By: Nicholas Chadi, MD, MPH, FRCPC, FAAP
At some point, most families use prescription medications for specific medical needs. Everyday examples might include meds for attention-deficit/hyperactivity disorder (ADHD), pain relief, anxiety or sleep troubles.
When used for the medical conditions they're meant to treat, and taken as prescribed, these drugs are generally safe. But every year, hospitals and medical offices see thousands of young patients who take controlled prescription medications for other reasons or not as prescribed—sometimes with deadly results.
AAP policy explained
A clinical report from the American Academy of Pediatrics (AAP), "
Nonmedical Use of Controlled Medications by Adolescents and Young Adults," points to the risks of nonmedical use of prescription medications among tweens, teens and young adults. Here's what parents need to know about the risks, along with steps they can take to protect their kids.
Prescription medications most commonly used nonmedically
Nonmedical use of prescription medications can start at any age. However, it is seen more often in young people from middle school through young adulthood. The medications usually involved are:
Stimulants, including
ADHD medicines prescribed to help with energy and focus
Sedatives, including prescriptions for
anxiety or
sleep
Pain relievers, especially
opioids
Young people who use prescription medications nonmedically may assume they are safe. But prescriptions may have strong ingredients that can cause harm when they're not taken exactly as directed. Worse yet, what might look like a prescription medicine—right down to the pharmacy bottle and printed label—could be a copycat drug laced with something more dangerous, such as
fentanyl.
Risks & signs of prescription medication misuse
Protecting your child starts with knowing what risks they might take with controlled prescription medications. Health experts point to these major concerns.
Taking medications prescribed for someone else. For example, your child might sample pain medication prescribed for a family member who had
surgery or a serious injury.
Sharing their own prescription with others. They might give or offer a dose of ADHD or anxiety medications to a study buddy thinking it might help with their performance or stress at exam time.
Taking higher or more frequent doses. Kids might change or modify the doctor's directions if they assume it will help them perform, lose weight or sleep better.
Using prescription drugs for the feelings they might give, not the medical condition they treat. This could mean taking prescriptions aiming (or hoping) to have fun, relaxation, a sudden burst of energy or a break from painful thoughts.
How do young people get caught up in these patterns?
You might feel shocked your child would even think of taking risks with prescription medications. But limited life experience can make it hard for them to see the dangers. The human brain continues to grow and develop until at least
age 24, so your child's reasoning skills are still "under construction."
Also keep in mind the challenges many young people face, such as:
Worries about fitting in with friends and classmates
Pressure to perform in school, sports and other activities
Fears or worries that chase them all day long and
Trouble falling asleep or staying asleep
Medical conditions that haven't been diagnosed or treated yet
Consider a young
athlete who hides a painful injury for fear of being kicked off the team—or a struggling student who feels too ashamed to tell anyone they can't concentrate or focus.
10 common-sense steps to protect against prescription medication misuse
1. Start with an open conversation.
Let them know you're coming from a place of love and concern. "I'm bringing this up because I care about you, and I want to be sure we're on the same page."
2. Make a point to listen as much as you talk.
Ask if they've ever witnessed or gotten involved in prescription medication sharing or other kinds of nonmedical use, for example.
(See "How to talk about ADHD medication sharing," below.) Make it safe for your child to tell you what's on their mind. A caring, non-judgmental approach will help them feel seen and heard.
3. Focus on the facts.
Stress that prescriptions are meant ONLY for the person the doctor is treating. It's never safe to assume that one person's medication is okay for someone else. Many prescription meds are controlled substances, so it's illegal to share them.
4. Store prescriptions safely.
All medications should be stored in a safe place. Avoid easily accessible bedroom drawers, kitchen shelves and counters. It is best to keep controlled medications in a locked cabinet. Choose a secure place and keep the key or combination in a secure spot.
5. Supervise your child's medications.
If your child takes ADHD meds, for example, carefully follow the doctor's directions. With middle schoolers, it's best to give out the medicine yourself and watch as they swallow it.
Talk with school health aides about safe dispensing and storage.
As your child moves toward high school and adult life, coach them in handling their own medications. Gradually let them take responsibility for it, well before they leave home so you can support them through any challenges.
6. Ask your pediatrician about naloxone.
In 2019, there were nearly 700 prescription opioid overdose deaths in people ages 15 to 24 years in the U.S.
Naloxone is a rescue drug that can reverse the effects of an opioid drug and prevent overdose deaths. If you, your child or someone else in your family takes prescription opioids, naloxone should be in your first aid kit. Many doctors suggest keeping it on hand for emergency use, whether or not there are opioids in your home.
7. Get rid of all unused medicines.
Your child's doctor can suggest safe places to drop off old, expired or leftover prescriptions. The answer could be as close as your neighborhood drugstore or a nearby hospital. In some cases, it is safe to flush medications down the toilet or mix them with food waste (like coffee grounds) and toss them in the trash. It's extra work, but your family's safety is worth it. Learn more about disposal of prescription meds
here.
8. Set a good example.
If you use prescriptions carefully and responsibility, you're laying the groundwork for your child to make healthy choices too.
9. Make health checkups a priority.
Your child's doctor is an important ally to help recognize signs of drug misuse or sharing (also called diversion). Regular screening can help you work together to keep your child safe.
10. If you see signs of trouble, get immediate help.
Don't wait to talk to your child about it and contact your pediatrician or family doctor if you're worried. Taking this step may lead to difficult conversations, disagreements or conflicts with your child. Remind your child that you love them, that you are concerned about their health, and trying to help.
How to talk about ADHD medication sharing
Stimulants are the medications most often prescribed to treat ADHD. Unfortunately, they're also the most often used
nonmedically. Talk with your child about the serious risks that come with sharing ADHD medications. As the conversation unfolds, tell them you care about their health and well-being. Consider sharing insights like these:
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Sharing your meds can hurt someone. Bad reactions to ADHD medications happen often, especially when young people take higher or more frequent doses. A dangerously fast heartbeat, a sudden panic attack, even suicidal thoughts or actions could result.
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It's illegal. Nearly all ADHD medicines are controlled substances. Federal law prohibits diversion of these drugs to anyone but the prescription holder. Talk to your child about the lifelong impact of having a controlled substance arrest on their record—and remind them it's not worth it.
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Your own health comes first. If your child accepts their ADHD diagnosis and knows the value of medication in their wellness plan, they're much less likely to divert doses to anyone else.
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There are effective ways to say no. Kids say it's hardest to refuse when a close friend begs for "just one pill." Being ready makes the situation less stressful. "Sorry, I need every dose just to handle my own life," or "If you had even the slightest bad reaction, I'd never forgive myself," are two possible responses.
If you see signs of prescription medication diversion—for example, running out of doses before scheduled refills, repeatedly "losing" meds, or more ADHD symptoms than usual—talk with your child and don't hesitate to get in touch with your child's pediatrician for resources and support.
More information
About Dr. Chadi
 Nicholas Chadi, MD, MPH, FRCPC, FAAP, is the first author of the AAP clinical report, "Nonmedical Use of Controlled Medications by Adolescents and Young Adults." He is an Associate Professor of Pediatrics at the University of Montreal and a clinician-scientist specialized in Adolescent and Addiction Medicine at Sainte-Justine University Hospital Centre.
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