Thursday, October 30, 2014

For the Pill of It

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Potluck-style teen pharma parties may or may not exist, but Arizona’s pill problem is real. And growing.

"See ya, Mom," the teenage boy says, cheerfully. Too cheerfully.

Instantaneously, it seems, the suburban Valley home is packed with frolicking youths – splashing in the pool, draining beer bongs, delighting in the lack of supervision. It all takes a dark turn when Junior calls the party to order. "Awright," he declares, with no small degree of formality. "Who's holding?"

Baggies of brightly colored pills rain down on the billiards table before him. Opiates. Anti-psychotics. Ritalin. Xanax. All swiped from family medicine cabinets. A random, indiscriminate potluck of pharmaceutical drug consumption, sometimes known as a Skittles party or "pharming" party, will follow.

Afterward, a young female pill-popper frames the moment in surprisingly lucid terms: "Who needs drug dealers with parents like ours?"

Ouch.

This cautionary tale of teen drug abuse is based not on a firsthand account, but a PSA video called "Pill Party," commissioned by the office of Arizona Attorney General Tom Horne, viewable on azag.gov. It is direct, persuasive and likely impossible to corroborate. The Skittles party, like the "knockout game" and the "literate Oakland Raiders fan," is one of those urban pseudo-myths too slippery to ever satisfy hardcore skeptics.

But teen and young adult pill abuse? The veracity of that phenomenon – especially in Arizona, where the drug-induced death rate exceeds the national average – is beyond debate. Fueled by an ever-growing prescription drug culture, kids are using illicit meds at unprecedented rates, spawning gateway addictions that feed the exploding heroin and street drug market. Experts say that teen med-heads are becoming more experimental and brazen in their habits, popping not only Oxycontins and Vicodins, but also drugs that provide an uncertain narcotic effect. Much like a pill party.

Candy bowls or no, pill abuse is a time-bomb for users – and a source of moral and financial liability for their parents.

Rise of the Pills
The prescription drug abuse "trend" is well-documented and hardly fresh, but warrants ongoing mention because – unlike the wax and wane of most drug trends – it shows little sign of waning. Part of the reason is expanding supply. According to a report by Columbia University's National Center on Addiction and Substance Abuse, the number of prescriptions filled for pharmaceutical drugs grew by 154 percent during the 10-year period between 1992 and 2002 – this, while the U.S. population grew by a mere 13 percent. Statistical gains the past decade were less dramatic, but still substantial. According to the Food and Drug Administration, total drug prescriptions now hover around 4 billion annually in the U.S. – or roughly 13 per person. In 2002, it was around seven per person.

Drug treatment professionals agree that the preponderance of prescription meds is the main root source for exploding overdose rates. "Prescription pill abuse is the nation's fastest growing drug problem... and it has been for a long time," Stephanie Siete says. As director of community education for Community Bridges, a statewide provider of behavioral health programs, Siete has seen addiction and abuse in most of its forms firsthand. She also knows her stats.

"Drug death rates since the early '90s have tripled," she says. "In 1999, 17,000 died [nationally] from drug overdoses. Ten years later, it was 37,000. More people die from drugs than car accidents, now. And the majority of them die from [prescription drugs]."

Arizona's high drug-overdose mortality rate – sixth in the nation at 17.5 per 100,000, according to a 2010 study by Washington think tank Trust for America's Health – doesn't spare its teenagers. According to the Centers for Disease Control, the poisoning death rate among teens ages 15 to 19 roughly doubled from 1999 to 2009, primarily because of a sharp increase in prescription drug overdoses.

Due to their restricted access to controlled substances like alcohol and tobacco, teens may be particularly prone to experiment with things they find in the family medicine cabinet, according to Arizona Attorney General Tom Horne. And they're also more likely to be naïve about the consequences. "Studies have shown that a large number of teens think prescription drugs are safer than street drugs," Horne says. "Which, of course, isn't true at all."

Siete backs up the numbers: "The survey shows that 27 percent of kids think prescription drugs are safer [than street drugs], while that figure is about one in six with parents."

Studies confirm that prescription drug use – and addiction – among teens is also fueling exploding street demand for heroin. With Oxycontin pills running upwards of $25 on the street, it's simply cheaper and easier to buy a $5 bag of heroin. According to the Substance Abuse and Mental Health Services Administration, initiations to heroin increased 80 percent among 12- to 17-year-olds between 2002 and 2012.

Colleen Feeney, a student assistant coordinator and counselor at Community Bridges, confirms the pill-heroin connection. Sadly, she lived it. Back in 2004, as a recent ASU grad, Feeney was prescribed Percocet following a medical procedure. She soon developed an extra-medical taste for prescription opiates. "I'd be out drinking at a bar and someone would have a Vicodin, and I'd ask for one," she says. "Pretty soon, I was seeking [the pills] out, trying to find people who had them. Through word of mouth I found a doctor not on the up-and-up. You just walked into the office and paid money and he'd write you a prescription. But he got busted by the DEA, so I had to find a different source.

"I'd met people in [the street drug] world and knew about a heroin dealer. And that's how it happened."

Six years later, having gone through "different phases of heroin and opiates," Feeney finally entered recovery, parlaying her ordeal into a career helping young people at a similar crossroads. She's counseled teens with an endless variety of drug histories, and her opinion on the state of the youth drug culture: It's getting a lot more random. And riskier.

Birth of the Pill Party
According to pill party authority Jack Shafer of Slate Magazine, the earliest known mention of a "pharming party" in a U.S. media outlet was a 2002 article in Public Opinion, a small newspaper based in Chambersburg, Pa. It was the kind of irresistible public-menace story that powerfully triggers the Middle American revulsion-fascination reflex: Fun-loving teens and young adults, cleaning out their family medicine cabinets and randomly dumping the illicit meds – uppers, downers, anti-psychotics, whatever – into a candy bowl. Youthful thrill-seeking, insidiously distilled into a living room parlor game, with potentially life-altering consequences.

In a series of articles starting in 2006, Shafer labored mightily to debunk the scourge of pharming parties, which by that time had garnered mainstream media coverage in publications like TIME magazine and the New York Times. He followed dozens of leads and secondhand accounts, but found no firsthand corroboration. Shafer's conclusion: Skittles parties probably don't exist. He acknowledged that teens take and trade meds, but that's hardly a new or novel phenomenon, he argued – and a far cry from randomly popping pills out of a grab bag. He was also dubious that teens would communally mix their expensive and hard-fought Oxycontins with the likes of Sudafed.

"If pharm parties are a trend, they're the best-hidden and least-talked about one in the country," Shafer wrote in a 2006 article.

Though possibly exaggerated – and possibly informed by hazy Baby Boomer nostalgia for the key parties of yore, which may put the pill abuse problem in terms that resonate with their parents – the Skittles party is not necessarily a chimera, according to Valley health experts. Though she has never heard stories of candy bowls, Feeney says authorities recently seized a pill bag containing "Adderall, Xanax and psych meds" at a local high school – precisely the kind of upper/downer/psychotropic stew suggested by the pharma party legend.

Bill Craig can testify to the sometimes odd, counterintuitive melange of drugs ingested by young people. As therapy coordinator for St. Luke's Behavioral Health Center, he sees plenty of kids who wander into compromised mental territory via drug abuse. Sometimes, the patients have an inherited mood disorder, like emerging bipolar, set off by a similarly-afflicted parent's meds. And sometimes, with increasing frequency, the patients are propelled into a psychotic state by mixing traditional abuse-drugs with psychotropics used to treat diseases like schizophrenia and bipolar disorder. "It's not unusual to see kids experiment with each other's anti-psychotics and stimulant drugs for disorders like ADHD," he says. "Lithium, Risperdal, Seroquel, along with the opiates. That's why they call them Skittles parties."

Typically, alcohol is thrown into the mix – and often marijuana, as well. "That's the problem [with treating psychotic patients] – we don't know what they're mixing it with," Craig says. "They'll have extrapyramidal symptoms, which are intense movement disorders, and respiratory arrest is a possibility if they're not treated. They will literally take two or three times the dose, and mix with alcohol and weed, and the result is very often psychosis. We see a lot of kids [like that]."

Asked to speculate on why teens would knowingly court such patently unenjoyable outcomes, with drugs not designed with an analgesic or pleasurable effect, recovery counselor Feeney is philosophical. "These kids just have the mindset of 'I'll take any pill.' Even things that don't get you high. I guess it's the allure of being in an altered state... I was always scared of not knowing, but maybe for them, it is the not knowing."

Recovery Program
Arizona leaders have not sat idle when it comes to the state's prescription drug abuse problem. In 2008, the Arizona State Board of Pharmacy launched its Controlled Substances Prescription Monitoring Program, which requires pharmacies to report the dispensing of Schedule II (codeine, hydrocodone), III (Benzphetamine, barbiturates) and IV (milder depressants and stimulants) drugs to a central database, and also tracks physicians who prescribe such drugs. It has widely been cited as a critical factor in limiting the practice of "doctor shopping" – i.e. collecting prescriptions from multiple physicians for the same meds.

Meanwhile, individual cities and agencies run their own drug disposal programs. The Mesa Police Department, for example, launched a MedReturn box program last year, placing no-hassle boxes in the lobbies of four departments.

High-profile officials have also taken a public stand on the issue. Though the Arizona Attorney General generally has no direct involvement with street-level drug matters, Horne was one of 29 state attorneys general to sign a letter lobbying the FDA to review its decision to approve Zohydro, a powerful prescription opiate that critics have dubbed "the new Oxycontin." And he also commissioned that PSA pill party video, lest we forget.

The existence of such parties – or, at least, the practice of dangerously mixing drugs – is more than just an academic matter, or a Bigfoot hunt for journalists. It may have very real legal consequences for the parents and guardians whose names are on the bottles. For instance, if a teen were to bring a bottle of Oxycontin to a party, and another minor were to overdose on the contents, the legal owners of said pills might be financially liable. "As a criminal matter, I don't know," Phoenix-based criminal defense attorney Rich Gaxiola says. "The more powerful case is against the parent for civil liability."

According to Gaxiola, the statutory award limit of $10,000 set by the state for negligent acts by a minor – say, if your "10-year-old kid were to go to school and break some other kid's eye socket" – wouldn't apply in our hypothetical drug overdose. "There would be no restriction on the amount of money that a jury could award you, since the parent is the negligent party."

A plaintiff would have a particularly strong case if they could demonstrate that the defendant "has a clear knowledge that they're aware of the epidemic of prescription drugs... and knew it was reasonable that people can safeguard those meds at home."

Never heard of a Skittles party? Well, you have now. So lock up those surplus Oxys, in case it actually exists.

 

U.S. Drug Overdose Mortality Rates
Arizona has the sixth-highest drug overdose mortality rate in the nation (17.5 per 100,000), according to Trust for America’s Health (2010).

 

Valley Take-Back Programs
Dispose of unwanted meds with the help of these local resources.

Mesa Police Department:
Became the Valley's first law enforcement agency to offer permanent drop-off locations with its MedReturn program. mesaaz.gov

DEA:
The federal drug agency is sponsoring a National Prescription Drug Take-Back Day on April 26 from 10 a.m. to 2 p.m. Visit deadiversion.usdoj.gov/drug_disposal to find a location near you.

City of Scottsdale:
Offers an online tutorial on how to safely dispose of drugs at home. scottsdaleaz.gov

Visit Earth911.com for programs in your neighborhood.

 

 

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