More teens taking high-risk meds

U. ROCHESTER (US) — The rate at which doctors prescribe controlled medications to teens has nearly doubled in the past 14 years—despite the fact that drug misuse is highest among young adults.

A new study published in the journal Pediatrics finds between 1994 and 2007, prescription rates for controlled medications rose from 8.3 to 16.1 percent among young adults and 6.4 to 11.2 percent in adolescents. This increase was observed for both males and females and across multiple settings—ambulatory offices, emergency departments, and for injury related and non-injury related visits.

Overall, a controlled medication—a drug the Drug Enforcement Administration deems as having the potential for abuse—was prescribed for young adults at approximately one out of every six visits and for young adult by adolescents one out of every nine encounters.

“Physicians must balance the need to treat patients’ symptoms while remaining aware of the possibility that prescription medications can be misused or shared with others. At times, it can be a delicate balance between treating a problem and inadvertently causing one,” says principal investigator Robert Fortuna, assistant professor of pediatrics and internal medicine at the University of Rochester.

The study, which examined prescription patterns for teens 15- to 19-years-old and young adults 20- to 29-years-old, broke down clinical visits by classification of drug prescribed, type of visit, place of visit, and demographic and geographic factors. Drugs were classified as narcotics (or opioids), sedatives, and stimulants.

Controlled medications were often prescribed for common conditions such as headaches and back pain.

While the study did not examine the appropriateness of prescriptions, researchers suggest that physicians take responsibility for monitoring patients receiving controlled medications to ensure that the treatment is effective and that the medications are being used appropriately.

The rising trend in prescriptions for narcotics among young adults may be due in part to evolving state and federal regulations increasing advocacy for pain management, say researchers. For example, prescriptions for narcotics rose after 2001, when the Joint Commission on Accreditation of Healthcare Organizations launched an initiative to monitor and treat pain as a fifth vital sign (along with temperature, pulse, respiration, and blood pressure).

Sedative medications were increasingly prescribed to young adults and adolescents. A heightened awareness of insomnia and anxiety, the availability of new pharmaceuticals, and widespread direct-to-consumer marketing may be key reasons, say researchers.

The study also suggests that adolescents are increasingly prescribed stimulant medications. While reports between 2002 and 2008 showed that the overall misuse of stimulant medications like Ritalin has decreased, a recent study found that poison centers are increasingly receiving calls from those who have intentionally misused stimulants, which could mean that the smaller numbers of those misusing stimulants are doing so more intensively.

While researchers acknowledged that prescribing more controlled medications does not necessarily foster abuse or diversion—sharing medications with others—they advocated for more vigilance when physicians prescribe medications to young adults and adolescents.

“Physicians need to have open discussions with patients about the risks and benefits of using controlled medications, including the potential for misuse and diversion,” Fortuna says.

Researchers used data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

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