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March 12, 2008
Testimony of Stephen J. Pasierb, President and CEO
"Abuse of Prescription and Over the Counter Drugs"
Senate Subcommittee on Crime and Drugs
United States Senate, March 12, 2008
Mr. Chairman, Senator Grassley, members of the Subcommittee and the Caucus, thank you for inviting me to testify about the problem of prescription and over-the-counter drug abuse among America's teenagers. I'm Steve Pasierb, President and Chief Executive Officer of the Partnership for a Drug-Free America.
I'd like to begin by thanking you, Mr. Chairman, and you, Senator Grassley, for your steadfast leadership on the substance abuse issue in general, and your concern with the abuse of medicine in particular. Your focus today on the public health threat posed by prescription and over the counter drug abuse is of critical importance and tremendous value to parents, healthcare professionals, the prevention and treatment communities, and ultimately, of course, to our children.
The abuse of prescription and over the counter medications -legal substances of tremendous benefit if used appropriately--is the single most troubling phenomenon on today's drug landscape.
The latest Partnership Annual Tracking Study* of roughly 6500 teens in grades 7 through 12 shows that 19%, or roughly one in five, teens report having tried a prescription drug without having a prescription for it at least once in their lives. About one in ten report having used over-the-counter cough medicine "to get high." Only alcohol, cigarettes, marijuana and inhalants are abused by teenagers at higher rates than prescription drugs. Cocaine and Ecstasy are each roughly half as prevalent as prescription drug abuse. The prevalence of teen abuse of methamphetamine is just over one third that of prescription drugs.
Source: Partnership Attitude Tracking Study (PATS), Teens 2007
While it's true that the prevalence of prescription and over the counter drug abuse has not increased over the past three years, it's troubling to realize that with just one or two exceptions, teen use of virtually all other substances of abuse -alcohol, tobacco, marijuana, methamphetamine and cocaine--has declined over the same period, and in fact has been in steady decline over the past decade.
Why has this trend proved resistant thus far to the nation's collective efforts at education and prevention? There are several reasons:
1. These substances are readily available to teens - in their own medicine cabinets and the medicine cabinets of friends--and very often they're available for free. Our data are very much in line with the findings of the National Survey on Drug Use and Health, which shows over 75% of teenage prescription drug abusers saying they got those drugs from friends or family.
I think it's worth noting that less than 1% of teens --in both the National Survey and in our research-- claim to have ordered their drugs over the internet.
It is true that many teens are searching the web for information about how how to abuse prescription and over the counter medications, on web sites such as www.erowid.com. The Partnership, working with the Consumer Healthcare Products Association (CHPA), has developed an "intercept strategy" for such web searches, so that a teenager typing "dxm abuse", for instance, into his / her search engine, will find among the top entries www.dxmstories.com - which is a Partnership developed site with teen-relevant information about the risks of abuse of dextromethorphan, the active ingredient in many cough medicines.
2. Teens' perception of the risks of abuse is relatively low. Our Partnership research shows that less than half of teens see "great risk" in trying prescription pain relievers such as Vicodin or Oxycontin that a doctor did not prescribe for them. Over one quarter of teens believe prescription pain relievers are not addictive. The University of Michigan's "Monitoring the Future" survey data going back over thirty years demonstrates that teens' perception of the risk associated with any substance of abuse, along with perceptions of "social disapproval", correlates significantly with actual teen abuse of that substance. So low perception of risk, coupled with easy availability, is a recipe for ongoing problems.
3. Research conducted by the Partnership in 2007, with support from Abbott Pharmaceutical, cast new light on the motivations of teens to abuse prescription drugs. We have traditionally thought of teens abusing illegal drugs and alcohol either to "party", or to "self-medicate" for some serious problem or disorder: adolescent depression, for example. But our 2007 research, like the research done among college students by Carol Boyd and Sean McCabe at the University of Michigan, suggests a wider range of motivations for young people's abuse of prescription drugs, including an emerging set of "life management" or "regulation" objectives. Teens appear to be abusing these drugs in a utilitarian way, using stimulants to help them cram for a test or lose weight, pain relievers to escape some of the pressure they feel to perform academically and socially, tranquilizers to wind down at the end of a stressful day. Once these substances have been integrated into teens' lives and abused as study or relaxation aids, it may become increasingly difficult to persuade teens that these drugs are unnecessary or unsafe when taken without a prescription.
4. Parents - who are usually our most valuable ally in preventing teen drug use - are generally ill equipped to deal with teens' abuse of prescription drug use, a behavior that was probably not on their radar when they were teenagers. They find it hard to understand the scale and purposefulness with which today's teens are abusing medications, and it's not immediately clear to them that the prime source of supply for abusable prescription drugs is likely to be their own medicine cabinet. Further, many parents themselves are misusing, or perhaps abusing, prescription drugs without having a prescription. In our study with Abbott, 28% of parents said they had used a prescription drug without having a prescription for it, and 8% of parents said they had given their teenaged child an Rx drug that was not prescribed for the teen.
5. And finally, the reason our efforts have not resulted in declines in teen abuse of prescription or over the counter medications is that our efforts as a nation -to date at least-- have been inadequate. There has simply not been the public attention or resources devoted to this issue that we have seen for other emerging drug threats.
There are some bright spots.
What Is Being Done
Mr. Chairman, the legislation you sponsored last year preventing abuse of dextromethorphan, or DXM, powder is important and very welcome.
The Partnership for a Drug-Free America has been working since 2003 on this issue, fielding research and developing research-based communications raising awareness among parents of the risks of prescription drug abuse, and what they can do to prevent it.
The Partnership has:
- Fielded research in 2004 identifying prescription drug abuse as a teen behavior involving the prescription and over the counter categories, not merely a brand-specific problem;
- Developed public service announcements addressing abuse of both prescription drug and over the counter medicines, beginning in 2004;
- Created online resources for teens and parents, putting forward the risks of abuse and identifying steps parents can take to safeguard their household medicines (2004 - present);
- Fielded in-depth research in 2007, surveying teens and parents on the attitudes and beliefs underlying their behavior related to prescription drug abuse;
- Focused in press events, town hall meetings and public relations outreach (covered by major national media) on the emerging threat of prescription drug abuse
And there have been other important steps as well.
The National Youth Anti-Drug Media Campaign (NYADMC) is mounting a major effort this year, targeting parents and providing them with information on how to safeguard their home supplies of prescription drugs and prevent their teenage children from abusing them. Television and print advertising are being supplemented with solid web-based information and point-of-sale educational brochures that are being stapled to pain reliever prescriptions in three major drug chains during the months of February and March. Nearly one fourth of the Campaign's media budget this year will be spent in support of this initiative, and -as is the case with all NYADMC advertising-- leveraged via a dollar-for-dollar match by the media.
The National Institute on Drug Abuse and some other federal agencies have been in the vanguard of those taking action.
Private sector rganizations in the prevention field, such as the Community Anti-Drug Coalitions of America and DARE, are doing their part.
In some quarters of the pharmaceutical and over the counter industries, there have been concern and support for prevention and education efforts - and those companies and professional associations should be commended for their pro-activity.
We at the Partnership for a Drug-Free America, in addition to our ongoing research with partners such as Abbott Pharmaceutical and the MetLife Foundation, are reaching parents with prevention programs such as our "Time to Talk" promotion, encouraging parents to communicate with their children about the risks of abusing alcohol and drugs, including prescription and over the counter. medications.
We have built robust web-based resources at www.drugfree.org, providing parents with an in-depth understanding of the risks of medicine abuse and the steps they can take to prevent it.
In partnership with PhRMA and others, we are exploring the development of simple tools for healthcare professionals, which would help them more effectively identify and assess prescription drug abuse in their patient populations.
And of course we continue to call on the pro bono resources of America's best communications companies and the media to create and run public service announcements helping parents understand the risks that this new, emerging drug threat poses to their teenaged children.
The Partnership is a non-profit coalition of volunteers from the communications industry. Using a national drug-education advertising campaign and other forms of media communication, the Partnership exists to reduce illicit drug use in America.
National research suggests that the Partnership's national advertising campaign - the largest public service campaign in the history of advertising - has played a contributing role in reducing overall drug use in America. Independent studies and expert interpretation of drug trends support its contributions. The New York Times has described the Partnership as "one of the most effective drug-education groups in the United States."
In addition to its work on the national level, the Partnership's State/City Alliance Program supports the organization's mission at the local level. Working with state and city governments and locally-based drug prevention organizations, the Partnership provides the guidance, on-site technical assistance and creative materials necessary to shape anti-substance abuse media campaigns tailored to the needs and activities of any given state or city.
The Partnership also participates in the National Youth Anti-Drug Media Campaign, coordinated by ONDCP. At the core of this multi-faceted initiative is a paid advertising program, featuring messages created by the Partnership.
Today, the Partnership is run by a professional staff of 50. Partnership campaigns have received every major award in the advertising and marketing industries for creative excellence and effectiveness, including the American Marketing Association's highest honor for marketing effectiveness.
But reducing adolescent abuse of prescription and over the counter drugs will require much more. The tragic death of Heath Ledger cast a sudden spotlight on this issue -much as Len Bias's death in 1986 focused the country's attention on the risks of cocaine abuse, which had been underestimated till that point. We must build on this growing understanding, and devote the necessary resources to prevention, education -and treatment--programs addressing the abuse of these legal, beneficial medications.
On behalf of the Partnership for a Drug-Free America, Mr. Chairman and Senator Grassley, let me thank the Subcommittee and the Caucus again for your concern.
*The Partnership Attitude Tracking Study of teens is conducted annually among approximately 6500 teens in grades 7-12, drawn from a nationally projectable sample of roughly 128 public, private and parochial schools. The questionnaire is self-administered and completed anonymously.