Running head: GENERATION ℞ 1

Generation ℞: Overprescription and Abuse of Prescription Drugs in Adolescents:

With an Emphasis in Mental Health

Connor J. McMullen

First Colonial High School: Legal Studies Academy

Generation ℞ 2

Abstract

This paper focuses on the prominence of prescription drug abuse and over-prescription of

america's youth. Specifically emphasizing and hinting at the rise of mental health issues in

America's youth as the biggest benefactor to this problem. The history of drug abuse and mental

illness will be briefly explained in order to emphasize the development of humans and human

nature in concerns to the current generational problem. This paper will touch on the nature of

prescriptions drugs and their legality as well as an emphasis on the moral and legal guidelines

doctors take when prescribing drugs. Next the rise of mental health issues as well as the

associated implications and effects it has had on today's society, as well as that of drug-abuse and

overprescription. CAM and In-School implementation of CAM therapies will be explained as

well as provided statutes both on the federal level that advocate for in-school mental health

therapy. Federal and State law will be used and explained as well as the development of the Drug

Enforcement Agency (DEA), to advance the research paper into a well rounded and legally,

historically and ethically pressing research paper.

Keywords: Prescription Drug Abuse, Over-Prescription, Mental Illness, CAM therapy, Youth
Generation ℞ 3

Overprescription and Abuse of Prescription Drugs in Adolescents

One of the fastest rising problems concerning drugs and adolescents is not the use of

illegal narcotics or black-market drugs, but the use of over-the counter/prescription medicines for

illegitimate purposes. Most people; adults and children alike, do not think that the use of

unprescribed drugs can inflict as much damage as the use of recreational and illegal drugs. One

in three parents state that they believe ADHD medicine, even in children without ADHD, will

and can help improve their testing abilities and concentration. One in four children believe that

such medicine can be used to enhance one's ability to study. One in four teens have abused a

prescription drug at least once in their lifetime, something around 17 million children (The

Partnership, 2013) .

Children who experiment with or use non-prescribed medicine, and even those who are

prescribed, must deal with short and long term implications of use. Adolescents who are

developing are susceptible to negative effects, primarily in the functioning and healthiness of the

brain. Therefore, the susceptibility to become addicted is much higher, an addiction that can

permanently alter that person's life forever which in turn forges very negative relationships

(Volk, 2016). But it is not without reason that prescription drugs rose so fast on the radar as a

new drug of choice. For to be an effect, their must be a cause, and this cause we find in mental

illness. Children with ADHD, bipolar disorder, schizophrenia, clinical depression or autism are

the most commonly medicated, and their is indeed a large portion of the population that consists

of adolescents ailed by these conditions. Human beings are not one and the same, cookie cutter

beings. All have storylines mixed and intertwined with physical, mental and spiritual happenings

which create different people. Which is why when it comes to the topic of mental illness such as

depression, there is no true cut way to deal with the issues at hand because there is no band-aid
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that can be immediately applied to heal a patient. When it comes to mental health, it really is

only self-discovery and application of ourselves when it comes to the core of the issue; which is

why conventional medicine in and of itself, specifically when concerning mental health, is only

so useful in healing. It may be a way to control unhealthy impulses, or to keep people in a non-

harmful state, but these prescriptions are not guaranteed answers, especially in people with a

unclear diagnosis. Prescriptions are not preventative but secondary to a problem. It is important

to state that there are clearly cases of individuals who do, indeed, need medication to contain or

control the symptom(s) of a mental illness or physical symptom. In fact, a 13+ year longitudinal

study of ADHD kids and the supposed pre-disposition of drugs, found that children are actually

less inclined to drug and alcohol abuse later in life and that, “Approximately 74% to 97% of

school age ADHD children respond positively to any given stimulant,” (Barkley, 2003). It must

be noted though,that the facts of the study do not account for multiple other types of

prescriptions and mental health issues in adolescents, it simply clears the name of culprit in one

community. This is not to say that no child prescribed with stimulants for ADHD does not

become a drug dependent later in life, but is to say that there is no real correlation on a large

scale. This is also not to say that no drugs should be allowed, because certainly as seen here, they

can be largely effective, but the dangers and problems that can arise because of their availability

and properties, especially to children without mental health issues and then use them is

incredibly dangerous. Children who need the drugs, need them. Children who don’t; need to be

taught how, why and what happens if you use prescription drugs illegally and the effects of

dependency.
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The problem that America is facing, is the percent of people who become complacent in

their adversity or illness and decide that abuse of prescription drugs is a legitimate way to deal

with their problems.

History of Mental Illness

Mental illness as described by the American Psychiatric Association as, “Health

conditions involving changes in emotion, thinking or behavior (or a combination of these).

Mental illnesses are associated with distress and/or problems functioning in social, work or

family activities” (Parekh, 2018). Of course, if there is to be an illness, something must be

wrong; there must be a reason why adolescents of this age are more prone to escapism tactics

and reclusiveness from the outside world. Their must be a reason that 1/5th of the youth

population in America live with a legitimate mental health issue and that suicide is the 3rd

leading cause for death among youth (NAMI, 2018). Historically, the approach to dealing with

mental health issues in any case whether young or old, male or female has been typically

approached with religious zeal and negative stigmatization. Patients were believed to be

possessed by demons or simply in need of religion in order to be cured, which of course can be

legitimate , but only to an extent; this topic will be touched on later. It is clear that with the

development of technology the understanding and development of medicine has excelled.

Alexander Fleming's discovery and later mass production of Penicillin, (a common antibiotic

used globally that has saved millions of lives) in 1928 is just one example. As medicines

develops, so do people's understandings of the human body.

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History of Drug Abuse and Overprescription in Adolescents

Drug abuse is the, “chronic, relapsing disorder characterized by compulsive drug seeking

and use despite adverse consequence. It is considered a brain disorder…(NIH, 2018)”;

Overprescription however, is the “process of overprescribing medicine (Merriam-Webster,

2018).” The most distinguishable difference between these two, is the informed negligence vs.

uninformed negligence of the actions. The doctor is responsible for the prescribing of drugs, in a

proper and safe amount as well as informing the patient of the risks involved; it is then the turn

of the patient to understand and know what they are being prescribed and then consent under an

informed state of knowledge.

Drug Abuse can involve any sort of drug whether legal or not, but the personal decision

of the person abusing the drugs is indeed informed, and negligent (Boeschen, 2018). The average

person is not expected to know about medicine and the health implications they can have nearly

as much as a professionally trained Doctor, so it is reasonable to assume that the average person

can only be held to such a standard of knowledge and safety when using the prescribed

medicine. In this way, people are entrusting their wellbeing in a doctor as well as their life.

Seeing as far back as one can historically, it is clear that humans from all cultures have

searched for way to alter the mind by means of alcohol or drugs (Dombeck, 2018). The use and

the types of drugs, as stated earlier, have developed tremendously with the development of

technology, but the principle remains the same: The alteration of the human body and mind in an

attempt to change it whether medically or recreationally (Dombeck, 2018)

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Current Prevalence

There are one thousand four hundred and forty three various legal and FDA approved

drugs in current use in american medical system (Gaffney, 2014). Before this number has been

officially released, it is also important to understand that there are many, many thousands of

unapproved drugs being sold legally and illegally. Five-hundred of which have been removed

from sale by the FDA (Shye, 2015). The FDAś primary goal in Drug approval is that the benefits

outweigh the risks and that depending on the risks, the ability to access and use of the drug is

determined upon this ratio. Before the FDA had really started to crack down on prescription

grade medicine, (during the opioid epidemic of the 90ś) the spike in use of prescription drugs

according to Dr. Ripley of Regent University's school of psychology, began with the “ 60ś drug

wave, which was primarily heroine and marijuana use, moving into the 80s which was led by the

mass use of cocaine, and the introduction of prescription drugs. This came about due to a

decrease in social productivity and direction, (specifically among the youth) and a desire to fix

that with an, ¨up and coming high energy attitude,” that led toward stimulant use like cocaine.

Dr. Ripley contends that all drug crazes occur because of social events and as influences grow,

and the models that children find themselves looking up to, i.e celebrities, parents, elders, peers,

etc. the children themselves will follow them when concerning decision making, like drug use.

Along with role-models, drug use also very dependent on the community and socio-economic

situation the child finds themselves living in. These are the biggest factors in looking at whether

the child is a candidate for drug abuse. Dr. Ripley relates this now, to the last decade

introduction of personal cell-phones into children's lives as well as prescriptions and most

notably mental illness. Children are now capable of accessing and viewing essentially anything

the media and world chooses to upload. The world is now more interconnected than ever before,
Generation ℞ 8

and in a country where seventy-three percent of teenagers have smartphones (Lenhart, 2015), the

chances of children actually managing their screen time to an effective manner is small. In a

CNN poll of one thousand and forty three teenagers (ages 14-18 and their parents), fifty percent

of the teenagers said they felt they were addicted to their phones (Wallace, 2016). A top

addiction therapist, Mandy Saligari states, “giving a child a smartphone is like giving them a

gram of cocaine (Saligari, 2017).”

Prescription drugs, just like cell phone´s can be incredibly addictive under the layer of

safety it seems to provide. Where one in four children believe medicine can be used to enhance

one's ability to study as well as a quarter of teenagers admitting they have abused a prescription

drug at least once in their lifetime. One out of four children in America is around 17 million

children. Currently 23.5 percent of children in America (18 or younger) are taking at least one

prescription pill a day, varying from antidepressants, opioids and psychotropics (Higashi, 2017).

Eight percent of teens admit to abusing prescription opioids (Higashi, 2017). Along with this a

fivefold increase in the number of children prescribed psychostimulant medications, along with

a six-fold increase in the number of antipsychotic medications prescribed (Higashi, 2017). The

overdose death rate in children has doubled 2008 (Higashi, 2017). Interestingly, since the late

90's the teenage abuse of opioids such as vicodin have dropped tremendously into 2017 and

continue to stay low (Uni. of Michigan, 2017). This statistic does not concern the abuse of other

prescription medicines such as antidepressants and psychotropics which are primarily used for

mental health treatment.

Ethical and Legal concerns of Prescriptions

Generation ℞ 9

The Hippocratic Oath was written by Hippocrates around 275 AD, and survives as one of

the earliest greek medical documents that still pertains to medical practice today. The oath

particularly focuses on the ethics behind medicine and the relationship and duties of a doctor to

his people. The Oath paraphrased reads,

“I swear to fulfill, to the best of my ability and judgment, this covenant:...

I will apply, for the benefit of the sick, all measures which are required, avoiding those

twin traps of overtreatment and therapeutic nihilism….Most especially must I tread with

care in matters of life and death. If it is given me to save a life, all thanks. But it may

also be within my power to take a life; this awesome responsibility must be faced with

great humbleness and awareness of my own frailty. Above all, I must not play at God…”

This oath has been used as a literal and typically symbolic oath taken by modern age doctors and

can be held not just as guideline but a moral compass when addressing the topic medical

responsibilities and practice (Oxtoby, 2016).

Medical Law, Health Law and Medical Jurisprudence

The hippocratic oath is only a moral based guideline in the medical field, but the factor of

legal requirements and laws must be put in place in order to stop people from being mistreated

and given protection legally from misdiagnosis, mistreatment, etc. There are currently many laws

from both State and Federal and local level that determine citizens rights and protection as well

as that of the doctor themselves. This branch of law is known as “Medical Law,” which

explicitly deals with the issues of Patients to Doctors rights and protections (Thomas, 2013).

¨Health Law¨ is the branch of law that deals with the healthcare provider of a person and the

issues that arise between them. And a third branch, actually considered a branch of medicine
Generation ℞ 10

instead of law is known as, “Medical Jurisprudence,” which deals with the scientific and medical

issues and questions in concern to the legal field, (a subsection of forensic science). These three

types of law all intertwine throughout history to create the laws and regulations that we have

today concerning the medical field and its capacity (Chesnakova, 2016).

Most laws concerning prescriptions drug fall down to the states themselves, with nearly

each state holding different requirements for the types of drugs, at what dose and how frequently

they can be prescribed by doctor and patient alike. There really are many laws concerning

prescription drugs, such as those concerning tampering of the prescription notes, time sensitivity,

refill alerts, doctor shopping, physical and psychological requirements and honesty tests as well

as online databases accessible by doctors to learn a patient's history and see if they are

susceptible to, “drug seeking,” habits (CDC, 2018). Doctor shopping is a common occurrence

among drug seekers, who go from doctor to doctor in an attempt to collect prescriptions at a

large amount. This is being combated by law enforcement and doctor communications, but their

are those who slip through, with varied reports of pervasiveness of 6.3% to 56% percent

(Sansone, 2012). Time sensitivity and refill alerts of a prescription means that the patient must

wait to refill a prescription or that the prescriber and or local authorities are notified when certain

classes of drugs are filled (CDC, 2018). The tests that are conducted vary from state to state, but

most include a level of testing on the pain a patient is feeling and an honesty test; especially

among psychologists, as their field can be more subjective and less physically concrete evidence

provided on the patients wellbeing and needs medicinally.

Federal Law
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1914 in the United States the Harrison anti-narcotic act was passed which limited the sale

of opium and opium related drugs, requiring physicians to log and pay taxes on the use and

prescription of these drugs. This law would usher the United States into a movement of

prescription grade drug legislation and new focus followed by the 1970s CSA or Controlled

Substance Act which legally allows the federal government to survey, control and limit drugs in

the nation; a major step into a regulated and safer society. This act would lay the groundwork for

what is now known as the DEA, or Drug Enforcement Agency which now employs around 5000

special agents and a budget of over two billion dollars to enforce and regulate drug issuing and

dispensing including but not limited to prescription drugs (Blake, 2013).

Classification of drugs. There are three primary types of drugs, being: stimulants, opioids and

depressants. Among these three classifications of drugs there are many different levels of

potency and variety within each family of drug as well as different criminal sentencing.

Stimulants vary from common drugs, such as caffeine all the way to amphetamines (Dexedrine®

and Adderall®) and methylphenidate (Ritalin® and Concerta®), other notable stimulants are drugs

such a cocaine and methamphetamine. All stimulants have in common a similar purpose, which

is to increase alertness, energy, and attention (NIDA, 2018). Opioids, are a class of drugs that are

used to treat moderate-to-severe pain and are typically prescribed after surgeries or those with

extreme pain, like cancer patients. Within the opioid family there are illegal drugs such as heroin,

synthetic opioids such as fentanyl, as well as pain relievers available legally by prescription, such

as: (Vicodin®), (OxyContin®), codeine, morphine, and many others (DEA, 2018). Depressants,

also known as CNS depressants (Central Nervous System depressants) of which are commonly

used for treatment like anxiety, panic and stress attacks and sleeping disorders (DEA, 2018).
Generation ℞ 12

CNS Depressants include tranquilizers, sedatives and hypnotics. Benzodiazepines depressants

include: (Valium®), (Klonopin®), (Xanax®), (Halcion®) and (Prosom®). Of the non-

benzodiazepine depressants which are sedatives and tranquilizers include: (Ambien®),

(Lunesta®) and (Sonata®). Barbiturate class depressants: (Mebaral®),(Luminal®) and

(Nembutal®) (DEA, 2018).

Legally the classifications of Drugs are referred to as schedules, of which the DEA ranks the

drugs and the associated sentencing when concerning the drug. Schedule I drugs are substances

with a high potential for abuse and no medically recognized purpose such as: Heroin, LSD,

Marijuana, Peyote, MDMA/Ecstasy. Schedule II are drugs that have approved medical uses but

still pose a high potential for abuse and dependence such as: Cocaine, Many opioid pain

medications like Vicodin, OxyContin, and methadone, Methamphetamine, Prescription stimulant

medications like Adderall and Ritalin. Schedule III are medications and substances with a lower

risk of abuse and dependence than drugs in Schedule II such as: Tylenol with codeine, Ketamine,

Steroids. Schedule IV are Medications with a low risk of abuse and dependence such as: Soma,

Many benzodiazepines like Xanax and Ativan , Tramadol. And schedule V are Drugs with the

lowest risk such as: Lyrica, Cough medications containing low codeine levels (DCC, 2018)

Correlation and Implications

The abuse of drugs have more than one effect to the person using them, the abuse of

prescription drugs are more than just a singular event that is unrelated to the rest of the world. It

is an epidemic that spans through personal health, family, community and to the government

(Volk, 2016). In today's society where the third leading drug sold into the black market is the
Generation ℞ 13

prescription depressant Xanax, and where youth are 50% more likely to be the abusers of this

drug it is extremely prevalent.

Health Implications

Health is the state of the human whole, and as such, the state of a human is quite wide

and varying, as any person can observe (WHO, 1998). It is common knowledge that people are

born and die every minute of the day. It is people who must deal with the implications and

happenings of their life and as such, must be meet with and meet life with actions and reactions.

Drug use, whether legal or not, has one goal: the alteration of the human body and mind in an

attempt to change it whether medically or recreationally (Dombeck, 2018). One cannot go over

all the implications of drug abuse, but to name a few: Damage of the prefrontal cortex, damage

to neuron receptors, affecting of judgement and inhibition, gateway into harder drugs, accidental

suicide, decay of internal organs like the liver and the heart, damage to the immune system and

loss of I.Q. (Volk, 2014), (Talbott, 2017).

Community implications

The Family unit is one of the most basic concepts of time. It is the basis of any country.

A group of families create a town, creating cities, states, etc. The point is that the family unit is

the structure of the world and how it has developed. Without procreation and the unity of

families, the functionalism and structure of the world would not be what it is today. It is the unit

that provides basic care, physically, mentally and spiritually develops a child and is a big factor

in determining how that child is going to grow up to affect the world around it (Wilson, 2013).

Drug abuse and effects of overprescription, can severely damage the relationships between a

child and the rest of their life in society (Volk, 2016).

Legal implications
Generation ℞ 14

Within the legal system there are many, many codes and measures in place for

determining punishment and the right path when dealing with a person who is a drug abuser.

Many drug abusers end up in drug court. Drug courts are judicially supervised court dockets of

which instead of sentencing for a prison or jail term, the accused is provided treatment and

supervision; especially in those with severe mental-health of substance abuse issues (NIJ, 2018).

In the case of overprescription however, it really can end up in both a criminal or a civil court.

In a recent incident, A Dr. Gaglione, a doctor in Hampton Roads, Va. lost his medical

license and was sentenced to thirty months in federal prison as well as a 15,000 dollar fine for his

overprescription of a seventeen year old girl, he prescribed her twelve different drugs, including

Percocet, Xanax, Ambien and stimulants which caused her to commit suicide in 2014 (Horne,

2018). It is only four years later that this man is being punished for medical malpractice, not an

incredibly quick turnaround. It is not every day though, that a doctor is caught and punished for

such an act. Dr. John Grohol contends that drugs, especially those used to treat ADHD, such as

Ritalin; are overprescribed due to heavy diagnosis (Grohol, 2018). Over-prescription and over-

diagnosis go hand in hand and it is the job of a doctor to know about such measures and be

cautionary. In August of 2018, a Dr. Dixon of Raleigh NC. was sentenced to twenty years in

federal prison for illegal sale of opioids (Cunningham, 2018). On November 30th of 2017 a Dr.

Li of New York was sentenced to 10-20 years in prison for running a drug mill of which he was

charged with, “two counts of manslaughter in the second degree, three counts of reckless

endangerment in the first degree, three counts of reckless endangerment in the second degree and

170 counts of criminal sale of a prescription among many other charges,” (People v. Li , 2017).

In Whalen V. Roe, an interesting case occurred where the a statute that required new york

doctors to fill out two forms, one of which was sent to a database collection that registered those
Generation ℞ 15

who were prescribed prescription drugs It was contended that the statute violated privacy rights

and was unconstitutional. In a Unanimous opinion, the court upheld the statute and hence, the

collection of prescription drug information on private citizens is legal. It must be noted that this

statute is upheld in new york state it is not a national statute (Whalen v. Roe, 1977).

CAM Therapy

An interesting and, though not relatively new, but now highly intriguing and researched

topic of health, is known as CAM. CAM stands for Complimentary or Alternative Medicine.

CAM as reviewed by Dr. Ripley of Regent University contends that it has recently been and is

being integrated into mainstream medical care providers, but the issue is that CAM in and of

itself is subjective and varies depending on the community that it servicing that CAM therapies

would need to honor and allow diversity in the community in its servicing (Ripley, 2018). About

one-quarter of US children with developmental disabilities have used complementary health

therapy approaches (Lindly, 2018) . In one study labeled, “Complementary and alternative

medicine use among children with mental health issues”, the findings from this year, is that

CAM use is now more popular in children who have mental health issues in comparison to those

without. Among these CAMS are therapies such as Herbal Remedies, Chiropractic care, and

mind-body therapies being the most popular. There has been a very clear and interesting remark

to CAM as it is primarily used by female subjects, with a majority of CAM therapies being fifty

percent or more likely for girls to use CAM then boys, the only outlier being the use of herbs and

other non-vitamin supplements. Of these girls who use CAM therapies, the biggest predictors of

use is that they are socio-economically better off and have a higher education. Over 9.5 million

parents whose children have mental health issues report using CAM therapy for a multitude of

reasonings. These reasonings vary from holistic approaches, “natural” or simply because they are
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helpful. Interestingly though, only 18.4% of western doctors advise CAM approaches, due to

CAM still being considered unconventional in western medicine (Wang, 2018). 69.2 percent of

parents say they find CAM therapy to be helpful (Wang, 2018). Because there is such a low

percentage of medical professional recommendation of CAM therapies, and doctors are not

equipped with enough CAM experience and knowledge; it is necessary that CAM be spread to

all levels of healthcare, not just those of higher education and opportunity so that the possibilities

and promising signs CAM shows can be used and implemented into communities (Wang, 2018).

In School Therapy

American children on average spend one-thousand hours per year in public school, this

does not even include after school activities; this is about 1/5th of a child's life from kindergarten

to high school graduation (Ed100, 2017). It is clear then that, that the 56.6 million children who

attend public schools in the US (NCES, 2018) and the fact that teachers are in constant contact

with children, of whom one out every five adolescents live with a legitimate mental illness

(NAMI, 2018) that in school therapies and CAMS should be implemented as measures to help

identify and help these children. Dr. Ripley comments on this, “We need to teach teachers

psychological pointers and dangers, the whole community needs to teach people the triggers and

what mental disorders look like. They are in constant contact and as so, in school therapies are

absolutely necessary in current culture.

In 2017, “House Bill 1532 Health education program; program to include safe use of

prescription drugs.” was introduced into the Virginia 2018 session and on March, 23rd of 2018 it

was ratified and is currently in effect. This bill allows for in-school therapies to take place

pending that they be, culturally and socially acceptable depending on the schools location and

that teachers be trained in mental health issues as well as more in-school therapists. This bill is
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still young, and the effects are still to be felt and seen. On the federal level, senate bill 1370 - “

Mental Health in Schools Act of 2017,” was introduced in March of 2017 and is still sitting in

the committee for Health, Education, Labor, and Pensions. This bill would essentially allow

schools to get grants for public or private healthcare for their schools and provide more training

and help children with mental health issues directly at school (Sen. Franken, 2017).

Conclusion

The problem that America is facing, is the percent of people who become complacent in

their adversity or illness and decide that abuse of prescription drugs is a legitimate way to deal

with their problems. Children come into the world and grow up being affected by every aspect

of the world around them, and with the prominent rise mental illness and prescribed drugs (Volk,

2016). It is important more than ever that the world be meet with a fierceness rivaling the

problems of America's youth. It is now more than ever that this generation of adolescents be

armed with the mental capacity and help they need to be diverted from prescription drug abuse

and it begins in the minds of America's youth.

Generation ℞ 18

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