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Prescription drugs find place in teen culture

When a teenager in Jan Sigerson's office mentioned a "pharm party" in February, Sigerson thought the youth was talking about a keg party out on a farm.

"Pharm," it turned out, was short for pharmaceuticals, such as the powerful painkillers Vicodin and OxyContin. Sigerson, program director for Journeys, a teen drug treatment program in Omaha, soon learned that area youths were organizing parties to down fistfuls of prescription drugs. Since February, several more youths at Journeys have mentioned that they attended pharm parties, Sigerson says.


Percentage of 12th-graders who said they had used certain drugs in the previous year:
Drug 2002 2005
Marijuana 36.2% 33.6%
Cocaine 5.0 5.1
Ecstasy 7.4 3.0
OxyContin 4.0 5.5
Vicodin 9.6 9.5

Source: Monitoring the Future survey by the University of Michigan

Mark Daniel Bauer started using prescription painkillers not prescribed to him for his back pain. He died May 28, 2004.
Mark Daniel Bauer started using prescription painkillers not prescribed to him for his back pain. He died May 28, 2004.

"When you start to see a pattern, you know it's becoming pretty widespread," she says. "I expect it to get worse before it gets better."

Drug counselors across the USA are beginning to hear about similar pill-popping parties, which are part of a rapidly developing underground culture that surrounds the rising abuse of prescription drugs by teens and young adults.

It's a culture with its own lingo: Bowls and baggies of random pills often are called "trail mix," and on Internet chat sites, collecting pills from the family medicine chest is called "pharming."

Carol Falkowski, director of research communications for the Hazelden Foundation, says young abusers of prescription drugs also have begun using the Internet to share "recipes" for getting high. Some websites are so simplistic, she says, that they refer to pills by color, rather than their brand names, content or potency.

That, Falkowski says, could help explain why emergency rooms are reporting that teens and young adults increasingly are showing up overdosed on bizarre and potentially lethal combinations of pills.

Overdoses of prescription and over-the-counter drugs accounted for about one-quarter of the 1.3 million drug-related emergency room admissions in 2004, the federal Substance Abuse and Mental Health Services Administration reported last month.

The abuse of prescription and over-the-counter drugs which barely registered a blip in drug-use surveys a decade ago is escalating at what Falkowski and other analysts say is an alarming rate.

In a 2005 survey by the Partnership for a Drug-Free America, 19% of U.S. teenagers roughly 4.5 million youths reported having taken prescription painkillers such as Vicodin or OxyContin or stimulants such as Ritalin or Adderall to get high.

Vicodin has been particularly popular in recent years; a study by the University of Michigan in 2005 found that nearly 10% of 12th-graders had used it in the previous year. About 5.5% said they had used OxyContin. Both drugs are now more popular among high school seniors than Ecstasy and cocaine.

Marijuana is still the most popular drug by far; about one-third of the 12th-graders surveyed said they had used it in the previous year.

More socially acceptable

Falkowski, whose foundation is a treatment center based in Center City, Minn., says prescription pills have become popular among youths because they are easy to get and represent a more socially acceptable way of getting high than taking street drugs.

Some kids, she says, are self-medicating undiagnosed depression or anxiety, while others are using stimulants to try to get an edge on tests and studying.

Falkowski says prescription drugs are familiar mood-altering substances for a generation that grew up as prescriptions soared for Ritalin and other stimulants to treat maladies such as attention-deficit disorder. "Five million kids take prescription drugs every day for behavior disorders," she says.

"It's not unusual for kids to share pills with their friends. There have been incidents where kids bring a Ziploc baggie full of pills to school and share them with other kids."

Pharm parties, she says, are "simply everyone pooling whatever pills they have together and having a good time on a Saturday night. Kids ... don't think about the consequences."

Lisa Cappiello, 39, of Brooklyn, N.Y., says that seemed to be the case with her son, Eddie. She says she knew that he had tried marijuana at 15 and sneaked beers at school.

But it wasn't until after he graduated from high school and took a year off before college that Cappiello realized the extent of her son's drug use and the hold prescription drugs had on him.

"In what seemed like the blink of an eye, it went from marijuana and an occasional beer to so much Xanax that (one day) my husband had to pick him up when he feel asleep on a street corner waiting for some friends," she said. "He hid his drug use from me so well."

The next day, Eddie Cappiello admitted to his parents that he had taken 15 pills of Xanax, a brand name for benzodiazepine that acts as a sedative. He told his parents Xanax helped him deal with anxiety and depression.

Eddie rejected professional help and vowed to stop taking pills, his mother says. He was clean for 10 months, she says, before he was hospitalized in July 2005 after overdosing.

Two months later, he entered a 28-day treatment program, his mother says. After he was discharged, he stayed clean for about two months then relapsed into weekend binging: 40 to 50 pills and a quart of Jack Daniel's, sometimes by himself, sometimes with friends, Lisa Cappiello says.

Eddie Cappiello, 22, died in his bed on Feb. 17 after overdosing on a mix of pharmaceuticals. He left behind a girlfriend and two young children.

A toxicology report said he had 134 milligrams of Xanax the equivalent of 67 pills and an opioid derivative in his system, his mother says.

"Before four years ago, I never even heard the word Xanax," Lisa Cappiello says. "Now ... I know kids as young as 12 are using it. Then I found out that Vicodin was a very big party drug. Before school, after school, at parties. Kids mixed them with alcohol and Ecstasy. It was baffling to me."

Cappiello says police, teachers and parents are so fixated on street drugs such as marijuana, cocaine and Ecstasy that they are missing the start of an epidemic.

"Eddie was not the first kid to die in this neighborhood from prescription drugs," she says.

'Troubling trend'

In recent months, federal anti-drug officials have acknowledged that they didn't anticipate the quick escalation of prescription-drug abuse. Most government-sponsored drug prevention programs focus on marijuana, tobacco, alcohol and methamphetamine.

"We were taken by surprise when we started to see a high instance of abuse of prescription drugs," says Nora Volkow, director of the National Institute of Drug Abuse (NIDA), which is collecting information about how teens perceive, get and use prescription drugs so it can try to craft an effective prevention campaign.

In a bulletin last year, NIDA called the increase in pharmaceutical drug abuse among teens "disturbing" and said pharm parties were a "troubling trend."

The increasing availability of prescription drugs is a big reason for the rise in their abuse, Volkow and other drug specialists say.

Pharmaceutical companies' production of two often-abused prescription drugs hydrocodone and oxycodone, the active ingredients in drugs such as Vicodin and OxyContin has risen dramatically as the drugs' popularity for legitimate uses has increased. Drug companies made 29 million doses of oxycodone in 2004, up from 15 million four years earlier. Hydrocodone doses rose from 14 million in 2000 to 24 million in 2004.

The 2005 Partnership survey found that more than three in five teens can easily get prescription painkillers from their parents' medicine cabinets. And as Falkowski says, the rising number of youths being treated with stimulants has made it easier for kids to use such drugs illicitly. About 3% of children are treated with a stimulant such as Adderall or Ritalin, up from less than 1% in 1987.

Almost all of the 13 youths at Phoenix House's intensive outpatient treatment program on New York City's Upper West Side have dabbled in prescription drugs, director Tessa Vining says.

"There's definitely easy access," she says. "Maybe a parent had some surgery and took one or two painkillers from a bottle of 10, and the rest are just hanging out in the medicine cabinet."

After her son died, Cappiello says she wondered how kids in her area were getting pills. She says she learned from police that one local dealer got Xanax from his mother, who had been given a prescription for the drug. Instead of taking the pills, she gave them to her son to sell for $2 to $3 each.

Paul Michaud, 18, of Boston, says he got his first taste of OxyContin pills he calls them OCs from a friend during his freshman year in high school.

Until then, Michaud says, he had smoked marijuana daily and taken a Percocet pill occasionally. Michaud's father had recently died of cancer, and Michaud says he was depressed and feeling like an outsider at school. The prescription painkiller made him feel like nothing could faze him, he recalls.

"The first time I did it, I was hooked," says Michaud, who is four months into a yearlong drug treatment program at Phoenix House in Springfield, Mass. He says he quickly became a daily OxyContin user, breaking apart the time-release capsules, crushing pills and snorting the powder from five 80-milligram pills a day.

"They're not very hard to get. I could find OCs easier than I could find pot," Michaud says. "There were plenty of people who sold them," including some dealers who got pills illicitly by mail order.

Cutting off the supply

To try to reduce the supply of prescription drugs on the black market, authorities have shut down several "pill mills" where doctors prescribe inordinate amounts of narcotics as well as Internet pharmacies that ship drugs with little medical consultation, says Catherine Harnett, chief of demand reduction for the Drug Enforcement Administration (DEA).

Last September, DEA agents arrested 18 people allegedly responsible for 4,600 such pharmacies.

A tricky part of the prescription-drug problem, Harnett says, is addressing the perception among youths that pills are safe because they are "medicine." Many teens don't equate taking such pills with using drugs such as heroin or cocaine, she says.

"If you start with pills, it seems fairly sanitary and legitimate," she says. "Kids have been lulled into believing that good medicine can be used recreationally."

Two in five teens in the Partnership study said prescription medicines, even if they are not prescribed by a doctor, are "much safer" to use than illegal drugs.

'A lot to live for'

Phil Bauer of York, Pa., believes his son, Mark, 18, an avid weight lifter, started using prescription drugs to relieve chronic back pain and didn't appreciate the potential risks of taking the drugs.

Bauer says his son never behaved as he imagined a drug addict would. "He wasn't hanging out all night. He had parents who wouldn't let him do that."

Mark Bauer died of an overdose on May 28, 2004. The toxicology report found morphine, oxycodone and acetaminophen the active ingredient in Tylenol but also an ingredient in Vicodin in his system, Phil Bauer says.

Before his son's death, "we didn't see a bleary-eyed guy. He wasn't slurring his words," the father says. "He seemed to have a lot to live for. I did not know prescription-drug abuse was a problem. There's so much guilt in that. I don't know if I stuck my head in the ground. I did not see this coming."

Michaud says he didn't equate his OxyContin addiction with hard-core drug abuse. "Where I come from, OC is a rich boys' drug," he says. "I thought, heroin abuse, that's pretty low. I'd never stick a needle in my arm."

However, Michaud says he eventually switched to heroin. "I sniffed it and a week later, I was shooting," he says. "I thought I wasn't like other people doing heroin. I wasn't that low. Come to figure out, it all leads to the same place."