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- Review the incidences of teenage prescription drug abuse
- Discuss risk factors for drug abuse
- Review prehospital assessment and management of teenage prescription drug abusers
- Discuss drug isolation and long-term management of these patients.
Squad 22 arrived on scene at Longfellow High School for a 16-year-old male who was reportedly lethargic. When the crew walked into the nurse's office, they were directed into the side exam room, where their patient was curled up under a blanket. They noticed the nurse had placed the patient on a nasal cannula. She explained that, at the end of study hall, which was 50 minutes long, the monitor noticed that "Joshua" did not get up with the bell. The nurse was summoned to his side and Joshua responded to verbal stimuli. He was then placed in a wheelchair and brought to the nurse's office.
While the nurse gave her report, the two EMTs performed an examination and obtained vital signs. The crew noted that the patient was slow to open his eyes and roll over with verbal command. He would not obey any other commands and kept rolling back into a fetal position. His pupils were equal, round and sluggish to light, airway was patent, lungs were clear, abdomen was soft and nontender, and there were no signs of trauma. Vital signs were: pulse 94, respirations 10 and shallow, blood pressure 108/62, skin warm, moist and pink.
The crew lifted Joshua to their cot and, as they checked his blood sugar to rule out hypoglycemia, they began reviewing the list of potential causes for Joshua's condition:
- Postictal following a seizure
- Toxin exposure
- Drug overdose
- Cerebral hypoxia
- Increased intracranial pressure
- Alcohol intoxication.
Prescription drug misuse and abuse is on the rise. More than 15 million Americans are currently abusing prescription drugs; 4.7 million admit to abusing pain relievers, the most commonly abused prescription drug in the United States.1 Opioid analgesics are the leading cause of prescription drug overdose-related deaths.2 Other commonly abused prescription drugs include central nervous system (CNS) depressants, such as barbiturates and benzodiazepines, and stimulants. In 2004, more than 48 million Americans ages 12 and older admitted to abusing prescription drugs at some point in their life.3
Prescription drug abuse is a rampant problem among today's adolescents. In 2004, more than 1.5 million teens met the diagnostic criteria for substance dependence and abuse.3 In 2009, the number increased to 1.9 million teenagers aged 12-17.4 A 2007 study showed that more teenagers recreationally used opioids than marijuana.2 Two opioids, oxycodone and hydrocodone, top the list of prescription drugs abused by today's teenagers, followed by analgesics, tranquilizers and stimulants.3 Somewhat surprisingly, girls abuse more prescription drugs than boys between the ages of 12 and 17.5 These numbers raise the questions of what drugs are being abused and why. It's important to answer these questions and solve this problem, because every day a new group of 2,000 teenagers take a prescription drug without a doctor's order.4
Drug Types and Frequencies
A variety of reasons help trigger the high abuse rate in teenagers. Among the most commonly cited are ease of access at home, ease of purchase via the Internet, prescription sharing at school, and the general mentality that the drugs are legal and thus safer than illegal drugs. Under the auspices of these beliefs, the majority of prescription drugs abused by teenagers fall into three main categories.