本帖最後由 lsc0019 於 2009-8-9 21:28 編輯
作者：Janis Kelly
出處：WebMD醫學新聞
July 20, 2009 — 購買處方藥物濫用的青少年比較可能有持續的藥物濫用問題，但是多數青少年的藥物誤用來自家庭或朋友。這是重要的，因為青少年處方藥物誤用增加，而其他非法藥物、酒、菸的使用則降低。
青少年誤用項目中，處方藥僅次於酒、菸和大麻。Ty Schepis博士和Suchitra Krishnan-Sarin博士的一篇研究，登載於2009年8月的美國兒童青少年精神醫學期刊，顯示此類藥物多數來自家中。
研究者也報告指出，如何預測取得處方藥物的青少年是否會發生同時濫用其他物質，如酒精，且視為更嚴重的濫用與處方藥物誤用問題的徵兆。同樣來自耶魯大學紐哈分醫學院的Schepis博士和Krishnan-Sarin博士，分析2005和2006年全國藥物使用與健康調查(NSDUH)的資料，顯示在所有的藥物(鴉片、興奮劑、鎮靜安眠劑)中，將近50%免費來自朋友或家中成員。
除了鴉片之外，最常見的來源是購自朋友或親屬(13.1%- 29.7%)或藥頭(4.6%- 12.0%)。至於鴉片，第二高的來源是醫師。
作者結論表示，同時有其他物質濫用的最高風險者，是那些從朋友、家庭或藥頭購得物用藥物者。相較於從醫師獲得誤用藥物的青少年，購買藥物的青少年更可能會喝酒(鴉片和鎮靜劑)、每天抽菸(鴉片和興奮劑)、過去一個月抽過大麻(全部三組)、過去一年用過古柯鹼(鴉片和興奮劑)。
【取得藥物太容易】
同樣從事青少年藥物濫用研究的Richard A. Friedman醫師向Medscape Psychiatry表示，這些資料強調了青少年取得可能濫用的處方藥物是那麼輕而易舉。從這些資料看來，很顯然，主要的來源不是街頭的藥頭，而是朋友、家庭成員和醫師。Friedman醫師是紐約市康乃爾大學Weill醫學院精神藥物門診主任、臨床精神科教授。
Schepis博士和Krishnan-Sarin博士表示，他們的資料指出，醫師應定期對所有青少年進行誤用處方藥物的篩檢。
Schepis博士向Medscape Psychiatry表示，篩檢處方藥物誤用端賴你對你的病患的臨床印象與其目前的物質使用狀況。對於目前抱怨有憂鬱症狀或焦慮的病患，簡單詢問有關酒類、菸、大麻、處方藥物等的使用狀況，最好採用非主觀的實際方法。
主要的問題是，病患是否曾有物質濫用、過去濫用的時間、在一段特定時間內的濫用頻率。這些資訊有助於開業醫師決定如何給予必要的介入。
當病患正接受物質濫用治療、或有明顯證據顯示病患蓄意誤導有關物質濫用情形時，即應進行驗尿。不過，Schepis博士表示，驗尿也有其風險，對於建立和保持信任可能會有不良後果，特別是出乎病患意料時。
【假象？】
Friedman醫師推測，因為處方藥物是獲得美國食品藥物管理局核准，且在平面和電子媒體廣泛對消費者直接廣告，年輕人或許會誤認這些藥物是安全的。
他表示，畢竟，如果病患使用這些醫師開立的藥物，會有多不好？另一個因素是同儕接受度。如果你注意本研究之外的其他資料，處方藥物的接受度正穩定增加，年輕人對於古柯鹼和興奮劑的態度則是轉為負面。
Schepis博士警告，容易取得也是因素之一。許多人將以前開方取得的藥物留在藥櫃內，這可能是手術後用的鴉片類止痛劑。這些藥物將輕易成為青少年希望嘗試的目標，甚至繼續使用或賣給同儕。因此，適當的藥物丟棄途徑是相當重要的，所有病患應有相關諮商。
【嚴重影響】
Friedman醫師表示，這些發現對於醫師的影響相當令人印象深刻。
他表示，醫師在開立可能會有濫用情況的處方藥物給青少年時必須相當小心。雖然這些人未被發現的精神疾病比率依舊相當高，除了治療注意力不足過動障礙症的興奮劑之外，抗憂鬱、抗精神病與心情穩定劑等，都不具成癮性。相對的，那些醫療上健康的人卻可能在醫學上合理合法使用(有成癮性的)鎮靜劑、安眠劑與麻藥。
國家健康研究中心部份支持本研究。作者們宣告沒有相關財務關係。
Teen Drug Use Often Begins With the Family Medicine Cabinet
By Janis Kelly
Medscape Medical News
July 20, 2009 — Adolescents who buy prescription drugs for illicit use are more likely to have ongoing substance abuse problems, but most teen-drug misuse involves drugs obtained for free from family or friends. This is important because prescription-drug misuse by teens is rising even though the use of other illicit drugs, alcohol, and tobacco has decreased.
Prescription drugs are surpassed only by alcohol, tobacco, and marijuana in misuse by adolescents. A study by Ty Schepis, PhD, and Suchitra Krishnan-Sarin, PhD, published in the August 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, shows that much of this drug use likely begins at home.
The researchers also report that how an adolescent obtains prescription drugs predicts whether other substances, such as alcohol, are being abused at the same time and signals a risk for more severe substance and prescription-drug misuse problems.
Drs. Schepis and Krishnan-Sarin, both from the Department of Psychiatry at Yale University School of Medicine in New Haven, Connecticut, used data from the 2005 and 2006 National Survey on Drug Use and Health (NSDUH) to show that, across all classes of medications (opioids, stimulants, tranquilizers, and sedatives), nearly 50% were obtained from friends or family members free of charge.
With the exception of opioids, the most common source was purchasing the drug from friends or relatives (13.1%?- 29.7%) or from a drug dealer (4.6%?- 12.0%). For opioids, the second most common source was from a physician.
"The group with greatest odds of concurrent other substance use may be those who purchased their medication for misuse from friends, family, or drug dealers. In comparison with adolescents who misused medication obtained from a physician, adolescents who buy medication are more likely to have endorsed binge alcohol use (opioids and tranquilizers), daily cigarette use (opioids and stimulants), past month marijuana use (all 3 classes examined), and past year cocaine use (opioids and stimulants)," the authors conclude.
"Disturbingly Easy" to Obtain Drugs
Richard A. Friedman, MD, who also studies teenage drug abuse, told Medscape Psychiatry that "these data underscore how (disturbingly) easy it is for young people to obtain potentially abusable prescription drugs. It is clear from these data that the main source is not street dealers, but friends, family members, and physicians." Dr. Friedman is professor of clinical psychiatry and director of the Psychopharmacology Clinic at Cornell University's Weill Medical College in New York City.
Drs Schepis and Krishnan-Sarin say that their data indicate that physicians should be routinely screening all adolescent patients for prescription misuse.
"Screening for prescription misuse depends on your clinical impressions of your patient and of his/her current substance use. With patients who have a presenting complaint of depressive symptoms or anxiety, simply asking about substance use across the spectrum of alcohol, tobacco, marijuana, prescriptions, etc, in a nonjudgmental and matter-of-fact way is likely best," Dr. Schepis told Medscape Psychiatry.
"The main questions are about whether the patient has ever used a substance, timeframe of last use, and frequency of use over a specified time period. That information can then help a practitioner decide how to proceed with a potential intervention, if one is needed."
Urine testing may be indicated when a patient is in treatment for substance use or there is clear evidence that the patient has intentionally misled care providers about substance use. The risk inherent in urine testing, however, is that it can be very counterproductive for establishing and keeping trust, especially if it is a surprise to the patient," Dr. Schepis said.
False Impression?
Dr. Friedman suspects that because prescription drugs are approved by the US Food and Drug Administration and are widely advertised directly to consumers in the print and electronic media, young people might have the mistaken impression that these drugs are safe.
"After all, if their parents use them and their doctors prescribe them, how bad can they be? Another factor is peer acceptance. If you look at other data from this survey, acceptance of prescription drugs has been steadily rising, while attitudes among youth about cocaine and stimulants has become more negative," he said.
Dr. Schepis warned that availability is also a factor. "Many people have medications that they previously needed that remain in their medicine cabinet, perhaps an opioid analgesic for a surgery. These medications are easy targets for adolescents wishing to experiment, continue to use, or sell medications to peers. Thus, proper medication disposal is really important, and all patients should be counselled on that."
Major Implications
Dr. Friedman said that the implications of these findings for clinicians are "huge and pressing."
"Physicians have to be very careful about prescribing drugs of potential abuse to young people. Although it's true that the rates of undetected psychiatric illness are quite high in this population, the mainstays of [pharmacologic] treatment, are, with the exception of stimulants for attention-deficit/hyperactivity disorder, drugs like antidepressants, antipsychotics, and mood stabilizers — none of which are addictive. In contrast, there is rarely a medically legitimate rationale to use tranquilizers, hypnotics, narcotics, and the like in this usually medically healthy population," he said.
The study was supported in part by the National Institutes of Health. The authors have disclosed no relevant financial relationships.
J Am Acad Child Adolesc Psychiatry. 2009;48:828-836. |
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