Steve Pasierb: Testimony before the U.S. House of Representatives

Mr. Chairman, Ranking Member Cummings, members of the subcommittee, thank you for inviting me to testify today about the problem of prescription drug abuse. I am Steve Pasierb, president and CEO of the Partnership for a Drug-Free America.

Before I offer my testimony today, I want to take this opportunity to thank the subcommittee – and especially you, Mr. Chairman and you, Mr. Cummings – for your leadership on the drug issue. Year after year, you remain steadfast in your dedication to help the country contend with the issue of substance abuse. I have no doubt that your leadership and perseverance have contributed to the progress we have made in the last seven years in reducing the number of teenagers who use illicit drugs. All of us who work in prevention, law enforcement, and treatment are exceptionally grateful for the work of this subcommittee, and especially to both of you, for your unwavering commitment to this critical issue.

Overview 

While overall substance abuse among teens has decreased 19 percent since 2001, when you examine individual drugs of abuse, there are some troubling trends, including the abuse of methamphetamine, inhalants, prescription drugs and over-the- counter drugs to get high. The Partnership is especially concerned about the advent of what we have dubbed “Generation Rx” – a cohort of young people for whom “pharming,” or abusing a host of medicines and chemical products to get high has become normative.

The Partnership’s 18th annual Partnership Attitude Tracking Study (PATS), which examines teen drug use and attitudes, showed that the intentional abuse of prescription and over-the-counter drugs to get high is now an entrenched behavior among teens. Our study confirmed that an alarming number of today’s teenagers are more likely to have abused prescription and over-the-counter drugs than a variety of illegal drugs like Ecstasy, cocaine, crack and methamphetamine. According to PATS:

— Nearly one in five (19 percent or 4.5 million) teens has tried a prescription medication to get high;

— One in 10 (10 percent or 2.4 million) teens report abusing cough medicine to get high; and

— Abuse of prescription and over-the-counter medications is on par with or higher than the abuse of illegal drugs such as Ecstasy (8 percent), powder/crack cocaine (10 percent), methamphetamine (8 percent) and heroin (5 percent).

The abuse of prescription medications has become “normalized” in teen culture. Two out of five teens report having a close friend who abuses prescription pain relievers to get high and nearly three out of 10 report having a close friend who abuses cough medicine to get high. So, even if teens are not abusing these medications themselves, one of their close friends may be. With this perception that “everyone is doing it” there is great risk that the “pharming” phenomenon will only grow larger.

The fact that prescription drugs are now the second most popular illegal drugs among teens, falling just behind marijuana, is certainly alarming. Equally disturbing is the number of people of all ages initiating use of this class of drugs. According to the National Survey on Drug Use & Health, in 2004 more people were initiating use of prescription pain relievers (2.4 million) than marijuana (2.1 million). Non-medical use of tranquilizers ranked third among initiates (1.2 million). 

From talking to consumers, we know that this problem is not even on parents’ radar screen. The Partnership has recently launched a nationwide media campaign to increase awareness and spur a dialogue about “pharming” between parents and teens. More information on this campaign follows.

Access and Perception of Risk

The Partnership’s study found that two key factors are driving the “pharming” phenomenon: many teens have a misperception that intentionally abusing prescription and over-the-counter medicines is not harmful, and teens say there is easy access to these drugs through a medicine cabinet at home or at a friend’s house or via the Internet.

When asked why they thought prescription drug abuse was becoming more of a problem among their peers, the most common response was the ease of access. In fact, 72 percent of teens say that it is easy to get these medications from their parents’ medicine cabinets; 65 percent say that it is easy to get these medications using other people’s prescriptions; 55 percent say that these drugs are available everywhere, and 36 percent say that it is easy to buy the drugs over the internet.

In addition to the ease with which these substances can be acquired, there is also a false sense of security about them because they are FDA-approved, legitimate medications from the medicine cabinet rather than street drugs imported into the United States and possibly cut with an unknown, dangerous substance. Because we know that the riskier a teen believes a drug is, the less likely they are to use it, The PATS study’s findings on perception of risk is especially troubling:

— Two in five teens (40 percent or 9.4 million) agree that prescription medicines, even if they are not prescribed by a doctor are “much safer” to use than illegal drugs; 

— Nearly one-third of teens (31 percent or 7.3 million) believe that there is “nothing wrong” with using prescription drugs without a prescription “once in a while;”

— Nearly three out of ten teens (29 percent or 6.8 million) believe prescription pain relievers, even if not prescribed by a doctor, are not addictive; and

— More than half of teens (55 percent or 13 million) don’t strongly agree that using cough medicines to get high is risky.

The challenge is to get the message across to teens that there is a difference between good medicine and bad behavior. When these medications are abused, or used for anything other than their intended purpose under a doctor’s supervision, they can be every bit as dangerous as illegal street drugs. 

Motivation for Use

The Partnership’s research shows that that teens see distinct benefits from different drugs and choose substances based on whether their motivation is simply to get high, to deal with problems such as stress or depression, to change their body or to help with school work. 

Marijuana is the classic party drug; 81 percent of teens tell us that they use it to get high, and only 16 percent use it to deal with problems. Those numbers look quite different when you ask a teen about prescription drugs. A sizeable number of teens are self-medicating with these substances in order to get ahead in school or to deal with stress or depression. Forty three percent of teens report that they use prescription stimulants like Adderall or Ritalin without a doctor’s prescription to help with school work, 31 percent say they use them to deal with problems, and 22 percent say they use them to get high. When it comes to prescription pain relievers, nearly half of kids say they use them to get high but 40 percent use them to help them to deal with a problem.

Parents Unaware of Teens’ Intentional Misuse of Medications

Parents are crucial in helping prevent the abuse of prescription and over-the-counter medications but right now there is a huge disconnect between parents and teens about “pharming.” Only one percent of parents say that it is “extremely or very likely” that their own teen has tried a prescription pain killer but 21 percent of teens admit to trying this type of drug to get high. The same holds true for prescription stimulants: two percent of parents say it is “extremely or very likely” that their own teen has used them to get high whereas 10 percent of teens actually have.

Today’s cohort of parents is the most drug-experienced in history, but they do not understand this new drug abuse behavior among teens. As a result, they are looking for the classic signs of illegal drug use and are missing this trend. Parents need to be aware that the drugs their teens abuse today, including medicines, are not the drugs from decades past. Only through education and parental involvement can we reverse this trend. Once parents are educated about this problem, they can get through to their kids about the dangers of these substances.

We know that kids who learn a lot about the risk of drugs from their parents are up to 50% less likely to use drugs than teens who don’t learn from their parents. Most parents say that they have talked to their kids about the dangers of drugs but our research shows that the message may not be getting through. Nine out of ten parents of teens say they have talked to their child about the dangers of drugs, yet fewer than one-third of teens (31 percent or 7.4 million) say they “learn a lot about the risks of drugs” from their parents.

Partnership research shows that parents are also the first place that teens turn for information about the risk of drugs. Fifty- six percent of teens report that they talk would turn to their mother and 45 percent would turn to their father when they have a question about drugs. Parents need to be educated so that they can seize that opportunity. The Partnership’s efforts are helping parents understand the power that they have when it comes to their kids’ decision about drugs and empower them to exercise it. 

The Partnership is working to increase awareness about the dangers of “pharming” so that parents can talk to their kids about the dangers of abusing prescription and over-the-counter drugs. Our research shows that we need to target parents specifically on this issue: while three out of five parents report discussing drugs like marijuana “a lot” with their children, only a third of parents report discussing the risks of using prescription medicines or non-prescription cold or cough medicine to get high.

The Partnership’s National Rx and OTC Medicine Abuse Campaign

The Partnership’s annual tracking study—the largest, ongoing analysis of drug-related attitudes in the country—began measuring teen abuse of select medications in 2003. With three years of data in hand and last year’s data heralding the emergence of this new category of substance abuse, the Partnership recognized this shift in teen drug abuse behavior as one of the most significant in recent history and immediately began developing a necessary prevention and education campaign directed at parents.

In May, the Partnership launched a comprehensive, multi-year prevention communications effort targeting the abuse of prescription and over-the-counter medications. It is the first national campaign of its kind. The Partnership created this effort with support from the Consumer Healthcare Products Association and its member companies. The campaign speaks directly to parents by alerting them that their own homes are easily accessible sources for teens to obtain and abuse these medications. The campaign is comprised of hard-hitting television, newspaper, magazine and radio messages, a multifaceted interactive online component, and is supplemented by informational brochures to help parents get the conversation started with their teen. A multi-faceted public relations effort will provide media support for the campaign, in addition to the great coverage it has already received. When the Partnership released the research findings and launched the campaign in May, there was significant coverage around the country in the broadcast, print, and internet media, including on CNN, CBS Evening News, the Associated Press and the Washington Post.

The prescription and over-the-counter drug education effort is a priority campaign for the Partnership, which will work directly with national and local media to gain significant placements for the public service campaign messages. Television messages from the campaign will run nationally across all Comcast systems throughout the summer. Comcast will donate more than $2 million in advertising media exposure to support the campaign. In addition, Univision will also be lending extensive radio support to Spanish-language radio messages targeting the Hispanic community via Univision’s national radio network. Univision will also be highlighting this issue in a special television program this Saturday, July 29.

The campaign also features an innovative online component consisting of unique and engaging Web sites focused on the dangers of abusing cough medicine/dextromethorphan (dextromethorphan, or DXM, is the active ingredient in cough medicine). And, in a first for the Partnership, we are driving visitors to the websites with a comprehensive search engine marketing campaign.

The Partnership’s Web site  www.drugfree.org features comprehensive online content on the abuse of prescription drugs. Original online content created specifically for parents and teens on the abuse of cough medicine can be found at: www.drugfree.org/Parent/. 

–For teens –  www.dxmstories.com/

The message of this campaign can be summed up in three words: educate, communicate and safeguard. Educate yourself about the medications kids are abusing. Communicate with your kids and dispel the notion – for yourself as well as for your kids – that these medicines can be safely abused. And safeguard your medications by learning which ones can be abused, limit access to them and keep track of the quantities you have in your home – and make sure your friends do the same. 

As I mentioned, the Partnership has worked closely on this campaign with the Consumer Healthcare Products Association and its member companies, who are taking seriously the abuse of over- the-counter cough medications and helping find proactive solutions that reduce a negative behavior. They have been wonderful in this regard. We have seen similar positive actions by individual companies in the prescription drug industry. The prescription industry overall, however, thus far has focused its attention on the appropriate use of their products as well as on product safety and efficacy. This is an important step, but needs to be linked to complementary efforts to address the separate and very different consumer behavior of intentional abuse to get high. Again, this is an issue of good medicine meeting bad behavior, something both teens and parents do not fully understand. We are optimistic that the industry will do more to acknowledge the unfortunate fact that teens are abusing these products and take part in comprehensive, appropriate education and prevention efforts.

Effectiveness of Media Campaigns 

The reason that the Partnership for Drug-Free America is focusing on a media campaign to educate parents about the problem of prescription and over-the-counter drug abuse is simple: anti-drug advertising works. This is documented in independent research, as well as in our own national tracking study, now in its 18th year.

A study published in the August 2002 American Journal of Public Health found anti-drug advertising is associated with a reduced probability of marijuana and cocaine/crack use among adolescents. A team including researchers from Yale University, New York University, the London Business School and Baruch College evaluated the effectiveness of drug-education messages from the Partnership for a Drug-Free America from 1987 through 1990. The researchers said that by 1990, “after three years of Partnership ads, approximately 9.25 percent fewer adolescents were using marijuana.” The team also noted the decrease came at a time when anti-drug ads had increasing levels of media financial support – and thus were seen more often. “Given the results,” the researchers said, “this increase appears to have been a worthwhile investment.”

Previously, the February 2001 issue of the American Journal of Public Health reported television advertising contributed to a significant decline in marijuana use among teenagers. Research funded by the National Institute on Drug Abuse (NIDA) chronicled the impact of anti-drug TV ads on teens described as “sensation seekers”—adolescents attracted to risky activity and behavior. Conducted by Dr. Philip Palmgreen and a team of researchers at the University of Kentucky, the study tracked the impact of ad campaigns in select counties in Kentucky. The study showed a 26.7 decline in marijuana use among sensation-seeking teens exposed to anti-drug ads over a two-year period. Most ads used in the study were created by the Partnership for the Media Campaign.

National tracking data also support the effectiveness of anti- drug ads. Dr. Lloyd Johnston, lead researcher for the University of Michigan’s Monitoring the Future study, said MTF research showed that: 

“Over the past two years, there has been an increase in the proportion of students seeing marijuana use as dangerous; this change in beliefs may well explain some of the recent gradual decline in use. Quite possibly, the Media Campaign aimed at marijuana use, that has been undertaken by the White House Office of Drug Control Policy in collaboration with the Partnership for a Drug-Free America, has been having its intended effect. I am not aware of any other social influence process that could explain these changes in how young people view marijuana.”

Johnston also remarked of the Partnership’s early efforts to combat inhalant abuse: “The use of inhalants began to turn downward in 1996, following the launching of an ad campaign by the Partnership for a Drug-Free America, and has been gradually and steadily declining since then.”

Dr. Johnston has also said the survey consistently finds a very high degree of recalled exposure to Partnership ads, that the ads have high credibility with the audience and that they have high-judged impact on the behavior of that audience.

The effectiveness of anti-drug advertising is also underscored in findings from the Partnership Attitude Tracking Study: Year after year, tracking data show that teenagers who are exposed to anti-drug advertising frequently have stronger anti-drug attitudes and are considerably less likely to use drugs than teens who see and hear these messages infrequently.

There is also evidence of effectiveness from the National Youth Anti-Drug Media Campaign. The data cited below are drawn from the 2005 PATS Study. Last year, we sampled over 7,200 teenagers, in grades 7 through 12, across the country; we also over-sampled for African- and Hispanic-Americans to enable specific analysis of these two groups. Our findings in PATS track consistently with those of the Monitoring the Future study, conducted by the University of Michigan’s Institute for Social Research under grants from the National Institute on Drug Abuse. 

— Significantly fewer teenagers are using marijuana today when compared to 1998, the year the Media Campaign launched. Reductions are evident in all measured categories of prevalence—lifetime, past year and past month use. As you surely know, the Media Campaign focuses heavily on preventing adolescent use of marijuana—the most widely abused of all illicit substances.

— Marijuana-related attitudes among teenagers have improved significantly over the same time. In the past year, teen perception that marijuana use carries ‘great risk’ of getting in trouble with the law and dropping out of school increased significantly. Looking at risks by category, or type of risk, relational risks such as upsetting their parents, losing their friends or not being able to get a girlfriend or boyfriend are all significantly greater than in 1998. 

— Teens are less likely to report that their close friends use marijuana. This is important because teens whose friends use drugs are more likely to use drugs themselves.

The Partnership for a Drug-Free America

The Partnership is a non-profit coalition of volunteers from the communications industry. Using a national drug-education advertising campaign and other forms of media communication, the Partnership exists to reduce illicit drug use in America. The organization began in 1986 with seed money provided by the American Association of Advertising Agencies. The Partnership, which receives major funding from the Robert Wood Johnson Foundation and support from more than 200 corporations and companies, is strictly non-partisan and accepts no funding from manufacturers of alcohol and/or tobacco products. All actors in the Partnership’s ads appear pro bono through the generosity of the Screen Actors Guild and the American Federation of Television and Radio Artists.

National research suggests that the Partnership’s national advertising campaign—the largest public service campaign in the history of advertising—has played a contributing role in reducing overall drug use in America. Independent studies and expert interpretation of drug trends support its contributions. The New York Times has described the Partnership as “one of the most effective drug-education groups in the United States.”

In addition to its work on the national level, the Partnership’s State/City Alliance Program supports the organization’s mission at the local level. Working with state and city governments and locally-based drug prevention organizations, the Partnership provides the guidance, on-site technical assistance and creative materials necessary to shape anti-substance abuse media campaigns tailored to the needs and activities of any given state or city. 

The Partnership also participates in the National Youth Anti-Drug Media Campaign, coordinated by ONDCP. At the core of this multi-faceted initiative is a paid advertising program, featuring messages created by the Partnership.

Today, the Partnership is run by a professional staff of 50. Partnership campaigns have received every major award in the advertising and marketing industries for creative excellence and effectiveness, including the American Marketing Association’s highest honor for marketing effectiveness.

Conclusion

The intentional abuse of medications among teens is a real issue threatening the health and well being of American families. We have a situation where a widespread and dangerous teen behavior has become normalized and has found our way into our homes. These findings should serve as a wake-up call to parents that their teens are facing a drug landscape that did not exist when they were teens. The abuse of prescription and over-the-counter drugs has taken root among America’s teens and the behavior is not registering with parents. Unless we all take action, it is a problem that is only going to get worse.

Thank you for calling this important hearing today to shed light on this problem. The Partnership for Drug-Free America looks forward to working with this Committee and the Congress to educate the public about this problem and change teen attitudes and behavior regarding “pharming.”