Stimulants Abuse in Teens

By Sandy Merino and Jennifer Yen, clinical pharmacists at CHOC Children’s

With final exams right around the corner, teens will be tempted to turn to stimulants as they hope to cram in some last-minute late-night studying. Kids seem to be under more pressure now than ever before. Get to know the dangers of stimulant abuse to help your kids make smart decisions and stay healthy while performing under pressure.

These days, stimulants are only prescribed to treat a few health conditions, including attention deficit hyperactivity disorder (ADHD), narcolepsy, and rare cases of depression that have not responded to other treatments. Any time these drugs are taken in a way that is not intended, it is considered abuse.. This includes taking someone else’s prescription, taking the medication in ways other than prescribed, and taking the stimulant to get high. A basic understanding of stimulant abuse can help you as a parent protect your family and friends against it.

The Science Behind Stimulants

As the name suggests, prescription stimulants increase biochemical activity in the brain that can help boost alertness, attention and energy. The most common prescription stimulants are Adderall, Ritalin and Concerta. ADHD is one of the most commonly diagnosed conditions in children and adolescents. According to the Centers for Disease Control (CDC) and National Institutes of Health (NIH), approximately ten percent of children between ages 4 and 17 years are diagnosed with ADHD, and about 60 percent of them take medication. When they are taken as prescribed they are generally safe and effective. Doctors prescribe these medications starting at low doses and then gradually increase them, monitoring for effectiveness and side effects. The lowest effective dose is then continued, and the child is monitored on a regular basis. When taken as prescribed, many of these children will experience a reduction in ADHD symptoms and an improvement their academic performance, behavior, social relationships, and self-esteem.

Unfortunately, stimulants can be abused, and often by friends and family. Did you know that almost ten percent of high school seniors admit to abusing ADHD medications in the past year, according to the National Institute on Drug Abuse? This number is as high as 35 percent among college students.

Pressure to perform tempts teens to turn to stimulants

Teens and young adults who abuse stimulants often do so for a better ability to concentrate, increased energy and more confidence. Academic pressures are the main trigger for teens and young adults to abuse stimulants, such as pulling all-nighters to study. What they might not realize, though, is that these drugs can be habit-forming when abused and can be dangerous when taken in high doses. Stimulants can speed up heart rate and blood pressure, and cause insomnia and anxiety. Although students expect stimulants to help their academic performance, studies have found that stimulants do not increase learning or thinking ability when taken by people who are not diagnosed with ADHD. Students who abuse prescription stimulants actually had lower GPAs in high school and college than those who didn’t abuse prescription stimulants, according to the NIH.  Although a late-night study session and some Adderall might seem like a good way to cram for exams, it actually doesn’t work, may hurt them in the short-term, and definitely won’t help them with their long-term goals.

While some teens turn to caffeine pills or Adderall medication believing it will help them focus and cram for school exams, others turn to energy drinks. Many teens aren’t aware of exactly how much caffeine they’re consuming in each energy drink. Although experts consider 200-300 mg of caffeine a day to be a moderate amount for adults, teens should limit their consumption to much less, about 100 mg per day. Meanwhile, many caffeinated drinks easily contain 80-160 mg of caffeine in one serving. Some popular energy drinks contain up to 240 mg per can. Teens consume caffeine in more places than they realize: hot chocolate, iced tea and non-cola soda all contain caffeine. Too much of it can lead to anxiety, dizziness and headaches.

Abusing stimulants to get high

While some teens abuse stimulants for academic performance, others may use them to get high. When stimulant medications are taken suddenly and in ways not prescribed, they can rapidly increase dopamine activity in the brain, causing a sense of euphoria, which can increase the risk of addiction. This effect on the body and brain is similar to the effect of illicit drugs. Prescription stimulants are normally meant to be taken by mouth in a pill form, but other ways of abusing them include crushing the tablets to snort or inject them. This can cause additional problems because inactive ingredients in the tablets can block small blood vessels, leading to severe damage to the heart, brain and other organs, not to mention the risks associated with intravenous drug abuse, such as hepatitis and HIV/AIDS. Another form of prescription stimulants is a prescription patch, which contains an entire day’s worth of medication that is meant to release slowly over time through the skin. Some people abuse the patch by extracting the medication and consuming it all at once or by chewing on the patch. This is an extremely unsafe method of prescription drug abuse due to the more rapid method of exposure.

Be aware of the most commonly abused stimulants and their side effects:

Drug Street Name Medical Use Reason for abuse Adverse Effects
Amphetamines (Eg: Adderall and Dexedrine)

Methylphenidate (Eg: Ritalin and Concerta)

Skippy

The Smart Drug

Vitamin R

Bennies

Black Beauties

Roses

Hearts

Speed

Uppers

Lightening

Amped

Black/Blue Mollies

ADHD

Narcolepsy

Depression

Academic performance enhancement

To stay alert

Lose weight

Get high

 Decreased sleep

Decreased appetite

Sense of anger

Paranoia

Increase in blood pressure

Dangerously high body temperatures

Irregular heartbeat

Risk for seizures and stroke at high doses

If you or your family has ADHD medication at home, be aware that it may be of interest to friends and family. Keep a close eye on your supply, especially if you have other teens and young adults in the house. Always keep medication out of reach of children. Keep open lines of communication with your kids about the pressures they experience and healthy perspectives on drug abuse. If you notice any red flags like a rapidly dwindling medication supply or sudden increases in cash flow, talk to them about it.

If you notice some changes in your teen and suspect drug abuse, look out for red flags such as: insomnia, excessive weight loss, twitching, disinterest in their hobbies, memory problems, neglect of personal appearance, sudden disinterest in work, school, or family responsibilities, or change in spending habits (for example, money missing or sudden requests for money without a reasonable explanation). If you notice or suspect signs of a drug problem in your teen, take action right away. Consult their primary care physician or school guidance counselor.

If you or someone you know is in a crisis and need to speak with someone immediately, call the National Suicide Prevention Lifeline: 1-800-273-TALK. This is a crisis helpline that can help with a variety of issues.

If you need information on treatment and available resources, speak to your child’s primary care doctor, or visit the Substance Abuse Treatment Facility Locator, or the National Institute on Drug Abuse for Teens.

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Quiz: How Much Do You Know About Teen Alcohol and Drug Use?

Each year, the National Institutes of Health observes National Drug & Alcohol Facts Week in an effort to dispel myths about alcohol and drug abuse, and educate teens on dangers of use and addition. Take this quiz to test your knowledge of alcohol and drug use among teens, including what may be a warning sign.

    1. Teens may abuse alcohol and drugs for a variety of reasons. Choose all that apply.
      1. Negative peer pressure
      2. Family tensions
      3. Access to cash, alcohol and drugs
      4. Trauma
      5. Pressure to perform at school, in the home, or in extracurricular activities
    2. True or false: One-third of high school students have consumed alcohol in the last 30 days.
    3. Cigarette-like devices have gained popularity in recent years. Which are true about the danger of e-cigarettes? Choose all that apply.
      1. E-cigarettes may sometimes contain less nicotine than conventional cigarettes, but the addictive substance is still present.
      2. Non-users can be affected by emissions through second- and third-hand exposure.
      3. E-cigarette and conventional cigarette use have comparable levels of exposure to formaldehyde (a carcinogen).
      4. Because using e-cigarettes mirrors the dangers of cigarette use, the best way to quit cigarettes is to promote alternatives including gums and patches.
    4. True or false: Over-the-counter medications are harmless since they do not require a physician visit or a prescription.
    5. In 2014, the nonmedical use of prescription drugs was highest among young adults. What can parents due to properly store medication in the home, helping prevent prescription drug abuse?
        1. Throw expired or unused prescription medications in the trash as soon as possible.
        2. Store prescription medications in a purse or nightstand, out of sight of kids and teens.
        3. Include education on the dangers of prescription drug abuse as part of your safe storage practices.

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Putting a Stop to Opioid Related Hospitalization in Children

By Grace Lee, Sakina Hussain and Alice Kim, clinical pharmacists at CHOC Children’s

Opioids are a type of medication used to treat pain by blocking pain signals to the brain and decreasing the body’s perception of pain. When used appropriately under the supervision of a physician, prescription opioids are safe and effective medications. However, they are not without potentially serious side effects.

“The past two decades have seen a medical industry-wide emphasis on recognition and treatment of pain. This may have resulted in greater customer satisfaction, but it has led to more opioid products available in more homes than ever before,” says Dr. James Cappon, CHOC’s Chief Quality and Patient Safety Officer. “There are local and national increases in both accidental ingestions and poisonings in children and adolescents, and intentional overdoses in adolescents, too often with serious or even fatal results.”

Examining the Increase in Opioid-Related Hospitalization in Kids and Teens

A recent research study from the Yale School Medicine confirms this observation. Over a 16-year period from 1997 to 2012, a total of 13,052 hospitalizations for prescription opioid poisonings in children were identified. The number of young children aged 1-4 years admitted for opioid-related hospitalization (ORH) doubled, while a similar increase was seen among teens aged 15-19 years.

The reasons for these hospitalizations also varied by age group: children ages 1 to 4 were hospitalized primarily for accidental ingestion, while a majority of teenagers took the drugs with the intent to commit suicide or unintentionally overdosed when taking the drugs for recreational purposes, according to the study.

Side effects of opioid use and abuse

Commonly prescribed opioids for moderate pain include hydrocodone, oxycodone or morphine. Potent opioids such as fentanyl are used to treat severe pain related to cancers and other chronic illnesses.

Opioids can cause severe constipation, nausea, stomach upset, rash, drowsiness and confusion. If taken in excess, there is potential for dependence. Opioid overdose can result in dangerously slow breathing, low blood pressure and coma. In particular, opioids and alcohol are a notoriously deadly mixture.

Safeguarding our children

This study underscores the dangers of prescription opioids, which can often be more accessible than street drugs. “While greater awareness around reducing opioid dependence and prescribing is developing in the medical community, it is extremely important that our patients and families partner in keeping our children safe,” says Dr. Cappon.

Safeguarding our children starts with education and developing a healthy respect for these powerful pain killers. Precautions should be taken to store these medications away from children. Parents can also learn to identify signs and symptoms of opioid overdose to in order to seek help as soon as possible. Some practical tips include:

  • Safe storage – keep all medications away from your child’s reach and sight. Store in locked cabinets, if possible.
  • Safety cap – when filling prescription medications at pharmacies, request child resistant caps to be placed on the medication bottles to prevent easy access.
  • Safe administration – when giving medication to you child, double check the directions on the medication label. Liquid medications should be measured accurately when giving to your child. Keep track of how much medication is left over.
  • Safe disposal ­– expired medications or those that are no longer needed should be disposed of properly. The Food and Drug Administration recommends disposing some medicines, including opioids, by flushing them down the toilet or sink. If you are not sure whether your unused medication can be safely flushed, please check online for community drug take back days in your area.
  • Be aware of medication side effects – be familiar with common side effects of opioids such as nausea, vomiting, constipation, urinary retention, dizziness, drowsiness and confusion.
  • Recognize signs and symptoms of overdose – overdose is life-threatening. If you notice any of the following symptoms, call 911 immediately:
    • Pale face
    • Clammy skin
    • Limp body
    • Blue/purple lips and fingernails
    • Choking or gurgling noises while asleep
    • Cannot be awakened or are unable to speak
    • Slow/no breathing or heartbeat
  • Recognize signs and symptoms of inadequate pain control – it is important to control your child’s pain adequately with the right medications. Besides discomfort, inadequate pain control can lead to drug-seeking behaviors. Talk to your provider about the addition of non-opioid medications that can help with pain.
  • Be aware of your child’s physical and mental health ­– studies have shown that there is an increased risk of substance abuse (including opioids) in children with psychiatric disorders. Be involved with your child’s health and have an open discussion to prevent abuse.

For reference, a list of opioids and their brand names:

Opioid Brand Name
Codeine
Fentanyl Actiq, Duragesic, Subsys, Lazanda, Fentora, Abstral
Hydrocodone Lortab, Vicodin, Norco  Hysingla ER, Zohydro ER
Hydromorphone  Dilaudid
Methadone Dolophine
Meperidine Demerol
Morphine MS contin, Kadian, Avinza, Embeda (with naltrexone)
Oxycodone Percocet, Oxycontin, Roxicodone, Oxecta, Xtampza ER, Oxaydo

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Exploring the Dangers of E-cigarettes

By Dr. Tomomi Hayashi, pediatric resident at CHOC Children’s

Cigarette-like devices have gained in popularity among teenagers in recent years. If you’re the parent of an adolescent, it’s important to separate fact versus fiction with these devices.

What are e-cigarettes?

E-cigarettes are battery-powered smoking devices that use cartridges filled with liquid containing nicotine. This liquid is then converted to a vapor which is inhaled. According to the Centers for Disease Control, 16 percent of high school students are currently using e-cigs, as of 2015. There are a variety of these delivery units: disposable cartridges that look just like a cigarette, all the way to complex rechargeable vaporizers.

E-cigarettes vs Cigarettes

E-cigarettes, unlike regular cigarettes, do not burn tobacco and therefore the individual does not inhale the same amount of tar and carbon monoxide. As a result, many people incorrectly assume they are safe to use. One common misconception is that e-cigarettes do not contain nicotine or other harmful substances. This is not true. In fact, e-cigarettes contain nicotine as well as other chemicals (toxicants, carcinogens and metal particles), that are harmful to the individual inhaling the substances and the people around them.

E-cigarettes contain anywhere from 0-36mg/ml of nicotine, while conventional cigarettes contain 10-30 mg of nicotine per cigarette. Nicotine is both toxic and addictive. It is absorbed into the lungs and body, affecting multiple systems including the brain and nervous system, as well as the heart by raising blood pressure, heart rate and possibly leading to abnormal heart rhythms. There is even the potential for heart failure and death. For children and adolescents, it can be very harmful to brain development. Because it is an addictive substance, once stopped individuals can feel depressed and tired. With prolonged use, nicotine can have serious effects on the body leading to heart disease, blood clots and stomach ulcers. Just like with smoking regular cigarettes, nonusers can be affected by emissions through second- and third-hand exposure.

While exposure to some chemical components has been shown to be lower in e-cigarettes, studies have shown comparable exposure to formaldehyde (a carcinogen), as well as increased exposure to compounds known to irritate the lungs and contribute to cardiovascular disease.

Alternatives for smokers

Because using e-cigarettes mimics cigarette use, the best way to quit cigarettes is to promote alternatives including gums and patches. Consult your primary care doctor with questions and information on a plan that is right for you.

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Alcohol & Drug Abuse in Teens

As adolescents become more independent, parents often worry about their teens making healthy decisions, including staying away from drugs and alcohol. In honor of National Drug and Alcohol Facts Week, we spoke to Dr. Harvey Triebwasser, director of adolescent medicine at CHOC Children’s about what parents can do to prevent alcohol and drug abuse in teens.

Warning Signs

The most common misconception among parents is the belief that “my kid would never do drugs.”

Parents play a crucial role in identifying possible warning signs of substance abuse in their child. But, outward appearance, school performance, or even extra-curricular activities are not necessarily indicators of drugs and alcohol abuse. Instead, parents should be aware of extreme changes in their teen’s mood, sleep patterns, and eating habits. Since these can also be signs of adolescent development, look for drastic changes, rather than minor shifts in habit.

Teens may abuse alcohol and drugs for a variety of reasons, says Triebwasser, including:

  • Negative peer pressure
  • Family tensions
  • Access to cash, alcohol and drugs
  • Trauma
  • Pressure to perform at school, in the home, or in extra-curricular activities

Parents who are mindful of these potential triggers can be proactive in preventing their teens from turning to drugs or alcohol as a coping mechanism.

Abuse Prevention

Parents must verbalize rules and expectations, including consequences for breaking rules. Quality communication is the key to building trust in the home, says Triebwasser.

They should also model the behavior they expect from their children. If a teen sees adults in their home abusing alcohol or drugs, they are more likely to experiment with substances themselves, he says.

Adults should also properly store and dispose of prescription medications. Behind alcohol and marijuana, prescription and over-the-counter drugs are the most commonly abused substances by Americans ages 14 and older, according to the National Institute of Drug Abuse.

Getting Help

A wide range of health services are available to teens at CHOC, provided my male and female physicians who specialize in adolescents.

Psychologists can also be part of the healthcare team, and address the needs of the whole family.

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