improvements in patients’ health is that a legal supply of known dose and purity is safer.)

Consequently, if as a society we are serious about protecting our kids from addiction and overdose, we should reform our approach to prevention with the following four measures:

1. Fact-Based Rx Drug Education

The previous facts all need to be acknowledged in education about prescription drugs. Teens also need to be taught that the brain inherently underestimates the risk of the familiar, so the dangers of Rx drugs are unconsciously minimized. We need to explain exactly what addiction is (and is not).

We also must stress that drugs with similar effects often synergize to produce results where one plus one equals five, not two. Kids need to understand that the riskiest form of drug use is taking a prescription pain reliever with alcohol and/or with an addictive sedative like Valium or Xanax. If a single fact can save lives, it’s this one. We can't pretend that marijuana carries the same danger.

2. Make Naloxone Mandatory First Aid

We also need to make the antidote to these overdoses—a safe, nonaddictive drug called naloxone—available over the counter and do an education campaign to encourage everyone to keep it in their first-aid kit. Parents are always going to deny that their own kids are at risk when it comes to overdose—but if every house has emergency naloxone, not only will there be little stigma to it but the lifesaving treatment will be at hand for whoever may need it.

3. Discard Extra Opioids

People also need to either secure or get rid of their leftover opioids and anti-anxiety drugs like benzodiazepines. For those willing to discard them, the DEA holds regular "Take Back" initiatives across the country, the next one scheduled on April 28. For those who are not fans of that agency, some pharmacies offer similar programs.

4. Drug Safes for All!

Many, if not most, people refuse, however, to dispose of their extra Rx drugs because they are afraid—especially in an environment of crackdown on prescription drug misuse, ironically—that they won’t have access during an emergency. Given this natural tendency to hoard, we need a public information campaign to promote the use of drug safes. This is more realistic than expecting these stashes to disappear. And again, it would not be stigmatizing if promoted as a universal precaution, like baby proofing.

We are never going to eliminate addiction. And only joyless ayatollahs would actually want a drug-free America, which would entail the elimination of caffeine, cigarettes and alcohol, not just illegal drugs—and might have to ban added sugar, just to be sure. But we can, with common-sense and compassionate measures, reach the mutual goals of many fewer addicted people and many fewer overdose deaths. We just need to face reality first—and stop lying to our kids and ourselves.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). 

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