Adolescents in U.S. public high schools have little trouble trading, selling, or giving away prescription medications, including stimulants, sedatives, and sleeping and pain relief drugs, according to a survey of 7th- to-12th grade students in an ethnically and racially balanced high school in southeast Michigan.

Conceding that their survey relied upon self-reports of drug swapping by students, where there may have been some exaggeration about the ease or frequency of the transactions, researchers said it appears there are still good reasons for concern about the problem, especially since the Substance Abuse and Mental Health Services Administration (SAMHSA) is pointing to misuse of prescription medications as the fastest-growing category of drug abuse.

In the survey, students were asked to respond to computerized questions about their medical and nonmedical use of sleeping, sedative, or anxiety, stimulant, and pain medications, and were asked if they had been solicited to divert their prescription drugs to other persons—and if so, who had asked for the drug, and who had received it.

Their data, while preliminary, show a number of things, the researchers said.

• In the study of 1,086 public school students, almost half had received a prescription for a scheduled medication (one described as Schedule I, II, or III by the Food and Drug Administration in terms of its potential for addiction or abuse) in their lifetimes, and one in three had had a prescription in the previous year. Opioid analgesics were the most widely prescribed and the most widely abused. Stimulant and sedative or anxiety medications had the highest illicit-medical use ratios.
• Diversion was common: between 29 percent and 62 percent of 390 students with legal prescriptions had been approached to divert their medications within the previous year.
• Students reported "trading" medications, and those who diverted them to others were more likely to have given them away than to have sold them. A relatively small number of students reported having had their prescription drugs taken from them by force. Girls appear to be slightly more likely than boys to divert medications, primarily to their female friends.

It appears from the numbers that physicians are quick to write prescriptions for Schedule II and III medications, which the FDA identifies as subject to addiction and abuse, though physicians rarely report talking to young patients about potential medication abuse. "Our data," said the researchers, "indicate that physicians, nurses, and dentists must discuss the proper use of abusable medications; it appears that many middle school and high school students engage in exchanges that challenge traditional ways of educating about drug abuse." And it appears from the numbers that "availability is high." A 16-year-old student speaking to one of the researchers said, "Pills are so easy to get; I can get Viocodin, Adderall, or Ritalin anytime I want at school." 

The Michigan researchers defined the terms they used in their study in describing the school drug diversion scene.

"Nonmedical use, prescription drug abuse, and illegal use of prescription medications (drugs) refer to the same phenomenon and are defined as the use of prescription medications to ‘get high,' to create an altered state, or for reasons (or by routes) other than what the prescribing clinician intended. The use of someone else's prescription is illegal. Diversion of prescription medications (drugs) is defined as the exchange of prescription medications that lead to the use of these drugs by people other than for whom the prescribing clinician intended or under conditions associated with ‘doctor shopping,' misrepresentation of medical problems, or theft."

In the computerized survey, students were asked if  "based on a health professional's prescription," they had used the following types of prescription drugs in their lifetimes or during the previous year:

• Sleeping medication (e.g., Ambien, Halcion, Restoril, etc.);
• Sedative or anxiety medication (e.g., Ativan, Xananx, Valium, Klonopin, etc);
• Stimulant medication for attention deficit/hyperactivity disorder (e.g., Ritalin, Adderal, Concerta, etc.), and
• Pain medication (e.g., Viocodin, OxyContin, Tylenol 3 with codeine, etc.).

What the study strongly suggests, the researchers concluded, is that secondary school students, physicians, nurses, and parents should be educated and should closely monitor the medical use, illicit use, and diversion of abusable prescription medications. "School administrators must enforce policies that require centralized medication monitoring. Too often, parents and students fail to report the medications they have been prescribed."

The research report on which this article is based, "Prescription Drug Abuse and Diversion Among Adolescents in a Southeast Michigan School District," was published in the March 2007 issue of Archives of Pediatrics and Adolescent Medicine.