| Every Thursday evening, I counsel a
group of teenagers with serious substance abuse problems. None of the youngsters
elected to see me. Typically, they were caught using drugs, or worse, by their
parents or a police officer and were then referred to my clinic. To be sure, all
the usual intoxicants--alcohol, marijuana and cocaine-are involved. But a new
type of addiction has crept into the mix, controlled prescription drugs,
including painkillers. This is hardly unique to my clinic. Several studies
report that since 1992, the number of 12-to 17-year-olds abusing controlled
prescription drugs has tripled. One of my patients, Mary, illustrates this trend all too well. Mary at 16 is a "garbage head", meaning that she will ingest anything she thinks will give her a high. Last December, she was taken to the hospital for an overdose of alcohol, and ketamine, a chemical cousin of angel dust that doctors sometimes use to anesthetize patients and that, more commonly, veterinarians use to sedate large animals. So where does this physically energetic teenager obtain her pills? Weeks earlier, she had an operation, a minor though uncomfortable procedure by any standards. The surgeon wrote a prescription for 80 tablets. Mary spent the next week in the addiction of the drug until her mother confiscated the last 20 tablets. At medical conferences, I hear colleagues fault parents who abuse and obtain these controlled substances but leave them easily accessible in their unlocked medicine chests where teenagers can help themselves. Other experts fault the Internet, where al-most anyone can obtain controlled prescription drugs from offshore pharmacies with a few clicks on a home computer. None of these targets come close to the real root of the problem. Many doctors are too quick to write prescriptions for these powerful drugs. The National Center for Addiction and Substance Abuse recently reported that 43.3 percent of all American doctors did not even ask patients about prescription drug abuse when taking histories; 33 percent did not regularly call or obtain records from a patient's previous doctor or from other physicians before writing such prescriptions; 47.1 percent said their patients pressured them into prescribing these drugs; and only 39.1 percent had had any training in recognizing prescription drug abuse and addiction. No one in pain--physical or psychic--should suffer. But the fact remains that we doctors still do the bulk of prescribing of the substances. The search for root causes of the epidemic with controlled substance abuse has to include doctors as active participants. A big part of the solution depends on reserving prescriptions for those who need, rather than de-sire, them. |