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Prescriptions for Stimulants, Painkillers Soaring Among Youth
Date:11/30/2010

By Amanda Gardner
HealthDay Reporter

TUESDAY, Nov. 30 (HealthDay News) -- The number of prescriptions for controlled medications such as opioids and stimulants has nearly doubled in adolescents and young adults since 1994.

The trend, reported in the December issue of Pediatrics, mirrors a similar increase in misuse of these drugs, with adolescents and young adults' illicit use of prescription drugs now outstripping all other illicit drug use except marijuana.

The researchers couldn't attribute the increased misuse directly to more prescriptions, but did urge both physicians and patients to be vigilant when considering the use of drugs such as Oxycontin or Ritalin.

"Our study did not look at the relationship between prescribing and misuse, but the increased prescribing increases the potential availability [of these drugs]," said study author Dr. Robert Fortuna, an assistant professor of internal medicine and pediatrics at the University of Rochester Medical Center. "Physicians and patients need to be aware of the increased rates of prescribing, be aware of misuse and have discussions about the risks and benefits."

"In total, a controlled medication was prescribed at approximately one out of 6 [health-care visits] for young adults and one in nine for adolescents," he added. "The numbers are large."

Increased prescribing rates for controlled medications is not a new phenomenon, and many believe that some of it has to do with recent initiatives to make sure pain isn't undertreated.

"We believe we've been underusing pain medicine and sedative-hypnotic medications because we have been so concerned about the potential for abuse," said Dr. Jess P. Shatkin, director of education and training at the NYU Child Study Center in New York City.

"Increases are possibly due to changing regulations at both the federal and state levels," Fortuna agreed. "There has been an increased advocacy to treat patients for pain, and there's some evidence that physicians are becoming increasingly comfortable prescribing these medications."

Opioids are a prime example, with sales of oxycodone surging 732 percent and those of methadone by more than 1,000 percent between 1997 and 2006.

The authors looked at two national databases to determine how often opioids, sedative-hypnotics and stimulants were prescribed to adolescents and young adults.

In 2007 alone, a scrip for one of these medications was written at 2.3 million visits by adolescents and 7.8 million visits by young adults.

In 1994, such medications were prescribed at only 6.4 percent of such visits for adolescents, but rose to 11.2 percent in 2007. For young adults, the rate increased from 8.3 percent to 16.1 percent.

Doctors wrote these prescriptions in regular doctors' offices and in emergency departments, for injuries and for more pedestrian complaints such as back pain.

A drawback of the study, Fortuna conceded, was that it "did not look at diverted or misused medications."

He and the other researchers called for more investigation into prescribing trends and prescription misuse, noting the potential for trauma, high-risk behaviors and unintentional overdose among those abusing controlled substances.

Other experts agreed that caution was necessary.

"There's a potential connection between the more prescriptions you have going on and the more potential risk that patients will use it themselves for a purpose it wasn't it intended for or divert it to a friend or someone else," said Shatkin. "It's not infrequent that that happens."

"We certainly have a concern about increased misuse and increased diversion," said Fortuna. "The increase in prescribing of controlled medications such as opioids, stimulants and sedatives in and of itself is not necessarily bad as long as they're being used appropriately."

More information

For more on drug abuse, visit the U.S. National Institute on Drug Abuse.

SOURCES: Robert Fortuna, M.D., assistant professor, internal medicine and pediatrics, University of Rochester Medical Center, New York; Jess P. Shatkin, M.D., director of education and training, NYU Child Study Center, New York City; December 2010 Pediatrics


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