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Thursday Sep 27, 2012

Step Up to Help Curb Teen Medication Abuse

Today, more than 2,000 U.S. teens will use prescription drugs to get high for the first time. Sadly, for many, it won't be the last time.

One in six teenagers has abused prescription drugs at least once, and more than one-third of all prescription drug abusers in the United States are between the ages of 12 and 17. Many become addicted, and some die. In fact, drug overdoses are the leading cause of accidental deaths in more than a dozen states.

So what can we do about it?

Some practices use a patient prescription agreement, in which the patient agrees to take medication as directed, not share it and dispose of unused meds properly.

In my practice, we've taken things a step further. Patients receiving prescriptions for controlled substances have to sign a contract, which requires them to use specific pharmacies and to submit to random urinalysis. If a patient doesn't cooperate, they don't get the meds.

It may sound harsh, but with the privilege of prescribing comes the responsibility to assess the needs of each patient, the risks and benefits involved and the need to monitor their use. Physicians who abuse that privilege threaten our ability to prescribe for patients with legitimate needs.

For patients who agree to submit labs, their urine samples tell us whether or not they are taking their medication. If their labs indicate they aren't taking the meds, we want to know why not and what happened to that medication. Labs also tell us if patients are mixing the prescribed medication with any other drugs -- legal or illegal.

This isn't a message about limiting access to pain medication. It is about balancing that need for access with the need to reduce abuse. At the same time we are grappling with abuse issues, under treatment of pain is a real problem for many patients. This summer, the AAFP released a position paper that opposes regulations that limit patients' access to physician-prescribed pharmaceuticals.

This week, the Academy supported The Partnership at DrugFree.org in its launch of a weeklong public awareness campaign: "Wake Up to Medicine Abuse." The initiative -- part of a multi-year campaign called the Medicine Abuse Project -- urges parents, law enforcement, teachers and health care professionals to take action.

So, again, what can we do? The Partnership's Medicine Abuse Project has resources written specifically for health care professionals, including fact sheets about teen medicine abuse and painkiller overdoses, an FAQ about prescription monitoring, a National Institute on Drug Abuse report, screening tools and links to best practices and guidelines. The site also offers patient education resources, including posters for our practices and a hotline for parents.

You also can check out the AAFP's webpage dedicated to pain management and opioid abuse.

This is a big problem, but family physicians can be a big part of the solution.

  • We can use well-child visits to talk about keeping medications up and away from children's reach.
  • We can educate parents of teens that this is a real problem of which they may not be aware.
  • We can inform patients -- adults and kids -- with legitimate need for these meds not to broadcast the fact that they're taking them because doing so could make those patients a target of people who would misuse those drugs.
  • Lastly, we can direct parents to unused drug disposal sites in our communities.

When you prescribe prescription pain killers for adult patients with children, what advice do you offer them? Please share your thoughts below.

Wanda Filer, M.D., M.B.A., is a member of the AAFP Board of Directors.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.