Twenty percent of U.S. high-school students have taken prescription drugs without a prescription, according to the results of a CDC survey released June 3. A separate report, also issued June 3 by the agency, estimates the direct health care costs of opioid abuse to be more than $9 billion a year and offers recommendations for physicians, payers and government agencies to help curb such abuse.
"Teens and others have a false assumption that prescription drugs are a safer high," said Grant Baldwin, Ph.D., M.P.H., director of the CDC's Injury Center Division of Unintentional Injury Prevention, in a June 3 media statement(www.cdc.gov). "These data and that from other sources show us that prescription drug misuse is a significant problem in both adolescents and adults."
The national Youth Risk Behavior Survey(www.cdc.gov), or YRBS, has been conducted every other year since 1991, but 2009 was the first time the survey included questions about prescription drug use.
In addition to findings related to misuse of prescription medications, the 2009 national Youth Risk Behavior Survey, or YRBS, reported disheartening statistics in several other areas.
In terms of illicit drug and alcohol use, teens in the 2009 survey reported numbers similar to those in the 2007 YRBS:
- 72 percent of high-school students said they had used alcohol at some point, and 42 percent had at least one drink in the 30 days prior to the survey;
- 37 percent had used marijuana, including 21 percent who had used it in the 30 days prior to the survey;
- 6.7 percent had used ecstasy;
- 6.4 percent had used cocaine; and
- 4.1 percent had used methamphetamine.
Additionally, nearly 12 percent had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high at least once.
Nearly half of students surveyed had tried cigarettes, and 20 percent had smoked during the 30 days prior to the survey. Nine percent had used smokeless tobacco during the 30 days prior to the survey.
Nearly half of the students surveyed reported having sexual intercourse at least once. Of the 34 percent who reported having sex during the three months prior to the survey, nearly 40 percent said they had not used a condom the last time they had sex.
The announcement about the YRBS findings coincided with the release of a CDC report on unintentional drug poisoning(www.cdc.gov) among both teens and adults that indicates 26,400 unintentional drug overdose deaths occurred in 2006. During that year, opioids were involved in more fatal overdoses than heroin and cocaine combined.
The drug poisoning report included the following recommendations for physicians:
- use opioid medications for acute or chronic pain only after determining that alternative therapies do not deliver adequate pain relief;
- the lowest effective dose of opioids should be used;
- in addition to behavioral screening and use of patient contracts, consider random, periodic, targeted urine testing for opioids and other drugs for any patient younger than 65 who has noncancer-related pain that is being treated with opioids for more than six weeks;
- if a patient's opioid dosage has increased to more than 120 morphine milligram equivalents per day without substantial improvement in pain and function, consult a pain specialist;
- do not prescribe long-acting or controlled-release opioids for acute pain; and
- periodically request a report from your state prescription drug monitoring program to determine whether other health care professionals also are prescribing opioids to your patients.
The CDC report also includes recommendations for private insurance providers, pharmacy benefit managers, and state and federal agencies to aid them in identifying patients who are using opioids for nonmedical uses and notifying prescribing physicians about such patients.
Furthermore, the report recommends that payers should only reimburse opioid prescription claims from a single designated physician and a single designated pharmacy. And state and federal agencies should work to improve the availability of substance abuse treatment services, the report says.
According to the report, there has been a 10-fold increase in the medical use of opioids during the past 15 years as clinicians have become more aggressive in managing patients' pain. During that time, painkillers have been increasingly associated with nonmedical uses and are widely available in illicit markets.
The Drug Abuse Warning Network, or DAWN, which is operated by the Substance Abuse and Mental Health Services Administration, estimates that in 2008, prescription and OTC drugs used nonmedically were involved in roughly the same number of emergency department visits as illicit drugs, with legal and illegal drugs each being linked to about 1 million visits.
Opioids were associated with 306,000 visits, and benzodiazepines were associated with 272,000 visits.
DAWN estimates that people ages 12-20 accounted for 14.5 percent of emergency department visits for nonmedical use of pharmaceuticals in 2008. That figure does not include suicide attempts.