Healthy Skepticism Library item: 2773

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Publication type: news

Harmon A.
Young, Assured and Playing Pharmacist to Friends
New York Times 2005 Nov 16
http://www.nytimes.com/glogin?URI=http://www.nytimes.com/2005/11/16/health/16patient.html&OP=68653bd2Q2Fg3Q7BQ3FgQ3DyVfeyyWQ5DgQ5D991gQ24Q24gQ24Q60gQ2BQ7BQ25aWQ2BgQ24Q60rQ25WqQ7BcWQ5CQ2BW-a

Notes:

Ralph Faggotter’s Comments:

In each generation a proportion of young people has always engaged in risk-taking behaviour against the advice of their parents etc.
Teenagers experimenting with mind-altering drugs feel uniquely invulnerable to the adverse or addictive effects of those drugs.
This is why 1/3 of the population is addicted to nicotine, and a signifcant but lesser proportion is addicted to other non-prescription drugs like alcohol, heroin, cocaine, amphetamines etc.

This is nothing new.

Neither is it new for a significant portion of the population to be addicted to prescription drugs.

In the 1950s and 60s addiction to barbituates was common, as were fatal overdoses from the use of these drugs.
When barbituates were replaced by Valium and other benzodiazepines for relieving anxiety, this was thought to be a major advance as it was harder to die from overdose and Valium was (incredibly) claimed to be non-addictive. Of course we now know what a disasterous drug Valium is, but using it as a ‘downer’ to counteract the effects of ‘uppers’ was common practice for those pariticipating in the drug culture of the 1970s. A very large proportion of the population over the age of 70 are addicted to prescription benzodiazepines. Many of these people started out on prescription barbituates to help them sleep.

Many a normal person, experiencing some traumatic life experience and having temporary trouble sleeping for a few nights, went to the doctor and got a prescrpition for 25 Serepax ( oxazepam) or Mogadon ( nitrazepam) or Normison ( temazepam) or Rohypnol ( flunitrazepam) and took one each night for 25 nights and by the time they had finished the bottle found themselves permanently hooked on these drugs.

Their temporary insomnia was converted into permanent insomnia by the regular nightly medication use.

I wonder what proportion of the current generation of teenagers will be addicted to bed-time benzodiazepines when they are ready for retirement? It coud hardly be any worse than the present generation of retirees.

Full text:

THE NEW YORK TIMES
November 16, 2005 Front Page
Being a Patient
Young, Assured and Playing Pharmacist to Friends
By AMY HARMON
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 former colleague who had traded it to her for the Vicodin that Katherine’s boyfriend had been prescribed by a dentist. The boyfriend did not mind, but he preferred that she not give away the Ambien she got from a doctor by exaggerating her sleeping problems. It helps him relax after a stressful day.

“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, who lives in Manhattan and who, like many other people interviewed for this article, did not want her last name used because of concerns that her behavior could get her in trouble with her employer, law enforcement authorities or at least her parents.

For a sizable group of people in their 20’s and 30’s, 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 like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

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

A spokeswoman for the Drug Enforcement Administration says it is illegal to give prescription medication to another person, although it is questionable whether the offense would be prosecuted.

The behavior, drug abuse prevention experts say, is notably different from the use of drugs like marijuana or cocaine, or even the abuse of prescription painkillers, which is also on the rise. The goal for many young adults is not to get high but to feel better – less depressed, less stressed out, more focused, better 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 seek 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; Mr. Tylutki and Katherine each had a bad experience with a medication taken without a prescription.

But doctors and experts in drug abuse also say they are flummoxed about how to address the increasing casual misuse of prescription medications by young people for purposes other than getting high.

Carol Boyd, the former head of the Addiction Research Center at the University of Michigan, said medical professionals needed to find ways to evaluate these risks. “Kids get messages about street drugs,” Ms. Boyd said. “They know smoking crack is a bad deal. This country needs to have a serious conversation about both the marketing of prescription drugs and where we draw the boundaries between illegal use and misuse.”

To some extent, the embrace by young adults of 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.

Direct-to-consumer drug advertising, approved by the Food and Drug Administration in 1997, has for most of their adult lives sent the message that pills offer a cure for any ill. Which ones to take, many advertisements suggest, is largely a matter of personal choice.

“If a person is having a problem in life, someone who is 42 might not know where to go – ‘Do I need acupuncture, do I need a new haircut, do I need to read Suze Orman?’ “ said Casey Greenfield, 32, a writer in Los Angeles, referring to the personal-finance guru. “Someone my age will be like, ‘Do I need to switch from Paxil to Prozac?’ “

For Ms. Greenfield, who could recite the pros and cons of every selective serotonin reuptake inhibitor on the market by the time she graduated from college, years of watching doctors try to find the right drug cocktails for her and for assorted friends has not bolstered faith in their expertise.

“I would never just do what the doctor told me because the person is a doctor,” said Ms. Greenfield, who dictates to her doctors what to prescribe for her headaches and sleep problems, and sometimes gives her pills to friends. “I’m sure lots of patients don’t know what they’re talking about. But lots of doctors don’t know what they’re talking about either.”

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. Medications for sleeping disorders in the same age group showed a similar increase.

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 that they believe will give them an edge. Another study, published recently in The Journal of American College Health, found that 14 percent of students at a Midwestern liberal arts college reported borrowing or buying prescription stimulants from each other, and that 44 percent knew of someone who had.

“There’s this increasingly widespread attitude that ‘we are our own best pharmacists,’ “ said Bessie Oster, the 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.”

Now, Going Online for Pills
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 1960’s and 1970’s are all available now on the Internet,” said Catherine Wood, a clinical social worker in Evanston, Ill., who treated one young client who became addicted to Xanax after buying it online. “You don’t have to go and steal a prescription pad anymore.”

In dozens of interviews, via e-mail and in person, 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 with a patient.

“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. “I tried Zoloft because my doctor said, ‘I’ve had a lot of success with Zoloft,’ no other reason,” said Laurie, 26, who says researching medications to treat her depressive disorder has become something of a compulsion. “It’s insane. I feel like you have to be informed because you’re controlling your brain.”

When a new psychiatrist suggested Seraquil, Laurie, who works in film production and who did not want her last name used, refused it because it can lead to weight gain. When the doctor suggested Wellbutrin XL, she replied with a line from the commercial she had seen dozens of times on television: “It has a low risk of sexual side effects. I like that.”

But before agreeing to take the drug, Laurie consulted several Internet sites and the latest edition of the Physicians’ Desk Reference guide to prescription drugs at the Barnes & Noble bookstore in Union Square.

On a page of her notebook, she copied down the generic and brand names of seven alternatives. Effexor, she noted, helps with anxiety – a plus. But Wellbutrin suppresses appetite – even better.

At the weekly meetings of an “under-30” mood-disorder support group in New York that Laurie attends, the discussion inevitably turns to medication. Group members trade notes on side effects that, they complain, doctors often fail to inform them about. Some say they are increasingly suspicious of how pharmaceutical companies influence the drugs they are prescribed.

“Lamictal is the new rage,” said one man who attended the group, “but in part that’s because there’s a big money interest in it. You have to do research on your own because the research provided to you is not based on an objective source of what may be best.”

Recent reports that widely prescribed antidepressants could be responsible for suicidal thoughts or behavior in some adolescents have underscored for Laurie and other young adults how little is known about the risks of some drugs, and why different people respond to them differently.

Moreover, drugs widely billed as nonaddictive, like Paxil or Effexor, can cause withdrawal symptoms, which some patients say they only learned of from their friends or fellow sufferers.

“This view of psychology as a series of problems that can be solved with pills is relatively brand new,” said Andrea Tone, a professor of the social history of medicine at McGill University. “It’s more elastic, and more subjective, so it lends itself more to taking matters into our own hands.”

To that end, it helps to have come of age with the Internet, which offers new possibilities for communication and commerce to those who want to supplement their knowledge or circumvent doctors.

Fluent in Psychopharmacology
People of all ages gather on public Internet forums to trade notes on “head meds,” but participants say the conversations are dominated by a younger crowd for whom anonymous exchanges of highly personal information are second nature.

On patient-generated sites like CrazyBoards, fluency in the language of psychopharmacology is taken for granted. Dozens of drugs are referred to in passing by both brand name and generic, and no one is reticent about suggesting medications 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?” someone who called herself Maggie asked earlier this month, saying she had told her doctor she wanted to double her daily intake of the antidepressant fluoxetine to 40 milligrams. xxxxxxxxxxx cut xxxxxxxxxxxxx

A Post-Hurricane Care Package
Dan Todd, marooned in Covington, La., after Hurricane Katrina, said he would be forever grateful to a woman in New Hampshire who organized a donation drive for him among the site’s regular participants.

Within two days of posting a message saying that he had run out of his medications, he received several care packages of assorted mood stabilizers and anti-anxiety drugs, including Wellbutrin, Klonopin, Trileptal, Cymbalta and Neurontin.

“I had to drive down to meet the FedEx driver because his truck couldn’t get past the trees on part of the main highway,” said Mr. Todd, 58. “I had tears in my eyes when I got those packages.”

It doesn’t always work out so well. When Katherine took a Xanax to ease her anxiety before a gynecologist appointment, she found that she could not keep her eyes open. She had traded a friend for the blue oval pill and she had no idea what the dosage was.

An Adderall given to her by another friend, she said, “did weird things to me.” And Mr. Tylutki, who took the Ritalin she offered one weekend last fall, began a downward spiral soon after.

“I completely regretted and felt really guilty about it,” Katherine said.
Taking Katherine’s pills with him when he returned to Minneapolis, Mr. Tylutki took several a day while pursuing a nursing degree and working full time. Like many other students, he found Ritalin a useful study aid. One night, he read a book, lay down to sleep, wrote the paper in his head, got up, wrote it down, and received an A-minus.

But he also began using cocaine and drinking too much alcohol. A few months ago, Mr. Tylutki took a break from school. He flushed the Ritalin down the toilet and stopped taking all drugs, including the Prozac that he had asked a doctor for when he began feeling down.

“I kind of made it seem like I needed it,” Mr. Tylutki said, referring to what he told the doctor. “Now I think I was just lacking sleep.”

Copyright 2005 The New York Times Company