Kate Johnson

April 18, 2011

April 18, 2011 (Washington, DC) — Adolescents seeking prescriptions for opioids should be carefully screened to rule out abuse or dependence because teen opioid addiction frequently stems from personal prescriptions, new research suggests.

Results from a retrospective medical record review presented here at the American Society of Addiction Medicine 42nd Annual Medical-Scientific Conference showed that of 125 teenagers seeking treatment for opioid addiction at the hospital's addiction treatment program, the majority (67%) had a history of at least 1 personal prescription for opiates during the past 2 years, with a mean number of 5.3 prescriptions per patient.

According to study investigator Steven C. Matson, MD, an adolescent medicine and addiction specialist at Nationwide Children's Hospital and Ohio State College of Medicine in Columbus, the patients' controlled substance prescription history was obtained using the Ohio Automated Rx Reporting System, which was established in 2006 to help identify drug-seeking behaviors.

"There was a range of histories, some patients had received no prescriptions, but 1 patient had received 59 prescriptions over 2 years, totaling almost 2300 pills," Dr. Matson told Medscape Medical News.

Although some patients obtained prescriptions from multiple physicians, many received them from a single physician, he added.

'Pill Mills'

"I can't say what's in doctors' minds. I think a lot of them are from orthopedics or ob/gyn, or they are ER [emergency room] docs that are just seeing people for a quick slice. But for a lot of these patients we got long histories of doctors who were prescribing 90 Xanax each month for a year — and many times it was the same doctor. Everywhere in the country there are certain rogue doctors who have practices that we call 'pill mills' — we have plenty in Ohio."

The mean age of the subjects in the study was 18.5 years, and the majority (59.2%) were female.

Although a significant portion (41.6%) were addicted to heroin alone, the majority were addicted to opiates — either alone (36.8%) or in combination with heroin (21.6%).

Common drugs included hydrocodone (67%), codeine (31%), oxycodone (30%), tramadol (29%), anxiolytics (20%), and stimulants (20%).

On average, females received more than twice as many prescriptions as males (6.6 vs 3.0), except for stimulants, which were prescribed more frequently to males (15% of males vs 11% of females).

In addition, opiate-only abusers received almost 3 times as many prescriptions (mean, 8.5) as heroin-only or opiate plus heroin abusers (mean, 2.9 and 3.0, respectively).

"I think there's going to be multiple ways we can use data like this," said Dr. Matson. "It speaks to us to go out and talk to emergency room physicians and maybe have them pull backgrounds like this. If they see a kid already has multiple prescriptions from other providers that might be a great opportunity to start talking about their drug abuse."

He said pharmacists can also play a role. "They can see if someone's been getting many prescriptions from different pharmacies so they also can intervene."

No Place for 'Benzos'

Reached for comment, Jeffrey T. Junig MD, PhD, a psychiatrist at the University of Wisconsin, Oshkosh, Student Health Service said, "The 'benzos,' like Xanax, have no role in teens — except in the oldest teens with the most severe panic disorder and only in very small doses."

Benzodiazepines are "amnestics," said Dr. Jung. "They prevent learning and concentration. That is basically how they treat anxiety — by making it hard to focus on the object of worry."

Dr. Junig, who is also assistant clinical professor of psychiatry at the Medical College of Wisconsin and runs a private clinic in Fond du Lac, Wisconsin, said most physicians recognize the need to use opioids in some patients, but it is rarely appropriate in teens.

"Using opioids at such an early age reinforces 'addictive thinking' — a inappropriate focus 'inward,' and the desire to change one's mood using medications," he said.  

"People who are appropriate candidates for opioids are those who have failed back surgeries or who have phantom limb pain, for example — people who have failed conservative measures. Teens are rarely in that position, and using opioids is only reasonable if one completely disregards the huge problems that will appear down the line — including tolerance, withdrawal, and psychological dependency."

Dr. Matson has disclosed no relevant financial relationships. Dr. Junig reports receiving speaker's fees from GlaxoSmithKline and Shire Pharmaceuticals.

American Society of Addiction Medicine (ASAM) 42nd Annual Medical-Scientific Conference: Abstract P16. Presented April 15, 2011.

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