When Sarah Roisman was 11 years old, her doctors prescribed Klonopin, a muscle relaxant, for a psychiatric disorder that caused her to have seizures. She liked how the drug made her feel. Her seizures went away.
But that's where her trouble with addiction began.
By age 14, the teen from an upper middle-class Philadelphia suburb led a dangerous double life. Editor of her school paper, strong student and popular athlete, Roisman was also hooked on painkillers and other drugs in an addiction that illustrates how prescription drug abuse can develop.
"My friends and I would take a bunch of different pills and break them up and put them all together and call it confetti. It could be any combination of anything," said Roisman, who is now 17.
Hollywood overdoses highlighting problem
The issue of prescription drug abuse shot to prominence with January's death of 28-year-old Hollywood actor Heath Ledger after he took six different prescriptions. The death of Ledger, who plays the Joker in the new Batman film The Dark Night, adds to a growing list of prescription drug overdoses that includes Playboy model Anna Nicole Smith in 2007.
Other deaths are less celebrated. In the 45 - 54 age group, overdose deaths fuelled by prescription drugs now surpass motor vehicle deaths as America's #1 cause of accidental death, federal data show.
The federal data also show nearly 7 million Americans abused prescription drugs in 2007 - more than cocaine, heroin, hallucinogens, Ecstasy and inhalants such as marijuana combined. The figure is up 80 percent since 2000.
Definitions of abuse vary, but refer typically to nonmedical use of prescription drugs.
The number of Americans treated for abuse of painkillers surged 321 percent from 1995 to 2005, federal statistics show - a trend some health experts link to another stunning figure: the 180 million prescriptions dispensed legally by US pharmacies each year for pain medication.
More deaths than from street drugs
In Florida, whose reputation for cocaine and other hard drugs was burnished in movies such as Scarface and Miami Vice, the rate of deaths caused by prescription drugs was three times the rate of death caused by all illicit drugs combined, according to an analysis of 2007 autopsies by the Florida Medical Examiners Commission released in June.
"What you have among over-the-counter and prescription drug use is a very low perception of risk," said Stephen Pasierb, president and chief executive of the Partnership for a Drug-Free America, a non-profit advocacy group.
"There's very low social disapproval. In fact, there are parents who almost relieved that their kid is using Vicodin and not smoking marijuana," he said.
Len Paulozzi, an epidemiologist with the National Centre for Injury Prevention and Control, testified recently in Congress that he believed physicians were improperly trained in the long-term dangers of therapy involving opioid painkillers, or drugs containing opium.
"There are guidelines out there, but we don't think that they're being routinely followed," he said.
Containing the abuse difficult
Senator Joseph Biden, a Democrat from Delaware, proposed to make August 2008 "National Medicine Abuse Awareness Month" in a resolution now before the Senate Judiciary Committee, saying the Internet had become "an information superhighway" for abuse of medicine in the United States.
But containing the abuse is notoriously difficult. Thirty-eight states have passed legislation for prescription drug monitoring programs to trace the source of drugs, and police in some states have had success in reducing pharmacy break-ins.
A University of Maine program provides pre-addressed, postage-paid pouches to the elderly so they can mail their surplus prescription drugs to state authorities for disposal in a bid to reduce the amount that get into the wrong hands.
None of the measures has stopped the growth nationwide, and experts point to several stubborn problems, including the phenomenon of "doctor shopping," in which patients go to multiple doctors to get several prescriptions.
Hundreds of online pharmacies also offer drugs that include generic versions of opiates like Purdue Pharma's OxyContin, methadone and Abbott Laboratories Inc's Vicodin, which are legitimately prescribed as painkillers, along with stimulants like Ritalin made by Novartis, and benzodiazepines like Pfizer's Xanax.
It is as easy to buy opiates or other abusable prescription drugs online as it is to purchase a book, said David Festinger, a scientist who has studied online drug sales at the Treatment Research Institute at the University of Pennsylvania. Regulating such trade is tough, he said.
"These Internet enterprises set up a bank account in one country, buy their drugs from another country, and do their merchandising and sales from another country," he said. "Everything is spread all over the globe. And in an instant, if anybody's on their tail, they can switch everything around."
For many children, getting the drugs is simple. In Philadelphia, Roisman and her friends raided family medicine cabinets for the big prizes - OxyContin, a kind of synthetic morphine also known as "hillbilly heroin", along with Ritalin and Vicodin - until she eventually passed out one day in school. A drug test showed she had seven drugs in her system.
"People think that it's okay because it's a prescribed pill. It comes from a credible source. Even if a doctor has not told you it's okay, they've told someone else it's okay," said Roisman, who became sober two years ago after treatment at a rehab centre.
She blames doctors for failing to "watch what they are prescribing" and parents for failing to understand "just how hard people will work to get what they want when they are an addict", adding many teens use the drugs to help study.
Students use drugs to cope with pressure
On college campuses, popping Adderall, Ritalin and other prescribed amphetamine-like psychostimulant drugs is a popular way to help cram for tests and cope with academic pressure.
Some are legitimately prescribed for attention deficit hyperactivity disorder, helping sufferers increase alertness, attention and energy.
Almost 60 percent of students have been offered an opportunity to try prescription stimulants by their third year of college in the US, said Amelia Arria, a senior researcher at the University of Maryland's Center for Drug Abuse Research, which surveyed 1 253 students on drug usage.
Health insurers are also feeling the effects. Some face mounting pressure to expand coverage to include substance-abuse disorders. Others are grappling with swindlers who obtain illicit prescription narcotics through fraudulent insurance claims for bogus prescriptions, treating phantom injuries.
Such fraud costs health insurers up to $72.5 billion a year, according to a 2008 report by the Coalition Against Insurance Fraud, an advocacy group based in Washington. – (Reuters Health, July 2008)
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