David Kadlubowski/Los Angeles Times Ryan Smith, left, and his younger brother Daniel began misusing prescription drugs while in high school. "At the time, it felt like I knew more kids who were doing pills than who weren't," Ryan Smith says. Now sober for almost a year, they attend college together in Arizona.
Ryan Smith remembers the night, during his junior year of high school, when a friend gave him his first Vicodin. "It felt so incredible. I remember thinking, 'I am going to do this for the rest of my life,' " he says.
Over the next year, Smith, now 22, and his friends moved on to other pills - Xanax, Valium, OxyContin and the attention deficit disorder medication Adderall, called "kiddie cocaine" for its ability to be crushed and snorted. "At the time, it felt like I knew more kids who were doing pills than who weren't," he says of his Utah high school days.
Daniel Smith, his younger brother, began using prescription drugs, called "pharming" the same way when a friend offered him Vicodin while watching a school football game during his sophomore year. By that summer, he began taking "weak painkillers" such as Lortab and Percocet. Finally, he turned to highly addictive OxyContin, using it several times a week.
Although the brothers eventually went through an addiction program, they never considered themselves "druggies." They were using pills safe enough to be used by millions of Americans, drugs both legal and easy to get. Each generation typically finds a new illicit drug to make its own: LSD in the '70s, cocaine in the '80s and Ecstasy and heroin in the '90s. Today's middle and high school students are experimenting with prescription drugs.
Their drugs of choice are those often preferred by adults. After amphetamines such as Ritalin, they're turning to painkillers such as Vicodin and Percocet, then sedatives and tranquilizers.
Nationwide, prescription pills have become a societal force. Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug.
Meanwhile, direct-to-consumer drug marketing that touts new and expanded uses has become widespread. Adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications.
Nationally, an estimated 14 percent of high school seniors have used prescription drugs for non-medical reasons at least once in their lifetime, according to a 2004 University of Michigan survey that tracks drug trends among middle and high school students.
"It's a major concern to us that young people have the impression they can use medicine as a party drug," says Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment at the Department of Health and Human Services.
The rise in prescription abuse - or "pharming" as young people and drug counselors sometimes call it - worries treatment counselors and drug research experts. A national push to reduce drugs such as marijuana, cocaine and heroin has started to pay off, with overall drug use among young adults declining slightly in recent years. But abuse of prescription drugs - especially among younger people often dubbed the "Ritalin generation" - has been growing and could grow further as drug sales continue to increase.
"Pills are more seductive to kids because they see them as cleaner, safer and less illegal," says Carol Falkowski, a drug researcher at Hazelden, a nationally known treatment center in Center City, Minn.
Many younger users don't know what many of the drugs are for or which pills are more addictive than others, Falkowski says. Nor do they have much sense of what dosages are truly dangerous or how separate drugs interact. Are four Percocets worse than two Vicodin? Can Valium be mixed with Xanax? Treatment counselors say some young users take a fistful of different drugs at once.
Data from the federal Drug Abuse Warning Network show that visits to hospital emergency departments increased significantly from 1994 to 2002 for overdoses of drugs such as narcotic prescription pain relievers and other medications.
Although the data isn't broken down by age group, overdoses of hydrocodone, or Lortab, for example, rose 170 percent; overdoses of oxycodone, or OxyContin, increased 450 percent; and overdoses of benzodiazepines such as Valium and Xanax rose 41 percent. Data also show that many were using more than one drug.
In face-to-face and telephone interviews with students at several middle and high schools in California, students say prescription drug use is frequently talked about at school but rarely discussed elsewhere.
Prescription drugs are often more attractive than other drugs, they say, because the pills don't have the telltale signs of use, such as the smell of marijuana smoke or the disorientation of being drunk.
Girls in particular appear to see the pills as "cleaner" than other drugs. They're less likely to use marijuana or cocaine than boys but equally likely to take prescription medications.
Some students see the pills as a way to enhance sports performance. They say football players at some schools take opiates such as Vicodin before games to blunt the pain.
Many schools have sophisticated black markets with fixed prices for individual drugs and dosages that vary according to supply and demand.
An 18-year-old senior and varsity athlete at Burbank (Calif.) High School says she doesn't consider herself a "big druggie." But about once a month, when she and her friends can find some, they like to take Vicodin, or "vikes," after school or before parties. "I just feel calmer on it. Nothing stresses me out," she says. Her friends are less cautious. They've also tried codeine, Valium, Percocet and Xanax, sometimes mixing several at once.
Students say prescription pills can often be less expensive than other drugs such as marijuana and cocaine. Pain pills such as Vicodin sell for around $5, depending on the dose, while stronger medications such as OxyContin can cost several times that. Ritalin, one of the most widely available drugs, sells for $1 to $2 a pill, students say, but can be more expensive before midterms and finals, when students use them to cram.
Under federal law, it's illegal to possess controlled substances without a prescription. But prosecutions for possession are rare, especially when minors are involved. Many schools bar students from carrying medications without a prescription, but enforcement can be difficult.
Response from state and federal governments and pharmaceutical companies, meanwhile, has been limited. Last year, the Bush administration introduced an effort to control prescription drug abuse, but most of the plan centers on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.
The Food and Drug Administration and the Substance Abuse and Mental Health Services Administration have instituted a new print and television ad campaign, "The Buzz Can Take Your Breath Away," highlighting the dangers of prescription drug abuse among young people. And Purdue Pharma, the maker of OxyContin, has introduced a public campaign about the dangers of abusing the drug after reports of misuse.
Ryan and Daniel Smith both recently completed a rehabilitation program for prescription drug abuse. Now attending college in Arizona, they say they're trying to keep each other from relapsing.
Both have been sober for nearly a year, and they've each started part-time jobs. The two say they occasionally attend narcotics anonymous meetings but don't like going because some of the people who attend depress them.
"We weren't really druggies," says Daniel. "We just fell into something. The pills were all over the place."