“They slow your brain down,” he said, clutching an orange bottle of pills.
“They iron out all the wrinkles . . . Maybe all the bad stuff happens in the wrinkles, but all the good stuff does, too.”
—RAINBOW ROWELL, FANGIRL
A PARENT’S
every parent dreads. A child is in the emergency room. Or one has died. Someone dies of an overdose of prescription drugs every nineteen minutes. These legal medications kill kids every year, as well as contribute to increased illegal drug use.
No matter how many times we listen to parents’ stories, they don’t get easier to hear. Once, we spoke to the mom of a boy who took OxyContin and Xanax at a party, washing them down with beer. He blacked out. Worried that they’d get into trouble, his friends took too long to call for help. By the time paramedics arrived, the kid was near death. He ended up in a coma.
“I don’t know what to wish for,” his mom told us. “If he lives, he’ll probably be brain-dead.”
Across all ages and most demographics, abuse of prescription pills is one of America’s most serious drug problems. More than four million teenagers regularly—meaning more than twice a month—use prescription and over-the-counter pharmaceuticals to get high. Seven out of ten people who use these drugs combine them with other drugs, increasing the likelihood of overdose or other devastating reactions.
These statistics aren’t surprising when pills are so accessible and easy to come by. Nearly half of Americans take at least one prescription drug every day, and 10 percent take as many as five or six.
The number-one way kids get prescription drugs is from a friend or relative, often taking them from medicine cabinets. Doctors also overprescribe medications that are then often abused. It’s not unusual for people to develop drug problems after getting hurt in an accident and being prescribed these drugs. We know a teenage girl who recently had to have her wisdom teeth out. She left the dentist’s office with a prescription for twenty Vicodin. She took half of one for the pain and had nineteen and a half to spare.
A study showed that more than a quarter of teenagers view pharmaceuticals as safer than street drugs and a third said they believe “it’s okay to use prescription drugs that were not prescribed to them to deal with an injury, illness, or physical pain.” After all, doctors prescribe them, and they come from pharmacies. Because these drugs have legitimate uses, teens believe prescription medications aren’t addictive or fatal, but they’re wrong. As this book goes to press, prescription medication overdose deaths are continuing to rise among teens and young adults, with rates tripling or quadrupling in one out of every three states.
If you or people you know are using (or thinking of using) pills, somehow believing that they’re safer than street drugs, you should keep in mind that drug overdoses have recently become the leading cause of death for Americans under fifty. In addition, as we’ll discuss soon, they often lead kids to a drug they’d never otherwise consider using: heroin.
OXYCONTIN, , AND OTHER PRESCRIPTION
opioids can treat serious pain—that’s why they’re called pain pills. But used without a prescription, or taken in other ways or for different reasons than the doctor prescribed, they can be addictive—and lethal.
There are many kinds of prescription opioids, including Vicodin, morphine, codeine, hydrocodone, roxicodone, and oxycodone (brand names include OxyContin and Percocet), and others. The drug fentanyl is used almost exclusively in hospitals to treat patients with cancer and other illnesses or injuries that cause severe pain.
Calling 911
Sometimes people who overdose die alone, but sometimes they die when they’re with their friends who don’t recognize an overdose, or, even if they do, don’t call 911 because they’re afraid they’ll get in trouble.
It’s important for people to know that most states have something called a 911 Good Samaritan law, which protects people from being arrested for drug possession if they call for help to save a person’s life. You can check online to see about your state.
With or without the law, imagine what it would feel like if you didn’t call 911 and a person you were with died. Time is of the essence; call 911 immediately if someone you’re with is unconscious, having a seizure, having trouble breathing, or experiencing chest pain. If they’re unconscious, while waiting for first responders, start CPR if you know how to do it. If they’re vomiting, turn them on their side so they don’t asphyxiate.
It’s also important to know that people can get in trouble—serious trouble—if they have a party at their house and someone leaves high and is stopped by police driving while intoxicated or if they get in an accident. Many states have what are called “social hosting” laws, which impose criminal penalties on the host of a party where underage drinking or drug-taking occurs. The penalties can include years in jail and tens of thousands of dollars.
Most fentanyl that people use to get high, however, is made in illegal laboratories. It may even be disguised as other drugs—pressed into pills that resemble OxyContin, Xanax, or other sought-after drugs—but with up to one hundred and fifty times the potency. Users may think they know what they’re getting with these pills, but there’s a real risk they’re getting a drug laced with fentanyl, one that may prove deadly.
An even stronger form, carfentanil, can be as much as one hundred times more potent than fentanyl. According to the New York Times, an amount “smaller than a snowflake” can kill a person.
Pain pills are sometimes swallowed and sometimes crushed and then snorted, smoked, or injected. The use or abuse of prescription pain pills can result in physical dependence and addiction. Dependence means that the body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped. Tolerance to the drugs’ effects also occurs with long-term use, so users often must take higher doses to achieve the same or similar effects they experienced initially—that is, one pill no longer causes the high, so a person uses two. Then two doesn’t do it, so a person takes three—and may continue to take higher and higher doses.
Overdose death on opioids (and this is generally true for other drugs, too) can happen in a few different ways. People asphyxiate on their own vomit, triggered when the body attempts to repel the toxic substance; their breathing stops and they basically suffocate; or their heart stops.
Opioids are ravaging communities across America. Deaths from heroin increased 500 percent between 2010 and 2016, and drug deaths from fentanyl and other synthetic opioids are now seeing a sharp rise as well. More Americans die from drug overdoses than in car crashes, and this increasing trend is driven by prescription painkillers.
Opioid overdose has become so common that emergency workers, police, and those who may be in contact with people who are using opioids are urged to carry around doses of naloxone, usually sold under the brand name Narcan. This drug, which can be administered as an injection into the vein or muscle or sprayed into the nose, is meant to counteract the effects of the opioid.
ADDERALL, , AND SIMILAR
people misuse to get high. There are many others. Stimulants are often prescribed to kids with attention deficit hyperactivity disorder (ADHD), and they can be transformative, helping those who’ve been overwhelmed at school, those who can’t sit still or focus and have received a diagnosis of ADHD. Ironically, though, where they tend to calm those kids who truly do suffer from ADHD and use them as prescribed, they energize those without the disorder who misuse them.
The drugs have become common in high schools and colleges, where students take them to study better, stay up all night writing research papers, and take tests—and to party. Sometimes they’re called smart drugs, but despite their reputation, these drugs—mostly Adderall, Ritalin, and Concerta—don’t really make anyone smarter. “Prescription stimulants do promote wakefulness, but studies have found that they do not enhance learning or thinking ability when taken by people who don’t suffer from ADHD,” reports the National Institutes on Drug Abuse. Research has shown that students who abuse prescription stimulants have lower GPAs in high school and college than those who don’t.
Most people don’t know that ADHD drugs are stimulants and are related to methamphetamine and cocaine. Many students never consider the risks of misusing them. Students are swapping, sharing, stealing, and selling ADHD medications, which they often mix with alcohol and other drugs. Consequently, since 2005, there has been an exponential increase in emergency room visits, overdoses, and suicides related to nonmedical use of ADHD drugs by college students and other young adults.
When these drugs are used in controlled doses to treat ADHD, there’s a slow and steady increase of dopamine and other neurotransmitters, which is similar to the way these neutrotransmitters are naturally produced in the brain. Physicians monitor the medications and adjust them as needed. Kids who party or use the drugs to study often take high and dangerous doses.
For some people, these stimulants supercharge the dopamine system—they can cause depression, sleeplessness, paranoia, and intense anxiety, and they can lead to psychosis, suicide or suicidal thoughts, and addiction. They may also damage the cardiovascular and other body systems.
In the past twenty years, the consumption of prescription stimulants like Adderall and Ritalin increased from five million to forty-five million prescriptions, and abuse of these drugs is up 92 percent in the last decade.
the category of depressants, sometimes referred to as central nervous system depressants or tranquilizers, because they “depress” normal brain activity. Depressants are most often prescribed for people with anxiety disorders and to help people sleep. They can be divided into three primary groups: barbiturates, benzodiazepines, and sleep medications. But the names don’t really matter. Taken as prescribed by a doctor, they can be safe and helpful. But taking someone else’s prescription drugs or taking these drugs to get high can cause serious, sometimes catastrophic reactions.
Most depressants increase a chemical in the brain called GABA that sends messages between cells. They slow down brain activity, which can have a relaxing effect. But the medications can also be addictive and even deadly, especially when combined with alcohol or other drugs.
The drugs’ side effects can include impaired motor coordination, impaired thinking and memory, confusion, depression, altered vision, slurred speech, stuttering, vertigo, tremors, respiratory depression, nausea, constipation, dry mouth, abdominal discomfort, anxiety, insomnia, loss of appetite, vomiting, and diarrhea.
Sound fun?
Because all these sedatives and tranquilizers work by slowing the brain’s activity, when a person stops taking the drugs, they can experience seizures and other harmful consequences. As with opioids, tolerance to the drugs’ effects can increase, so people often take more and more of them.
PCP, KETAMINE, DXM,
they cause a person to “dissociate”—disconnect with or separate from—reality. People on these drugs can become confused, psychotic, and suicidal.
One dissociative drug is PCP (phencyclidine), a white crystalline powder that easily dissolves in water or alcohol. It was developed as an anesthetic, but it was taken off the market because it was shown to be dangerous. Like some other drugs that were initially made by pharmaceutical companies, PCP is illegal. It’s created in illegal laboratories, and some batches are tainted with other dangerous drugs.
PCP often comes in the form of tablets, capsules, or colored powders. It’s snorted, smoked, injected, or swallowed. Also called angel dust, embalming fluid, killer weed, rocket fuel, and supergrass, PCP offers a trancelike, sedative effect, a feeling of being out of one’s body, detached from one’s environment. Its effects can include shallow breathing, flushing, profuse sweating, numbness of the limbs, and poor muscular coordination.
PCP can also cause hallucinations, as well as blurred vision, vomiting, seizures, coma, and death, though the latter most often comes from accidental injury or suicide while under the drug’s influence. Long-term PCP users report memory loss, mood disorders, difficulty speaking and thinking, depression, and weight loss. These symptoms can persist a year or more after drug use stops.
Ketamine—known as cat tranquilizer, cat Valium, jet K, kit kat, purple, special K, special la Coke, super acid, super K, and vitamin K—is another dissociative drug. It’s currently used in human anesthesia (knocking someone out during surgery, for example) and veterinary medicine. In fact, much of the ketamine sold on the streets has been stolen or otherwise diverted from veterinarians’ offices. The drug affects memory, attention, and learning. It can cause high blood pressure and depression, and it can slow breathing to the point that it becomes fatal.
Like PCP, ketamine is manufactured as an injectable liquid, but for street use it is often evaporated into a powder that’s snorted or swallowed. And also like PCP, ketamine has dissociative effects that can lead to psychosis.
Ketamine causes dreamlike states and hallucinations, along with sensations ranging from a pleasant feeling of floating to feeling you are being separated from your body. Of course, that’s a best-case scenario.
A bad trip on ketamine can lead to a terrifying feeling of almost complete sensory shutdown, leaving users unable to pull themselves out of a hallucinatory state. Ketamine can also cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. Prolonged use may also cause agitation, cognitive difficulties, and unconsciousness.
Because ketamine is odorless and tasteless, it can be used as a so-called date-rape or acquaintance-rape drug, on its own or sometimes in combination with alcohol. It induces amnesia. The drug has led to horrifying cases of sexual assault and other violent crimes punishable by lengthy prison sentences.
DXM, or dextromethorphan, is a cough-suppressant found in some cold and cough medications. Like PCP and ketamine, DXM can cause hallucinations. Users also describe everything from seeing mild distortions in color to losing motor control.
Because of the abuse of this drug, more states are regulating cough syrups and cold tablets and gel caps that contain DXM, but some have yet to do so. And while some adults can’t imagine kids abusing cough syrup to get high, the reports of middle school and high school kids showing up in emergency rooms after drinking cough syrups that contain the chemical DXM are on the rise.
Another problem is that cough medicines containing DXM usually have other ingredients such as acetaminophen, which can be very dangerous when taken in large quantities, potentially causing liver damage. DXM is also sometimes abused in combination with other drugs or alcohol, which can increase the dangerous physical effects. “Lean” or “purple drank” is another way kids get high. Users mix medications that contain codeine, such as Robitussin AC, with soda and candy to make lean.
ROHYPNOL AND
(an antianxiety medication) and GHB (an anesthetic) are dissociative drugs with a sedative effect that cause amnesia.
Rohypnol is called by many names: circles, the forget pill, the forget-me pill, roach, roofies, rophies, and wolfies, among others. It’s a powerful sedative that depresses the central nervous system. Roofies, swallowed as pills, dissolved in a drink, or snorted, are sometimes taken to enhance a heroin high or to mellow or ease the experience of coming down from cocaine or crack.
Used with alcohol, the drug creates a sleepy, relaxed, and drunk feeling that lasts two to eight hours. Other effects may include blackouts, with a complete loss of memory; dizziness; dangerously slow breathing; disorientation; nausea; and difficulty with motor coordination and speech. Rarely, users of these drugs fall into comas, and some die.
These pills are also used in the perpetration of crimes of robbery or sexual assault. The offender slips the drug into a victim’s drink in order to render them unconscious, or at least too hazy to be in their right minds. Because of this, experts advise people at parties or concerts, in crowded bars, or in similar social situations to keep an eye on their drinks.
GHB, another central nervous system depressant, is used similarly. It is also manufactured as a clear liquid or a white powder, or in tablet and capsule forms. The ingredients in GHB are more commonly used as floor-stripping solvents and drain cleaners.
Bodybuilders have been known to abuse GHB to stimulate muscle growth. It is also commonly abused as a recreational drug, particularly among partygoers in the club scene. Combining it with other drugs, such as alcohol, can result in nausea, loss of muscle control, and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating.
As the dose increases, the sedative effects may result in unconsciousness and eventual coma or death. Other effects include difficulty thinking, hallucinations, slurred speech, headaches, and amnesia.
STEROIDS
of the hormone testosterone. They activate cell growth, particularly in muscles, and help maintain or increase male physical traits. They are also prescribed for conditions such as wounds that won’t heal, pulmonary and bone marrow disorders, and muscle loss.
Though steroids are classified as a schedule III controlled substance—meaning that not only must they be prescribed by a doctor, but also that extra rules are in place to prevent their abuse—they are still subject to misuse by teenagers. The hope is that these drugs will help build muscle, strength, and speed for athletic pursuits or improve users’ physical appearance in other ways. Though boys tend to be the most frequent abusers of steroids, girls have been known to abuse them as well.
Unfortunately, the use of steroids comes with the risk of damaging physical effects, many of which are irreversible. These can include high blood pressure and cholesterol levels, heart and liver abnormalities, fertility issues, and acne. Male users may suffer from shrinkage of the testes and growth of breast tissue. Girls may grow facial and body hair or have issues with their menstrual cycles.
In many cases, users will suffer from mood swings and an increase in anger and aggressive behavior, damaging not just their bodies but their relationships with their loved ones and others. It’s helpful to note, too, that much of what users hope to accomplish by taking steroids can be more safely accomplished through normal weight training, diet, and a sensible course of exercise.
MIXING MISTAKES
that are dangerous on their own are more dangerous when they’re mixed with other drugs, including alcohol.
A father told us a horrifying story about his son, Patrick, who went to what was called a Skittles party, where kids all kick in a variety of prescription drugs stolen from parents’ dresser drawers and medicine cabinets, bought from friends, and prescribed by the psychiatrists treating their friends for depression, ADHD, bipolar disorder, sleeplessness, and anxiety.
Every party’s assortment of Skittles is different. That night, the mix at the party included Adderall, Xanax, Prozac, and a few OxyContins. Friends held the bowl of “Skittles” in two hands, offering it to one another as if it were a bowl of chips. Each kid would dip in, pluck out one or a few, and swallow them down with cup of punch—a mix of cranberry juice cocktail, Red Bull, and vodka, served over ice.
An hour after taking a few pills, Patrick passed out on a couch alongside a girl named Annie. She lay semiconscious, curled up against him.
After doing some tequila shots in the kitchen with some other kids, a boy wandered into the living room and noticed that Patrick and Annie were still asleep. They hadn’t moved in a while, so he went to check on them.
They didn’t seem to be breathing.
He tried to wake them. Patrick stirred a little, but Annie didn’t. She seemed to be having a difficult time breathing.
The boy tried to feel Annie’s pulse, but he didn’t really know what he was doing. Fear shot through him, sobering him up fast. He rushed through the house, telling everyone to take off, to grab their drugs and booze and go.
Someone grabbed the bowl of pills. Then the boy gathered the leftover drugs and flushed them down the toilet. The room was still a mess, so he grabbed a garbage bag and tossed in trash and paraphernalia, including empty beer cans and pipes, which he carried outside to a bin. Once back inside, he dialed 911.
“There’s a girl here. I think she’s overdosing.”
The EMTs arrived in less than fifteen minutes. The boy whose home it was let them in. Trying to keep it together, he made excuses—Annie must have had some drugs—but a paramedic pushed him aside.
The paramedic saw that Patrick was breathing but Annie wasn’t. He attempted CPR while his partner filled a syringe with naloxone, a drug that can reverse an opiate overdose. He injected Annie but got no response.
At the same time, the police arrived and, a moment later, another ambulance crew. Patrick was placed on a gurney and wheeled to an ambulance. After supplying Annie’s name, the boy who hosted the party was arrested. A police officer searched Annie’s cell phone for the number of a relative. He called Annie’s parents. And then he called the coroner.
