US NY: GENERATION WRITES OWN PRESCRIPTIONS

Nathan Tylutki arrived late in New York, tired but eager to go out
dancing. When his friend Katherine K. offered him the Ritalin she had
inherited from someone who had stopped taking his prescription, he
popped two pills and stayed out all night.

For the two college friends, now 25 and out in the working world,
there was nothing remarkable about the transaction. A few weeks
later, Katherine gave the tranquilizer Ativan to another friend who
complained of feeling short of breath and panicky.

"Clear-cut anxiety disorder," Katherine decreed.

The Ativan came from a colleague who traded it to her for Vicodin
that Katherine's boyfriend had been prescribed by a dentist. The
boyfriend did not mind, but he asked her not to give away the Ambien
she got from a doctor by exaggerating her sleeping problems. It helps
him relax.

"I acquire quite a few medications and then dispense them to my
friends as needed; I usually know what I'm talking about," said
Katherine, a researcher at a nonprofit agency in New York. She did
not want her last name used because of concerns that her behavior
could get her in trouble with her employer, police or at least her parents.

For many people in their 20s and 30s, deciding on their own what
drugs to take -- in particular, stimulants, antidepressants and other
psychiatric medications -- is becoming the norm. Confident of their
abilities and often skeptical of psychiatrists' expertise, they
choose to rely on their own research and each other's experience in
treating problems such as depression, fatigue, anxiety or a lack of
concentration. A medical degree, in their view, is useful but not essential.

They trade unused prescription drugs, get medications without
prescriptions from the Internet and, in some cases, lie to doctors to
get medications they think they need.

The behavior, drug abuse prevention experts say, is notably different
from the use of drugs such as marijuana or cocaine, or even the abuse
of prescription painkillers. The goal for many young adults is not to
get high but to feel better -- less depressed, less stressed out,
more focused and well-rested. It is just that the easiest route to
that end often seems to be medication for which they do not have a
prescription.

Some aim to regulate every minor mood fluctuation; some want to
enhance their performance at school or work; some simply want to find
the best drug to treat a genuine mental illness. And patients say
that many general practitioners, pressed for time and unfamiliar with
the ever-growing inventory of psychiatric drugs, are happy to take
their suggestions, so it pays to be informed.

Health officials say they worry that as prescription pills get passed
around in small batches, information about risks and dosage are not
included. Even careful self-medicators, they say, may not realize the
harmful interaction that drugs can have when used together or may
react unpredictably to a drug -- Tylutki and Katherine each had a bad
experience with a medication taken without a prescription.

'Head meds' are familiar

To some extent, young adults embracing better living through
chemistry is driven by familiarity. Unlike previous generations, they
have for many years been taking drugs prescribed by doctors for
depression, anxiety or attention deficit disorder.

Prescriptions to treat attention deficit disorder in adults age 20 to
30 nearly tripled from 2000 to 2004, according to Medco, a
prescription management company.

Antidepressants are now prescribed to as many as half of the college
students seen at student health centers, according to a recent report
in The New England Journal of Medicine, and increasing numbers of
students fake the symptoms of depression or attention disorder to get
prescriptions.

"There's this increasingly widespread attitude that 'we are our own
best pharmacists,' " said Bessie Oster, director of Facts on Tap, a
drug abuse prevention program for college students that has begun to
focus on prescription drugs. "You'll take something, and if it's not
quite right, you'll take a little more or a little less, and there's
no notion that you need a doctor to do that."

The new crop of amateur pharmacists varies from those who have gotten
prescriptions -- after doing their own research and finding a doctor
who agreed with them -- to those who obtain pills through friends or
through some online pharmacies that illegally dispense drugs without
prescriptions.

"The mother's little helpers of the 1960s and 1970s are all available
now on the Internet," said Catherine Wood, a clinical social worker
in Evanston, Ill. "You don't have to go and steal a prescription pad anymore."

'I don't think it's unethical'

In dozens of interviews, young people spoke of a sense of empowerment
that comes from knowing what to prescribe for themselves, or at least
where to turn to figure it out. They are as careful with themselves,
they say, as any doctor would be.

"It's not like we're passing out Oxycontin, crushing it up and
snorting it," said Katherine, who showed a reporter a stockpile that
included stimulants, tranquilizers and sleeping pills. "I don't think
it's unethical when I have the medication that someone clearly needs
to make them feel better to give them a pill or two."

Besides, they say, they have grown up watching their psychiatrists
mix and match drugs in a manner that sometimes seems arbitrary, and
they feel an obligation to supervise.

To that end, it helps to have come of age with the Internet. People
of all ages gather online to discuss "head meds," but participants
say the conversations are dominated by a younger crowd for whom
anonymous exchanges of personal information is second nature.

On sites such as CrazyBoards.org, fluency in the language of
psychopharmacology is taken for granted. Drugs are referred to by
both brand name and generic, and no one is reticent about suggesting
meds and dosage levels.

"Do you guys think that bumping up the dosage was a good idea, or
should I have asked for a different drug?" asked someone who called
herself Maggie, saying she told her doctor she wanted to double her
daily intake of the antidepressant fluoxetine to 40 milligrams.

Even for psychiatrists, patients say, the practice of prescribing
drugs is often hit or miss. New drugs for depression, anxiety and
other problems proliferate. Research has found that antidepressants
affect different patients differently, so many try several drugs
before finding one that helps. And in many cases, getting doctors to
prescribe antidepressants, sleeping pills or other psychiatric
medications is far from difficult, patients say.

The result is a surplus of half-empty pill bottles that provides a
storehouse for those who wish to play pharmacist for their friends.