2. On-line, off-shore and Mexican pharmacies This list has been added because of the requests we receive for pharmaceutical advice. In particular, site visitors ask where they can obtain pain-relieving medications that alone make their life worth living, but which their physician denies them owing to our prohibitionist drug laws. Some, but not all, of the pharmacies listed here may be of uncertain reliability. In a more enlightened age - and in a free society - none of them will be necessary. (last updated September 2010)

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4. Internet Sites Advertising or Offering to Sell Controlled Prescription Drugs, 2004-2008

5. Adolescent Abuse of Prescription Drugs Margot L. Waitz, DO Christiana Care Health Systems Wilmington, DE

6. Historical Perspective

18. Overview of the Problem In the 2009 Partnership/MetLife Foundation Attitude Tracking study, teens were noted to have had an increase in the use of alcohol, marijuana and ecstasy from 2008. This followed a decade of declines in teen drug use.

19. Overview of Problem In 2009 teens in grades 9 – 12 were significantly more likely to have drunk alcohol in the past month than in 2008. All measures of use of marijuana – ever tried, past year use, past month use – significantly increased between 2008- 2009. The use of ecstasy also increased among teens in grades 9 – 12.

20. Overview of Problem Teen abuse of prescription and OTC medicines remained stable between 2008 – 2009.

21. Overview of Problem 1 in 5 teens (19%) report abusing a prescription medication at least once in their lives 1 in 10 teens (10%) report having abused a prescription pain reliever in the past year About 7% of teens abused OTC cough medicine in the past year 2008 Partnership Attitude Tracking Study on Teen Drug Abuse

22. Past Year Initiates for Specific Illicit Drugs Among Persons Aged 12 and older, 2006

23. First Time Users of Pain Relievers Continue to Surpass All Other Drugs The Partnership for a Drug Free America - 2006

24. Overview of Problem 1 in 5 teens report being offered Rx medicine from a friend or peer to get high Sources: Partnership Attitude Tracking Study; Partnership Mapping Study 2006

25. Lifetime Trial Among Teens Marijuana Inhalants RX Medicines RX pain relievers Cough Medicine Ketamine Ecstasy RX stimulants Crack/ Cocaine Meth LSDHeroin GHB Source: Partnership Attitude Tracking Study (PATS) Teens 2006

26. Pain Reliever Abuse Past-year nonmedical use of Vicodin and OxyContin increased during the last 5 years among 10th-graders and remained unchanged among 8th- and 12th-graders. Nearly 1 in 10 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin. NIDA InfoFacts: High School and Youth Trends

27. Nonmedical Use of Prescription Pain Relievers in the Past Month, by Age Group: Percentages, 2002 to 2007

28. Pain Reliever Abuse 1 in 3 teens report having a close friend who abuses Rx pain relievers to get high Source: Partnership Attitude Tracking Study 2006

29. Pain Reliever Abuse Obtaining medication About 52 percent of 12th-graders said they were given the drugs or bought them from a friend or relative. 30 percent reported receiving a prescription for them A negligible number of 12th-graders reported purchasing the narcotics over the Internet. NIDA InfoFacts: High School and Youth Trends

30. Source of Rx Drugs among Those Who Used in Last Year Grade 12, 2007-2009 (percentages) Bought on Internet Took from friend/relative without asking took from friend took from relative Given for free by friend or relative by a friend by a relative Bought from a friend or relative from a friend from a relative From a prescription I had Bought from drug dealer/stranger Other method weighted N= Narcotics other than heroin 2007-2008 2009 2.3 0.0 24.2 18.6 ---- 3.6 ---- 17.9 50.5 51.5 ---- 46.1 ---- 10.1 37.1 33.6 ---- 33.6 ---- 2.9 40.2 30.3 18.6 13.0 8.5 10.0 361 153 Monitoring the Future Study, 2009

31. Stimulant Abuse Between 2004 and 2009, a drop in past- year use of methamphetamine was reported for all grades, and lifetime use dropped significantly among 8th-graders, from 2.3 to 1.6 percent.

32. Stimulant Abuse SAMHSA's National Survey on Drug Use and Health estimated that about 510,000 youth aged 12 to 17 (2%) used stimulants (including methamphetamines) nonmedically in the past year in 2006.

33. Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean Age at First Use of Methamphetamine among Past Year Methamphetamine Initiates Aged 12 to 49: 2002-2007

34. Stimulant Abuse According to the DAWN for 2004, an estimated 7,873 drug-related emergency department visits involved methylphenidate or amphetamine- dextroamphetamine The most frequent reason for these ADHD stimulant medication related visits was nonmedical use (48%), followed by adverse reactions associated with medical use (34%), accidental ingestion (10%), and suicide attempts (8%).

35. Stimulant Abuse Over 71% of youth who used stimulants nonmedically in the past year compared with 34% of youth who did not use stimulants nonmedically also engaged in at least one of the six types of delinquent behaviors in the past year that were included in SAMHSA's National Survey of Drug Use.

36. Stimulant Abuse These delinquent behaviors were: – got into a serious fight – took part in a group fight against another group – sold drugs – stole anything valued more than $50 – attacked someone – carried a handgun

37. Cough Medication Abuse The cough suppressant dextromethorphan (DXM) is found in more than 140 over-the- counter (OTC) cough and cold medications.

38. Cough Medication Abuse In the NSDUH, 2006 about 3.1 million persons aged 12 to 25 (5.3%) had ever used an over-the-counter cough and cold medication nonmedically. Nearly 1 million persons aged 12 to 25 (1.7%) had used an over-the-counter cough and cold medication to get high in the past year.

39. Cough Medication Abuse 1 in 4 teens report having a close friend who abuses cough medicine to get high Source: Partnership Attitude Tracking Study 2006

40. Cough Medication Abuse According to the DAWN for 2004, an estimated 12,584 emergency department visits (0.7% of all drug related emergency department visits) involved pharmaceuticals containing dextromethorphan. DAWN – Drug Abuse Warning Network

41. Attitudes Affecting Teen Medicine Abuse Medicine Abuse Normalized in Teen Culture Misperception that abusing medicine is not dangerous Misperception that abusing medicine is safer than street drugs Sources: Partnership Attitude Tracking Study; Partnership Mapping Study 2006

42. Attitudes Affecting Teen Medicine Abuse Three quarter of teens reported that the number one reason for using drugs is to cope with the pressure at school. 65% of students noted that using drugs to feel better and to look cool were the other top reasons. Sources: Partnership Attitude Tracking Study; Partnership Mapping Study 2007

43. Multiple Perceived Benefits of Medicine Abuse Amongst Teens Helps me deal with my problems Helps me manage my life Enhances my performance To get high Sources: Partnership Attitude Tracking Study; Partnership Mapping Study 2006

44. Teens Perceived Ease of Access Medicine cabinet, at home or friends house Another persons prescription, family or friend From many sources on the Internet Sources: Partnership Attitude Tracking Survey; Partnership Mapping Study 2006

45. Prevention

46. Teens Perceptions Peer approval of getting high significantly increased between 2008 – 2009. Decrease in social disapproval and risk in using marijuana. Between 2005 – 2009 there has been a decrease in the perception of risk of using ecstasy along with an increase in the acceptability of use. Partnership for a Drug-Free America and Metlife Foundation 2009 Parents and Teens Attitude Tracking Study Report, 3/2/10

47. Teens Perceptions Decrease in learning from parents, schools and media about the risks of using alcohol and drugs between 2008 – 2009. Less exposure to anti-drug commercials on TV between 2004-2009. Partnership for a Drug-Free America and Metlife Foundation 2009 Parents and Teens Attitude Tracking Study Report, 3/2/10

48. Parent Education Only 7% of parents thought that teens might use drugs to deal with stress –73% of students reported the top reason for using drugs was to cope with school pressure. Parents often have a hard time accepting that their teen may have a problem. Parents may ascribe the regular use of drugs by their teens as normal teenage experimentation Partnership for a Drug-Free America and Metlife Foundation 2009 Parents and Teens Attitude Tracking Study Report, 3/2/10

49. Parent Education Parents of teens who use drugs more regularly may feel that they have no influence on their teens decision and do not feel that they can enforce any rules about substance abuse. Partnership for a Drug-Free America and Metlife Foundation 2009 Parents and Teens Attitude Tracking Study Report, 3/2/10

50. Need to Increase Parental Involvement Only 31% of teens learn a lot about the risk of drugs from their parents. Source: Partnership Attitude Tracking Study 2006

51. Rx and OTC Medicine Abuse Education Campaign Multi-media public service advertising National consumer public relations (parents) Web-based parent resources Interactive teen web-site Parent brochure, hard copy and online Research tracking and evaluation www.drugfree.org Partnership for a Drug-Free America

52. www.drugfree.org Teachable Moments Show Kids You Care Tips for Talking: Approach Your Teen About Their Possible Alcohol and Drug Use Know What Drugs Kids Face Today

53. www.drugfree.org Time To Act –Step by step guidance from experts in the field of substance abuse for parents who have concerns about their teen.

56. On September 25, 2010, DEA will coordinate a collaborative effort with state and local law enforcement agencies to remove potentially dangerous controlled substances from our nations medicine cabinets. Collection activities will take place from 10:00 a.m. through 2:00 p.m. at sites established throughout the country. The National Take-Back Day provides an opportunity for the public to surrender expired, unwanted, or unused pharmaceutical controlled substances and other medications for destruction. These drugs are a potential source of supply for illegal use and an unacceptable risk to public health and safety. This one-day effort is intended to bring national focus to the issue of increasing pharmaceutical controlled substance abuse.

57. The program is anonymous. Prescription and over the counter solid dosage medications, i.e. tablets and capsules accepted. Intra-venous solutions, injectables, and needles will not be accepted. Illicit substances such as marijuana or methamphetamine are not a part of this initiative.

58. National Drug Intelligence Center National Prescription Drug Threat Assessment 2009 April 2009

59. Teens and Prescription Drugs Office of the National Drug Control Policy Executive Office of the President January 2008

60. Executive Summary Teens are turning away from street drugs and using prescription drugs to get high. New users of prescription drugs have caught up with new users of marijuana. Next to marijuana, the most common illegal drugs teens are using to get high are prescription medications.

61. Executive Summary Teens are abusing prescription drugs because they believe the myth that these drugs provide a medically safe high. The majority of teens get prescription drugs easily and for free, often from friends and relatives.

62. Executive Summary Girls are more likely than boys to intentionally abuse prescription drugs to get high. Pain relievers such as Oxycontin and Vicodin are the most commonly abused prescription drugs by teens. Adolescents are more likely than young adults to become dependent on prescription medication.