WHEN TEENAGERS ABUSE PRESCRIPTION DRUGS, THE FAULT MAY BE THE DOCTOR'S

Every Thursday evening, I counsel a group of teenagers with serious
substance abuse problems. None of the youngsters elected to see me.
Typically, they were caught using drugs, or worse, by their parents
or a police officer and were then referred to my clinic.

To be sure, all the usual intoxicants - alcohol, marijuana,
amphetamines, LSD and cocaine - are involved. But a new type of
addiction has crept into the mix, controlled prescription drugs,
including potent opiate painkillers, tranquilizers and stimulants
used to treat attention deficit disorders.

This is hardly unique to my clinic. Several studies report that since
1992, the number of 12- to 17 -year-olds abusing controlled
prescription drugs has tripled.

In fact, dabbling with some of the pharmaceutical industry's finest
psychoactive compounds constitutes the fastest growing type of drug
abuse in the United States, outpacing marijuana abuse by a factor of
two. One of my patients, Mary, illustrates this trend all too well. A
voracious reader and a talented musician in her high school
orchestra, Mary at 16 is also a "garbage head," meaning that she will
ingest anything she thinks will give her a high.

Last December, she was taken to the hospital for an overdose of
hallucinogenic mushrooms, alcohol, and ketamine, a chemical cousin of
angel dust that doctors sometimes use to anesthetize patients and
that, more commonly, veterinarians use to sedate large animals.

Lately, she has been playing with one of the strongest opiates and
potentially addictive painkillers ever created, Oxycontin. She downs
a few with a single shot of vodka and calls the combination "the
sorority girl's diet cocktail," because it simultaneously allows for
a stronger kick of inebriation and far fewer calories than mere alcohol alone.

The most recent Monitoring the Future report, the continuing study of
teenage drug use conducted by the University of Michigan and the
National Institutes of Drug Abuse since 1975, found that 5.5 percent
of all high school seniors abused Oxycontin, up from 4 percent in
2002. Oxycontin abuse has increased 26 percent since 2002 among 8th,
9th and 12th graders.

A listing of Food and Drug Administration-approved uses for Oxycontin
shows that it is specifically for patients in moderate to severe
round-the-clock pain like that in advanced stages of cancer.

So where does this physically robust teenager obtain her pills? Weeks
earlier, she had a tonsillectomy, a minor though uncomfortable
procedure by any standards. The surgeon wrote a prescription for 80
tablets. Mary spent the next week in a narcotized and medically
sanctioned bliss, until her mother confiscated the last 20 tablets.

At medical conferences, I hear colleagues fault parents who abuse and
obtain these controlled substances but leave them easily accessible
in their unlocked medicine chests where teenagers can help
themselves. Other experts fault the Internet, where almost anyone can
obtain controlled prescription drugs from offshore pharmacies with a
few clicks on a home computer.

The favorite scapegoat is deceptive: addicted patients who, the
argument goes, "doctor shop" and manipulate the physicians into
prescribing the medications, alter the prescriptions themselves or
buy them from drug dealers at exorbitant prices.

None of these targets come close to the real root of the problem.
Many doctors are too quick to write prescriptions for these powerful drugs.

The National Center for Addiction and Substance Abuse recently
reported that 43.3 percent of all American doctors did not even ask
patients about prescription drug abuse when taking histories; 33
percent did not regularly call or obtain records from a patient's
previous doctor or from other physicians before writing such
prescriptions; 47.1 percent said their patients pressured them into
prescribing these drugs; and only 39.1 percent had had any training
in recognizing prescription drug abuse and addiction.

Yet from 1992 to 2002, prescriptions written for controlled
substances increased more than 150 percent, three times the increase
in prescriptions for all other drugs.

The morning after hearing about Mary's Oxycontin holiday, I called
her surgeon and asked him whether he had read her medical chart
detailing an extensive history of substance abuse. "Why did you
prescribe this narcotic bazooka when a BB gun of a painkiller such as
acetaminophen might have done the trick?" I asked.

Sheepishly, the surgeon replied, "Well, I guess I wasn't thinking."

No one in pain - physical or psychic - should suffer. But the fact
remains that we doctors still do the bulk of prescribing of the
substances. The search for root causes of the epidemic with
controlled substance abuse has to include doctors as active
participants. A big part of the solution depends on reserving
prescriptions for those who need, rather than desire, them.