When Teenagers Abuse Prescription Drugs, the Fault May Be the Doctor's </nyt_headline>
Every Thursday evening, I counsel a group of teenagers with serious substance abuse problems. None of the youngsters elected to see me. Typically, they were caught using drugs, or worse, by their parents or a police officer and were then referred to my clinic.
To be sure, all the usual intoxicants - alcohol, marijuana, amphetamines, LSD and cocaine - are involved. But a new type of addiction has crept into the mix, controlled prescription drugs, including potent opiate painkillers, tranquilizers and stimulants used to treat attention deficit disorders.
This is hardly unique to my clinic. Several studies report that since 1992, the number of 12- to 17 -year-olds abusing controlled prescription drugs has tripled.
In fact, dabbling with some of the pharmaceutical industry's finest psychoactive compounds constitutes the fastest growing type of drug abuse in the United States, outpacing marijuana abuse by a factor of two. One of my patients, Mary, illustrates this trend all too well. A voracious reader and a talented musician in her high school orchestra, Mary at 16 is also a "garbage head," meaning that she will ingest anything she thinks will give her a high.
Last December, she was taken to the hospital for an overdose of hallucinogenic mushrooms, alcohol, and ketamine, a chemical cousin of angel dust that doctors sometimes use to anesthetize patients and that, more commonly, veterinarians use to sedate large animals.
Lately, she has been playing with one of the strongest opiates and potentially addictive painkillers ever created, Oxycontin. She downs a few with a single shot of vodka and calls the combination "the sorority girl's diet cocktail," because it simultaneously allows for a stronger kick of inebriation and far fewer calories than mere alcohol alone.
The most recent Monitoring the Future report, the continuing study of teenage drug use conducted by the University of Michigan and the National Institutes of Drug Abuse since 1975, found that 5.5 percent of all high school seniors abused Oxycontin, up from 4 percent in 2002. Oxycontin abuse has increased 26 percent since 2002 among 8th, 9th and 12th graders.
A listing of Food and Drug Administration-approved uses for Oxycontin shows that it is specifically for patients in moderate to severe round-the-clock pain like that in advanced stages of cancer.
So where does this physically robust teenager obtain her pills? Weeks earlier, she had a tonsillectomy, a minor though uncomfortable procedure by any standards. The surgeon wrote a prescription for 80 tablets. Mary spent the next week in a narcotized and medically sanctioned bliss, until her mother confiscated the last 20 tablets.
At medical conferences, I hear colleagues fault parents who abuse and obtain these controlled substances but leave them easily accessible in their unlocked medicine chests where teenagers can help themselves. Other experts fault the Internet, where almost anyone can obtain controlled prescription drugs from offshore pharmacies with a few clicks on a home computer.
The favorite scapegoat is deceptive: addicted patients who, the argument goes, "doctor shop" and manipulate the physicians into prescribing the medications, alter the prescriptions themselves or buy them from drug dealers at exorbitant prices.
None of these targets come close to the real root of the problem. Many doctors are too quick to write prescriptions for these powerful drugs.
The National Center for Addiction and Substance Abuse recently reported that 43.3 percent of all American doctors did not even ask patients about prescription drug abuse when taking histories; 33 percent did not regularly call or obtain records from a patient's previous doctor or from other physicians before writing such prescriptions; 47.1 percent said their patients pressured them into prescribing these drugs; and only 39.1 percent had had any training in recognizing prescription drug abuse and addiction.
Yet from 1992 to 2002, prescriptions written for controlled substances increased more than 150 percent, three times the increase in prescriptions for all other drugs.
The morning after hearing about Mary's Oxycontin holiday, I called her surgeon and asked him whether he had read her medical chart detailing an extensive history of substance abuse. "Why did you prescribe this narcotic bazooka when a BB gun of a painkiller such as acetaminophen might have done the trick?" I asked.
Sheepishly, the surgeon replied, "Well, I guess I wasn't thinking."
No one in pain - physical or psychic - should suffer. But the fact remains that we doctors still do the bulk of prescribing of the substances. The search for root causes of the epidemic with controlled substance abuse has to include doctors as active participants. A big part of the solution depends on reserving prescriptions for those who need, rather than desire, them.
Dr. Howard Markel, a professor of pediatrics at the University of Michigan, is the author of "When Germs Travel."