Monday, March 21, 2016

Pre-Gaming with ADD Meds...A Dangerous Party Plan

Binge drinking in college students is not exactly breaking news.  My patients repeatedly explain "if you can't handle five shots of vodka, you are pretty lame".  They toss back multiple shots, have beers, then top off with mixed drinks. Hit the replay button once or twice, and the weekend is over. On Monday morning, they head back to class, seeming none-the-worse for wear beyond a headache.  How is this possible? Especially for adolescents who are only STARTING to drink, how exactly can they tolerate this volume of alcohol?  I started asking...and heard the same answer, over and over. "Well, to be honest, I pre-game with my ADD meds". 

PRE-GAME? Yes. Young people have figured out that when they take a prescription stimulant right before going out to party, they can "hold" more liquor. The stimulant takes away the typical buzzed, relaxed sedation of the first few drinks. Many have told me they "feel absolutely nothing at all from the alcohol...till I reach a certain number of shots, then suddenly I go from sober to super buzzed, and then either puke or pass out."

At first this confused me...wasn't the POINT of their drinking to catch that buzz in order to feel more social or confident? It seems counterintuitive. But if the peer pressure now is not only to drink, but to show you are so comfortable with drinking that it doesn't affect you- then this plan makes total sense. Except that this plan is so very dangerous, which makes it terrifying instead.

Unfortunately, not "feeling" the effects of alcohol does not mean that the alcohol is less potent within your brain, liver, bloodstream or nerves. This practice makes it far too easy to reach ALCOHOL POISONING levels, because you have turned off all your body's warning signs. Short term, you can hit toxic levels of alcohol that make you stop breathing. Or enough to "just" pass out...but then throw up and choke on your vomit. Long term, you are taking the HOV lane to end-stage alcohol complications because although you may only drink on weekends, you are getting huge quantities in at one time. And socially, this practice is normalizing binge drinking, because everyone sees their friends routinely drinking numerous drinks without it seeming to affect them.

A recent Cochrane meta-analysis Social norms information for alcohol misuse in university and college students examined 70 studies, including nearly 45,000 students. The premise was that college students have an inflated misperception of how much their peers are drinking, and therefore educating them about the true social norms may reduce alcohol-related consumption and subsequent problems. Although there were some significant effects, the "substantive meaningful benefits" were not enough to recommend policy changes.

As a side note, many students are taking ADD meds they have borrowed or purchased from a friend, which is not only illegal but magnifies their medical risk.

Yes, binge drinking in college has been around for a very long time, and thankfully the majority give up this habit when they hit the real world- if they survive their risky behavior. Note that a standard screening question for alcohol abuse is "have you had more than 4 drinks in one day during the last year?" 

Wondering how many drinks it would take for YOU to get alcohol poisoning? Check out one of my favorite resources: Aware, Awake, Alive

BOTTOM LINE: Doctors, parents and teens ALL need to know the dangers of "pre-gaming" with ADD meds. 

Wednesday, March 16, 2016

Drug Abuse from YOUR Medicine Cabinet

Prescription drug abuse is at an all time high- no pun intended. Sadly, studies have found that 1 in 5 high school students say they have taken a prescription drug without a prescription. What are they taking? Pain killers, stimulants, and anxiety medications. Specifically, the most common drugs are OxyContin, Vicodin,  Percocet (narcotic pain pills), Ritalin & Adderall (ADD stimulant drugs), and Xanax (called "bars" because of the shape-an anti-anxiety sedative like valium.)

Many people have a false sense of security using prescription medications to catch a buzz, especially adolescents. The prescription element seems to be a stamp of safety for them (similar to "organic" equals "better"-but I digress). Frankly, it terrifies me to hear of kids swapping any prescription medications, particularly ones as potent as these. Add in that these pills are often combined with alcohol, and you now have a recipe to take your breath away- literally. Both narcotics and alcohol can suppress your drive to breathe, and they are additive when taken together.  Accidental overdose is a frighteningly common cause of death for teenagers, and inappropriately used prescription drugs are a major culprit. When I prescribe codeine cough syrup (which is the most common reason I prescribe narcotics this time of year), I always remind my patients that this "cough" medicine is a narcotic, and NARCOTICS + ALCOHOL = DEATH.

Another common pairing of prescription medications and alcohol is "Pre-gaming" with ADD meds, with the intent of revving up with the stimulant so they can "handle" their liquor better...which is a fast track to alcohol poisoning.

What can parents do about this alarming trend?
Number one, TALK to your teen. Ask (in a non-threatening, conversational tone) if they are aware of anyone borrowing prescription medications from friends. Let them know this is DANGEROUS and ILLEGAL. Please throw in the fact that it is a FELONY to buy or sell prescription drugs, and that charge is a one way ticket the wrong direction. The truth is that there is a ton of "altruistic" sharing of medications in college, and that sharing often becomes buying and selling between friends. Kids want the stimulants to help them pull an all-nighter, and that seems like a good and worthy cause to them (although numerous studies have proven all-nighters don't help grades.) Students also want these drugs to lose weight, or "hold their liquor", or  to use as an escape. Acknowledging these issues up front can lead to a more productive conversation, and talking with your teen at least lets them know you are aware of this risky behavior in general.

Next step? Take a close look at your medication cabinet. Throw away expired drugs, and keep close inventory of any potentially abused medications. If your kid is on ADD meds, make sure they are taking them as prescribed. Finally, if you realize that you are using prescription drugs inappropriately, it's time for a difficult conversation with your physician. You can't abuse it if we don't prescribe it, so this is a problem we need to tackle together, and there are solutions beyond simply cutting you off.

BOTTOM LINE: Prescription drug abuse is out of control. Learn the facts and protect and educate your teens. Get more info at the National Institute on Drug Abuse.