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 Health & Beauty | On Addiction | February 2005 
Their Drugs of Choice
 Daniel Costello - The Los Angeles Times
Ryan Smith remembers the night, during his junior year of high school, when a friend gave him his first Vicodin. "It felt so incredible. I remember thinking, 'I am going to do this for the rest of my life,' " he says.
 Over the next year, Smith, now 22, and his friends moved on to other pills - Xanax, Valium, OxyContin and the attention deficit disorder medication Adderall, called "kiddie cocaine" for its ability to be crushed and snorted. "At the time, it felt like I knew more kids who were doing pills than who weren't," he says of his Utah high school days.
Daniel Smith, his younger brother, began using prescription drugs the same way when a friend offered him Vicodin while watching a school football game during his sophomore year. By that summer, he began taking "weak painkillers" such as Lortab and Percocet. Finally, he turned to highly addictive OxyContin, using it several times a week.
Although the brothers eventually went through an addiction program, they never considered themselves "druggies." They were using pills safe enough to be used by millions of Americans, drugs both legal and easy to get. Each generation typically finds a new illicit drug to make its own: LSD in the '70s, cocaine in the '80s and Ecstasy and heroin in the '90s. Today's middle and high school students are experimenting with prescription drugs.
Their drugs of choice are those often preferred by adults. After amphetamines such as Ritalin, they're turning to painkillers such as Vicodin and Percocet, then sedatives and tranquilizers. With illicit use tied to availability, California's share of the problem is considerable. Californians account for 12% of the nation's population and 8% of the nation's prescription drug use.
Nationwide, prescription pills have become a societal force. Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug.
Meanwhile, direct-to-consumer drug marketing that touts new and expanded uses has become widespread. Adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications.
As prescription drug sales have soared - up nearly 400% since 1990 - prescription medication has become the fastest-growing category of drugs being abused, with the biggest growth of abuse among people ages 12 to 24, according to the federal Substance Abuse and Mental Health Services Administration. After marijuana, prescription drugs are the drugs most commonly abused by teenagers, the federal agency says.
Nationally, an estimated 14% of high school seniors have used prescription drugs for non-medical reasons at least once in their lifetime, according to a 2004 University of Michigan survey that tracks drug trends among middle and high school students.
"It's a major concern to us that young people have the impression they can use medicine as a party drug," says Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment at the Department of Health and Human Services.
The rise in prescription abuse - or "pharming" as young people and drug counselors sometimes call it - worries treatment counselors and drug research experts. A national push to reduce drugs such as marijuana, cocaine and heroin has started to pay off, with overall drug use among young adults declining slightly in recent years. But abuse of prescription drugs - especially among younger people often dubbed the "Ritalin generation" - has been growing and could grow further as drug sales continue to increase.
"Pills are more seductive to kids because they see them as cleaner, safer and less illegal," says Carol Falkowski, a drug researcher at Hazelden, a nationally known treatment center in Center City, Minn.
Many younger users don't know what many of the drugs are for or which pills are more addictive than others, Falkowski says. Nor do they have much sense of what dosages are truly dangerous or how separate drugs interact. Are four Percocets worse than two Vicodin? Can Valium be mixed with Xanax? Treatment counselors say some young users take a fistful of different drugs at once.
Data from the federal Drug Abuse Warning Network show that visits to hospital emergency departments increased significantly from 1994 to 2002 for overdoses of drugs such as narcotic prescription pain relievers and other medications.
Although the data isn't broken down by age group, overdoses of hydrocodone, or Lortab, for example, rose 170%; overdoses of oxycodone, or OxyContin, increased 450%; and overdoses of benzodiazepines such as Valium and Xanax rose 41%. Data also show that many were using more than one drug.
Easily Available
In face-to-face and telephone interviews with students at several middle and high schools in California, students say prescription drug use is frequently talked about at school but rarely discussed elsewhere.
Prescription drugs are often more attractive than other drugs, they say, because the pills don't have the telltale signs of use, such as the smell of marijuana smoke or the disorientation of being drunk.
Girls in particular appear to see the pills as "cleaner" than other drugs. They're less likely to use marijuana or cocaine than boys but equally likely to take prescription medications.
Some students see the pills as a way to enhance sports performance. They say football players at some schools take opiates such as Vicodin before games to blunt the pain.
Researchers say many teenagers don't even have to leave the house to get high. In many cases, students filch drugs from their parents or family members - or they abuse their own medications. It is not uncommon these days, for example, for young patients to get painkillers for a sprained wrist or after a trip to the dentist. "If someone breaks their arm, kids will ask them the next day if they have Vicodin or something else they can sell," says Samantha Szelog, a 16-year-old junior at Malibu High School who says she does not use or sell drugs. Some kids, she adds, make a considerable amount of money selling their pills.
Many schools have sophisticated black markets with fixed prices for individual drugs and dosages that vary according to supply and demand.
The most abused drugs largely mirror those that adults commonly take, according to the University of Michigan survey. Most often misused are amphetamines, such as Ritalin, which are abused by 15% of students. Next are pain medications such as Vicodin and Percocet, used by 13% of students last year, up from 6% a decade ago. Sedatives and tranquilizers follow. They were used by 10% of students, nearly double the number over the same period.
An 18-year-old senior and varsity athlete at Burbank High School says she doesn't consider herself a "big druggie." But about once a month, when she and her friends can find some, they like to take Vicodin, or "vikes," after school or before parties. "I just feel calmer on it. Nothing stresses me out," she says. Her friends are less cautious. They've also tried codeine, Valium, Percocet and Xanax, sometimes mixing several at once.
A senior at Palo Alto High School, also 18, has been taking his friend's attention deficit disorder medication, Ritalin, for the last nine months. He started buying his own this summer and now takes several pills nearly every day. Although he recently started having problems sleeping, "I don't see it as a bad thing," he says, noting that he believes he has been able to study better on the pills. "Nothing bad has come from it, only good."
He adds that it's easier for people his age to get prescription drugs. "You can't go around the house and find a bag of cocaine in your parent's house, but you can find Vicodin," he says. Both students asked not be identified because of the illegal nature of their activity.
Students say prescription pills can often be less expensive than other drugs such as marijuana and cocaine. Pain pills such as Vicodin sell for around $5, depending on the dose, while stronger medications such as OxyContin can cost several times that. Ritalin, one of the most widely available drugs, sells for $1 to $2 a pill, students say, but can be more expensive before midterms and finals, when students use them to cram.
A Government Solution
Under federal law, it's illegal to possess controlled substances without a prescription. But prosecutions for possession are rare, especially when minors are involved. Many schools bar students from carrying medications without a prescription, but enforcement can be difficult.
Response from state and federal governments and pharmaceutical companies, meanwhile, has been limited. Last year, the Bush administration introduced an effort to control prescription drug abuse, but most of the plan centers on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.
The Food and Drug Administration and the Substance Abuse and Mental Health Services Administration have instituted a new print and television ad campaign, "The Buzz Can Take Your Breath Away," highlighting the dangers of prescription drug abuse among young people. And Purdue Pharma, the maker of OxyContin, has introduced a public campaign about the dangers of abusing the drug after reports of misuse.
Makers of the other prescription drugs, including Vicodin's Abbott Laboratories Inc., Valium's Hoffmann-La Roche Inc. and Pfizer Inc., the maker of Xanax, say they have instituted public awareness campaigns about the dangers of prescription drug abuse, such as giving doctors and parents brochures about monitoring the pills.
Many parents have yet to address the issue at home. According to the Center for Addiction and Substance Abuse at Columbia University, 44% of parents believe that teens who abuse prescription drugs get them from their parents - yet 71% don't take any precautions with prescription drugs in their homes.
Ryan and Daniel Smith both recently completed a rehabilitation program for prescription drug abuse. Now attending college in Arizona, they say they're trying to keep each other from relapsing.
Both have been sober for nearly a year, and they've each started part-time jobs and are dating. The two say they occasionally attend narcotics anonymous meetings but don't like going because some of the people who attend depress them.
"We weren't really druggies," says Daniel. "We just fell into something. The pills were all over the place."
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