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Safe and Drug-Free Schools: Alcohol, Tobacco, and Other Drugs
Facts about alcohol, tobacco, and other drugs / Matrix of commonly abused drugs

Over-the-Counter and Prescription Drugs

Although statistics indicate that many teens are turning away from street drugs, there's a new threat from the family medicine cabinet: the abuse of prescription (Rx) drugs and over-the-counter (OTC) medications. In fact, seven out of the top eleven drugs abused by 12th graders are prescription drugs and over-the-counter medications. These include:

  • painkillers, such as those drugs prescribed after surgery;

  • depressants, such as sleeping pills or anti-anxiety drugs;

  • stimulants, such as those drugs prescribed for attention deficit hyperactivity disorder (ADHD), and

  • OTC drugs, such as cough and cold medications.

Prevalence of Use

  • Every day, 2,500 youth age 12 to 17 abuse a pain reliever for the very first time.

  • More teens abuse prescription drugs than any illicit drug except marijuana.

  • In 2006, more than 2.1 million teens ages 12 to 17 reported abusing prescription drugs.

  • About 40 percent of 12th graders say that painkillers are fairly or very easy to get, and more than half say the same of stimulants.

  • Among 12- and 13-year-olds, prescription drugs are the drugs of choice.

According to the Center for Substance Abuse Research, 56 percent of youths ages 12-17 who first started using drugs in the past year began with marijuana; around one-fourth (24 percent) started with non-medical use of prescription-type drugs.

Health Risks

There are serious health risks related to abuse of prescription drugs. A single large dose of prescription or over-the-counter painkillers or depressants can cause breathing difficulty that can lead to death. Stimulant abuse can lead to hostility or paranoia, or the potential for heart system failure or fatal seizures. Even in small doses, depressants and painkillers have subtle effects on motor skills, judgment, and the ability to learn.

Why teens use drugs

Teens report many reasons for abusing prescription and over-the-counter drugs. They may use to get high, to party, to escape reality, to experiment, or to relieve boredom. But teens also say there are other reasons to abuse prescription drugs:

  • To help them cope, such as to manage stress, depression, or anxiety, or to help them relax.

  • To help them deal with pressures. For example, some teens say they abuse stimulants to help them do better in school by increasing alertness or concentration. Others report abusing stimulants to help control their weight.

  • To self-medicate, such as to relieve pain or sleep better.

Signs of Drug Use

Some signs that your teen might be abusing prescription and/or over-the-counter (OTC) drugs include

  • constricted pupils,

  • slurred speech, or

  • flushed skin.

Parents and teachers should be alert to the following:

  • personality changes,

  • mood swings,

  • irritability,

  • excessive energy,

  • sleepiness or avoiding sleep,

  • sweating,

  • loss of appetite,

  • forgetfulness, or

  • clumsiness.

Sources of drugs

Where are teens getting prescription drugs? Teens say they are readily available in their own homes, from friends or relatives, and from online pharmacies.

More than 70 percent of people who abuse prescription painkillers say they get them from family or friends. With cell phones and PDAs, teens can instant message their friends and acquaintances about getting and partying with drugs. In addition, teens often swap stories of their drug experiences and offer "tips" on social networking sites (such as which also may encourage risky behaviors.

Teens also report that these pharmaceutical drugs are not hard to find as many drug traffickers are now dealing prescription drugs. In addition, numerous web sites provide detailed information on which prescription and OTC drugs to take to get high, and how much to take for different effects.

There are also hundreds of pharmacies on the internet that sell prescription drugs without a prescription. 

In 2004, The National Center on Addiction and Substance Abuse(CASA),published the first report on drugs and the internet entitled "You've Got Drugs!": Prescription Drug Pushers on the Internet", followed by a second report in 2007. The reports document the widespread advertising and sale of controlled prescription drugs online without a prescription. They show that the Internet is and continues to be a viable source for the purchase of controlled prescription drugs such as OxyContin, Vicodin, Valium, and Ritalin by our youth.

The survey found that sites advertising controlled substances increased by 135 percent, from 168 in 2006 to 394 in 2007. Sites selling these drugs increased by seven percent, from 174 in 2006 to 187 in 2007. Of these 187 sites, only two were certified by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites™.

The survey also found that:

    • 84 percent of sites selling these drugs did not require a prescription

    • Of the 16 percent who claimed to require a prescription, most (57 percent) simply ask that it be faxed, allowing customers to use the same prescription many times;

    • Over the past four years, the number of sites selling controlled prescriptions increased from 154 in 2004 to 187 in 2007;

    • Benzodiazepines (Xanax and Valium) continue to be the most frequently offered controlled prescription drug, sold on 79 percent of the sites, followed by opiods (Vicodin and OxyContin) on 64 percent of the sites.

    • There are no controls stopping the sale of these drugs to children.


  • Be alert to your teen running out of pills quickly, losing pills, or requesting refills.

  • Safeguard all drugs at home. Monitor quantities and control access.

  • Talk to school nurses, teachers, coaches, and counselors about teen prescription drug abuse to ensure they are aware of the problem and know the warning signs.

  • Set clear rules for teens about all drug use, including not sharing medicine and always following the medical provider's advice and dosages.

  • Always monitor your teen's time online, set limits and rules about which sites are okay to visit, and check web site histories.

  • Be a good role model by following these same rules with your own medicines.

Facts About Painkillers

What are painkillers or opioids? Opioids are drugs that contain opium or are derived from and imitate opium. They are prescribed for pain relief and are only available by prescription. Most opioid or painkilling drugs are non-refillable and, when used properly under a medical doctor's supervision, are safe and effective. Opioid drugs act by effectively changing the way a person experiences pain.

Morphine derivatives, also known as "narcotics", come from opioids and are used to therapeutically treat pain, suppress coughing, alleviate diarrhea, and induce anesthesia. When using these narcotics, abusers experience a general sense of well-being by reduced tension, anxiety, and aggression.

Painkillers are also the most abused type of prescription drugs by 16- to 17-year-olds, followed by stimulants, tranquilizers, and sedatives. Almost two out of five teens report having friends that abuse prescription painkillers and nearly three out of 10 report having friends that abuse prescription stimulants. Painkillers like OxyContin and Vicodin are the prescription drugs most commonly abused by teens. In fact, within the past year nearly one in 10 high school seniors has abused Vicodin and more than five percent of seniors have abused OxyContin.

a. Examples of Painkillers
Some of the most well-known painkillers are listed below with the names you might find on a prescription label.

  • Codeine: like morphine, this is found in opium, is weaker in action than morphine, and is used especially as a painkiller.

  • Fentanyl (and fentanyl analogs): a man-made opioid painkiller similar to morphine that is administered as a skin patch or orally.

  • Morphine: the powerful, active ingredient of opium is used as a painkiller and sedative.

  • Opium: from the opium poppy, formerly used in medicine to soothe pain but is now often replaced by derivative alkaloids (as morphine or codeine) or man-made substitutes (opioids).

  • Hydrocodone: often combined with acetaminophen for use as a painkiller. Vicodin is an example.

  • Oxycodone: a narcotic painkiller, for example OxyContin, Percocet, and Percodan.

Oxies, OC, oxycotton, 80s, percs, vikes, and vikings are commonly used slang terms to refer to painkillers.

b. Signs and Symptoms
Short-term effects
Painkillers can cause drowsiness, inability to concentrate, apathy, lack of energy, constriction of the pupils, flushing of the face and neck, constipation, nausea, vomiting, and most significantly, respiratory depression.

Long-term effects
If painkillers are abused for a period of time, a person can become addicted to the drug and experience withdrawal symptoms when he/she stops taking the drug. Associated with addiction is tolerance, which means more and more of the drug or a combination of drugs is needed to produce the same high or euphoric feeling, possibly leading to overdose. Physical signs of overdose include pinpoint pupils, cold and clammy skin, confusion, convulsions, severe drowsiness, and slow or troubled breathing.

Facts About Stimulants

Stimulants are sometimes prescribed by doctors to treat conditions such as asthma, respiratory problems, obesity, attention deficit/hyperactivity disorder (ADHD), and sleep disorders like narcolepsy.

This class of drug is often abused for its ability to produce euphoric effects or to counteract sluggish feelings induced by tranquilizers or alcohol. In the hands of teens, stimulants are taken to stay awake, increase alertness and concentration, boost energy, and get high. Sometimes teens go beyond swallowing these pills. If they are prescribed drugs for ADHD, they can save up their pills during the week and share them with friends at weekend parties. They then crush and snort them, or mix with alcohol. Teens also report saving and selling their own ADD drugs around exam time.

a. Examples of Stimulants

  • Amphetamines and dextroamphetamine are stimulant drugs whose effects are similar to cocaine.

  • Methamphetamine is a highly addictive stimulant drug that is part of a larger family of amphetamines.

  • Methylphenidate is a central nervous system stimulant. It has effects similar to, but stronger than, caffeine and less potent than amphetamines.

Ritz, rippers, dexies, and bennies are commonly used terms to refer to stimulants.

b. Signs and Symptoms
There are a number of symptoms and side effects to look for if you suspect someone is abusing stimulants.

Physical side effects
Dilated pupils; decreased appetite; loss of coordination; collapse; increased heart and respiratory rates; elevated blood pressure; dizziness; tremors; headache; flushed skin; chest pain with palpitations; excessive sweating; vomiting; and abdominal cramps.

Psychological side effects
Feelings of restlessness, anxiety, and delusions; hostility and aggression; and panic, suicidal, or homicidal tendencies. Paranoia, often accompanied by auditory and visual hallucinations, may also occur.

Withdrawal symptoms associated with discontinuing stimulant use may include depression, disturbance of sleep patterns, fatigue, and apathy

Overdose or death is preceded by high fever, convulsions, and heart failure. Since death in these cases is partially due to strain on the heart, physical exercise increases the risks of stimulant use.

Facts About Depressants

Depressants, or downers, are often prescribed by doctors to treat a variety of health conditions including anxiety and panic attacks, tension, acute stress reactions, and sleep disorders. When given in high doses, depressants may act as anesthesia.

Often referred to as sedatives and tranquilizers, depressants are substances that can slow normal brain function. Most depressants reduce brain function through a neurotransmitter called gammaaminobutyric acid (GABA) which is a chemical that enables communication between brain cells.

While different depressants work in unique ways, they produce a drowsy or calming effect that can help those suffering from anxiety or sleep disorders. Because they can produce a state of intoxication, they have a high potential for abuse.

a. Examples of Depressants

  • Barbiturates are a type of depressant often prescribed to promote sleep.

  • Benzodiazepines are a type of depressant prescribed to relieve anxiety.

Benzos, xanies, xani-bars, xani-bombs, and roofies are commonly used terms to refer to depressants.

b. Signs and Symptoms
Physical side effects
Dilated pupils and slurred speech; relaxed muscles; intoxication; loss of motor coordination; fatigue, respiratory depression; sensory alteration; and lowered blood pressure. People taking barbiturates may exhibit side effects such as slurred speech, dizziness, sedation, drowsiness, and fever.

Psychological side effects
Poor concentration or feelings of confusion; impaired judgment; and lowered inhibitions. People on barbiturates may experience depression, fatigue, confusion, and irritability.

Withdrawal symptoms include anxiety, insomnia, muscle tremors, and loss of appetite. Going "cold-turkey" off of some depressants can have life-threatening complications, cause convulsions, delirium, and in rare instances, death.

Prevalence of Use



  • Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and antianxiety drugs—in some cases, 55 percent more likely. Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12- to 17-year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers 
    NIDA - National Institute on Drug Abuse

  • In 2006, 16.2 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed. Source: National Survey on Drug Use and Health;

  • The NIDA-funded 2007 Monitoring the Future Study showed that 2.7% of 8th graders, 7.2% of 10th graders, and 9.6% of 12th graders had abused Vicodin and 1.8% of 8th graders, 3.9% of 10th graders, and 5.2% of 12th graders had abused OxyContin for nonmedical purposes at least once in the year prior to being surveyed. Source: Monitoring the Future


  • In 2007, the Nebraska Risk and Protective Factor Student Survey showed that 2.2% of 6th graders, 4.9% of 8th graders, 9.5% of 10th graders and 12.4% of 12th graders had ever used prescription drugs (such as Xanax, Valium, Ritalin, Oxycontin, Adderall or sleeping pills) without a doctor telling them to take them.

  • Additional data from the Nebraska Risk and Protective Factor Student Survey showed that .6% of 6th graders, 1.8% of 8th graders, 4.3% of 10th graders and 4.8% of 12th graders had used prescription drugs (such as Xanax, Valium, Ritalin, Oxycontin, Adderall or sleeping pills) without a doctor telling them to take them during the last thirty-days. Source:


The following sites provide additional information on prescription and over-the-counter drugs abuse.

The National Institute on Drug Abuse (NIDA) has general information on prescription drugs and the "Mind Over Matter" series designed to encourage young people in grades 5 thru 9 to learn about the effects of drug abuse on the body and the brain.

The National Clearinghouse for Alcohol and Drug Information's home page has information on prescription drugs and other substances of abuse.

Substance Abuse & Mental Health Services Administration's (SAMHSA) Office of Applied Studies (OAS) provides the latest national data on alcohol, tobacco, marijuana and other drug abuse.

The Drug Enforcement Agency Demand Reduction site provides information on prescription drugs and other substances of abuse including marijuana and methamphetamine.

A Dose of Prevention provides teachers, guidance counselors, school nurses, psychologists, and administrators an insider's look at the cough medicine abuse subculture; helps you understand the facts; and gives you the tools you need to prevent and stop this latest trend. 

Stay Smart, Don't Start: The Truth About Drugs and Alcohol includes a special section on prescription and over-the-counter medicine abuse. This 16-page newspaper supplement helps educate parents and teens about the dangers of abusing drugs and alcohol. It is published by CADCA, in partnership with the Newspaper in Education (NIE) Institute, PhRMA, and CHPA 

The Partnership for a Drug-Free America has information on all substances of abuse including a new fact sheet entitled "Preventing Teen Abuse of Prescription Drugs".

Stop Cough Medicine Abuse was developed by the leading makers of OTC cough medicines to explain this substance abuse behavior, provide tips to prevent it from happening, and encourage all parents to safeguard their medicines.

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