INTRODUCTION
This project is designed to illustrate the effects of prescription and over the counter drug abuse. It will not only show a comparison between the effects of illicit drugs and prescription drugs but it will also serve to show the significance of the prevalence and effects of prescription drug abuse.
“There is an erroneous belief that because these are medicines, whether prescribed by physicians or over-the-counter, that they are safer,” stated by Nora D. Volkow, MD, director of the National Institute on Drug Abuse (Kheun, 2007). Teenagers and young adults have the concept that prescription or over the counter drugs are not harmful even if consumed in extreme doses. This is due to the fact that they are legal and are created and designed by pharmaceutical and medical professionals. This is quite contradictory because it has been noted by researchers (Ford & Rivera 2008) that these drugs, when abused have very serious and even fatal consequences. Some of which include increased heart rate, hallucinations and other alterations in mental state. Though not highly publicized, these “every day” drugs such as Ritalin, OxyContin, Vicodin and Dexedrine can cause all of the aforementioned symptoms (Arkes & Iguchi 2008).
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The effort of research in this area however, does not parallel the gravity of the problem and it has been noted by The International Narcotics Control Board that prescription drugs are about to become as much of a problem as illicit drugs (Zarcosta, 2008). Nevertheless, little or no research has been done in this field of prescription drug abuse and the seriousness of its effects as it relates to teens and young adults. With the research that this subject so rightfully deserves, all vulnerable persons (young persons, parents, teachers and health care providers) should become aware of the following:
The types and examples of prescription drugs commonly abused.
Ways in which these prescription drugs can be abused.
Who is at a higher risk of prescription drug abuse?
Signs and symptoms of prescription drug abuse.
The consequential effects of abusing prescription drugs.
Avenues in which one can seek help for this type of drug abuse.
This project’s intention therefore is to give enlightenment on all these areas, create awareness on the relevant and ubiquitous issue of prescription drug abuse and most importantly research the effects of prescription drug abuse.
HYPOTHESIS
Abuse of prescription drugs is as hazardous as the use of illicit drugs.
RESEARCH DESIGN
This research will take on both forms of qualitative and quantitative designs therefore it will be a mixed design. It will be qualitative in order to include statistics about the prevalence of prescription drug abuse. However it will quantitative in order to include reasons and effects of prescription drug abuse on young adults.
LITERATURE REVIEW
While rates of illicit drug abuse among teens in the Unites States continue to decline, abuse of prescription drugs in this age group is increasing at an alarmingly high rate. Recent anonymous survey results show that the one in every 10 high school seniors had used the painkiller Vicodin in the last year without a doctor’s orders (Arkes & Iguchi,2008 as cited by Johnston, O’Malley, Bachmen &Schulenberg, 2004). Even though, there is research done on the prevalence, causes and risk factors associated with prescription drug abuse, there is a lack of information on the effects. The aim of this literature review is to provide sufficient information for researchers to conduct further research on the effects on the prescription drug abuse. This literature review will explain the following topic questions:
• How prevalent is prescription drug abuse?
• What are the major causes/reasons of prescription drug abuse?
• Who is at a higher risk?
How prevalent is prescription drug abuse?
The abuse of prescription drugs in the USA is a growing problem. Prescription drug abuse is as prevalent as the abuse of illicit drugs. There has been a significant rise in the nonmedical use of prescription drugs in the US over the past 15 years. In 2004, an estimate of 2.4 million Americans aged 12 years or older initiated prescription opioid abuse within the past year, which exceeded those who were abusing illegal drugs like cocaine ( 1 million) or marijuana ( 2.1 million) ( McCabe, S.E., West, B.T., Morales, M., Cranford, J.A., & Boyd, C.J., 2007). The debate as to whether prescription drug abuse is as prevalent as illegal drug abuse is interesting and. The commonly abused prescription drugs are painkillers, sedatives, tranquilizers, opioids and stimulants (Levy, M.S., 2007).
In the United States, the abuse of prescription drugs especially opioids is a major health concern. In 2005 a study was carried out and it was found out that approximately 227,000 Americans were abusing and highly dependent on illicit drugs like heroine whereas 1.5 million Americans abused and were highly dependent on prescription opioids (Wu, Li-Tzy, Blazer, D.G., Stitzer, M.L., Patkar, A.A., & Blaine, J.D., 2008) Additionally, in 2006, it was established that the nonmedical use of prescription drugs especially pain relievers actually surpassed that of illicit drugs. (Wisley et al)There has also been an alarming increase in the number of deaths associated with accidental overdoses of prescription drugs compared to those of illegal drugs. Statistics state that in 2002 it was established that the number of fatal heroine poisonings increased by 12.4% while shockingly the number of fatal opioid analgesic poisonings increased by 91.2% in the same population (Wunsch, M.J., Nakamoto, K., Behonick, G., & William, M., 2009). This information further concretes the fact that there is a drastic increase in prescription drug abuse.
Statistics in 2001 reveal that approximately 3 million youths aged 12 to 17 and almost 7 million young adults aged 18 to 25 years had misused prescription drugs in their life-time. (Kelly, B.C., & Parsons, J.T., 2007).
In conclusion, prescription drug abuse is on an alarming increase amongst the youth. With this increase, come various causes that will influence one to begin abusing prescription drugs.
Definitions
1. Prevalence- Existing very commonly
2. Abuse- Use of a drug to get pleasure, or to improve a person’s performance of an activity, or because a person cannot stop using it.
3. Dependence- To need something all the time especially in order to continue existing or operating.
4. Prescription drugs- Also known as over-the-counter drugs.
What are the major causes/reasons of prescription drug abuse?
With the way you are brought up and other environments, one develops values that in turn influence personal choices. Even though most illegal drugs are easy to access (Califano, 2002 as cited by Finley, 2007), an increasing number of youth prefer to use prescription drugs for non-medicinal purposes. In an article by Youth Trade, 2005 (cited by Finley, 2007) Students in high schools and colleges are having ‘pharming’ parties, where they shift responsibility for bringing the prescription drugs. This in-turn makes them appear ‘cool’ and up-to-date with the times as another teen had explained once her school mates found out that she had prescription drugs.
Some opt to use prescription drugs out of boredom, often times along with illegal drugs, with others choosing to use Ritalin as a stimulant because it works like caffeine. Others actually believe that since prescriptions drugs are safe to use under prescription, then it must be safe for them without doctor’s orders. In the case study by Finley (2007) as stated by Birhanemaskel (2005) prescription drugs do not have the give-away smell as marijuana, yet give the same effects; more youth prefer prescription drugs to get high. This thought is generally upheld by girls making them less prone to use marijuana. Also young females prefer to use prescription drugs because of the expectation that they would help them slim down thus fitting in better with the other girls (Monarch Avalon, 2005 as cited by Finley, 2007).
In a study (Lankenau et al., 2007), participants gave stories of how their first experiences of non-medicinal use of prescription drugs. One man mentioned that his first prescription drug was Ritalin which he used to help him stay up so he could be able to study. He would then use Xanax to help him get to sleep. This all helped keep balance of his school, athletics and social life. Another student mentioned that he began using prescription drugs to get the same feeling of a heroin high by taking 2 Xanax pills and alcohol simultaneously when he was curbing his heroin addiction. Also, some admitted to using Adderall as they were cheap; each pill was about $0.90. Finley (2007) also suggested that having parents that use prescription drugs to help them get up in the morning could also encourage teenagers to recreationally use prescription drugs. By parents allowing teenagers to take cough syrups, for instance, and not inquire about shows ignorance and leniency which leaves the teenager to believe there is nothing wrong with misuse of prescription drug abuse (Gavin, 2004).
Even with these significant causes, some youth are at more ‘attracted’ to prescription drugs than others.
Who is at a higher risk?
Teens themselves being very vulnerable to prescription drug abuse have certain factors which could put them at an even higher risk. These include teens:
1. A history substance abuse.
The quest for more pleasure, diminished anxiety, the relaxation of time, quickening of insight, deepening mythic awareness are the major reasons why teens repeatedly use substances like illicit drugs and alcohol and before they realize, they get addicted. It becomes nearly impossible for them to live without getting high or feeling highly ecstatic.
The addiction rises to an extent that they start to engage in illegal activities to obtain these substances.
However, now they have found a new ‘legal’ way to do this. As stated, prescription drugs are much easier to obtain and less expensive than other substances. Teens with a history of substance abuse use this as an advantage and now they have an easier means to get high. The annual study by the National Institute on Drug Abuse, conducted by the University of Michigan, showed as many as one in every 14 high school seniors said they used cold medicine “fairly recently” to get high. A student, during a study that included an in-depth interview conducted by Lankenau, S.E. et.al said, “[My mother] used to get a whole lot of [OxyContin] and she would just bring them home and I’d see it all laid out. You take 20 milligrams and its like dope [heroin]. It’s really like dope.”
2. With Adverse childhood experiences.
Adverse Childhood experiences are common and destructive. It includes abuse (physical, mental or sexual), neglect, domestic violence and other forms of serious and interrelated household dysfunction. They can determine the health and well-being of a person. The associated problems are painful to recognize and difficult to cope with.
The study by Anda, R.A et.al shows a direct relationship between adverse childhood experiences and prescription drug abuse. Teens with adverse childhood experiences may have feelings of helplessness, chaos, and impermanence and may have problems self-regulating affective states. Thus, prescription drug abuse may serve as an avenue to escape or dissociate from the immediate emotional pain, anxiety, anger that likely accompany such experiences.
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3. Homeless youth.
A common stereotype of the homeless population is that they are all alcoholics or drug abusers. The truth is that a high percentage of homeless people do struggle with substance abuse but addictions should be viewed as illnesses and require a great deal of treatment, counseling and support to overcome. Substance abuse is both a cause and a result of homelessness, often arising after people lose their housing. (Substance abuse and homelessness, July 2009).
People who are homeless often turn to drugs and alcohol to cope with their situations. They use substances in an attempt to attain temporary relief from their problems. With the increasing use/prevalence of prescription drug abuse over other substances, the homeless population is also starting to use more prescription drugs. Lankenau, S.E. et.al and Sander, B et.al proved a high percentage of prescription drug abuse among the homeless from their studies.
In conclusion, there is a large number of youth abusing prescription drugs for various reasons. This number is rapidly increasing especially amongst the sample age with the major causes and risk factor highlighted above. The easy accessibility, inexpensiveness and the belief that prescription drugs are safe to use has resulted in the youth change their usual use of illicit drug to prescription drug as their means to get high, to fit in and in their struggle to balance their social and academic life . Even though, the youth themselves are a very prone population for prescription drug abuse, there are certain risk factors which make them more vulnerable. This includes a history of substance abuse, adverse childhood experiences and the homeless youth. Researchers around the world should consider the severity of this prevalence and its serious consequences. Further research needs to be conducted on the effects and ways to control and prevent prescription drug abuse.
DATA GATHERING INSTRUMENT
The following are the data gathering instruments that will be utilized in this project.
Questionnaires: This will be a combined questionnaire which will contain a series of thirty (30) close ended and open ended questions. The questionnaire will be of a structured non disguised format in which the respondent will be informed of the purpose of collecting the information. The data will then be quantified.
Interviews: These will consist of personal interviews which are discussions between an interviewer and an interviewee in order to obtain in-depth information about a particular issue or research question. The interviews will take the unstructured format.
Focus Groups: This involves a group of participants who share their thoughts ideas and feelings on a specific topic. Hence the parents/guardians and the youth will be allowed this time to express themselves.
Observations: This is a research method used to give an objective view on the verbal and nonverbal behaviors of the participants. Hence the interviewees will be observed by this method.
DATA GATHERING PROCEDURE
Surveying: The questionnaire will be distributed randomly to various educational institutions. The actual distribution of the questionnaires within the schools will be done by the school administration. They will have approximately one week to administer and collect all questionnaires which will then be collected by the relevant authorities.
Interviews: Private interviews will be held with patients of selected Drug Addiction Rehab Centers at the center itself.
Focus Groups: This will be held with the parents/guardians and health care providers of the patients.
Observations: While they are interviewed the same patients will be observed by well reputed psychiatrists/psychologist through a one way mirror. Also the behaviors of the patients will be observed for approximately two weeks by the same psychiatrists/psychologists.
APPROPRIATE SAMPLING TECHNIQUE
In this project random sampling will be utilized. Six rehabilitation centers for substance abusers will be randomly selected. Sixteen individuals (eight males and eight females) within the age group of thirteen to eighteen (13-18) and sixteen individuals (eight males and eight females) within the age group of eighteen to twenty five (18-25) will be utilized. Eight schools will be randomly selected in which one hundred and sixty questionnaires will be distributed. Eighty will be distributed to students within the age group of 12-15 ( forty for females and forty for males). The remaining eighty will be distributed to students between the age group of 16-18(forty for females and forty for males).
ETHICAL CONSIDERATIONS
With each research, there are several ethical considerations. The following is a list of the ethical concerns considered in this study:
Before an individual becomes a participant, he/she will be fully informed of the aims, methods, harms, and benefits of the research: Each participant has the right to be fully informed about the research project in which he/she will be potentially participating, so that he/she has a full understanding of the project. If participants experiences any harm during the study, however, he/she will be compensated.
The individual has the right of voluntary participation. Individuals will not be coerced to participate in the research project as participation will be strictly voluntary. This includes bribery offers, threatening or any kind of direct/ indirect pressures.
He/she has the right to terminate his/her participation at any time. Participants will not be forced to continue with the project if he/she chooses to end his/her participation, neither will he/she be chastise for not continuing with the project. If the reason for terminating his/her is due to physical or psychological harm, participants will be compensated.
The confidentiality of his/her responses. The information gathered will not be made available to any persons who are not directly involved in study. All the information will be kept in a vault in which only the primary investigator will know the combination.
He/she remains anonymous throughout research: Participants will not be required to place their names on the questionnaires and if it is done, the questionnaire will be disregarded.
The teenager will not be allowed to participate without his/her parent’s consent. Any youth who is under twenty one (21) will not be interviewed unless there is written consent from his/her parent.
ANTICIPATED RESULTS
The anticipated results of this research proposal are as follows:
There will be a higher than expected prevalence of prescription drug abuse.
It is just as easy to get addicted to prescription drugs as it is to get addicted to illicit drugs.
The effects of prescription drug abuse can be as detrimental as the effects of illicit drug abuse.
CONCLUSION
The research project was aimed to discover the effects of prescription drug abuse and incorporated both qualitative and quantitative methods. The quantitative method consisted of questionnaires while the qualitative consisted of focus groups, interviews and observation methods. The sample would consist of students between the ages 13-18 and patients of rehabilitation centers ages 18-25. The delimitations of the project were the number of schools, the number of rehabilitation centers and the number of individuals from which information would be gathered. It would serve to bridge the gap of the insufficient research on the effects of prescription drug abuse and also as an informative tool to the society.
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