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Vol.21, No.7, July 2005 - How do teens regard peers with psychiatric disorders? - OxyContin acting as pathway drug for adolescent heroin addiction

How do teens regard peers with psychiatric disorders?


Results of a new study suggest that adolescents tend to stigmatize peers most severely when they abuse alcohol, followed by peers suffering from mental illness. Having a brain tumor, however, mediates the stigmatizing effect of mental illness. These results are similar to studies carried out among adults showing that people with psychiatric disorders are stigmatized more severely than people with physical health problems.

Patrick W. Corrigan, Psy.D., and colleagues analyzed questionnaires from 303 high school students (ages 13-19 years; 171 females) who made up a sub-sample of subjects recruited from a larger study that examined the impact of an anti-stigma program conducted by the National Mental Health Awareness Campaign. Participants were asked to rank 7 factors (responsibility, pity, anger, dangerousness, fear, help and avoidance) in relation to 4 hypothetical situations: (1) a mentally ill student transferring from a special school; (2) a student with a drinking problem; (3) a student with behavioral symptoms who actually has a brain tumor; and (4) a student who has leukemia. The ranking of attributes ranged from 1 (not at all) to 9 (very much).

Participants also completed a Level of Contact Report (See Table 1) that assessed levels of familiarity with mental illness.

Table 1. Levels of familiarity with mental illness
among 303 adolescents
Variable N (%)
I have never observed a person with mental illness 33 (11)
I have watched a television show that included a person with mental illness 264 (87)
I have observed a person with severe mental illness 227 (75)
I have been in class with a person with severe mental illness 151 (50)
A friend of the family has a severe mental illness 85 (28)
I have a relative who has a severe mental illness 88 (29)
I live with a person who has a severe mental illness 21 (7)
I have a severe mental illness 12 (4)
[Adapted from Table 3: Corrigan PW, et al., 2005]


The results showed that adolescents tended to differentiate among health conditions, similar to the results of studies carried out in adults. Alcohol abuse was stigmatized the most compared with mental illness or leukemia, particularly in terms of anger, blame and dangerousness. However, stigma diminished when a mental disorder was caused by a brain tumor. Participants also rated the teen with the brain tumor as "less dangerous, less likely to be feared, more worthy of help, and less likely to be avoided than the teen with mental illness without organic cause." The authors suggest that although one might conclude that the difference is due to blaming the teen with the brain tumor less, the study results showed no difference in attributing responsibility.

Based on the 7-item attribute ranking, adolescents who agreed that mentally ill persons are responsible for their illness and dangerous, exhibited more discrimination against those persons. However, this finding did not apply to persons with alcohol abuse.

Other data from this study showed a perceived relationship between alcohol abuse and responsibility as well as a relationship between mental illness and responsibility. Responsibility was directly associated with anger on the part of the participants and was inversely associated with pity. Pity was directly associated with help, and anger and help were inversely related. The adolescents who blamed peers for abusing alcohol were likely to be angry, less likely to offer help, and less sympathetic than adolescents who blamed peers with mental illness. Also, the participants who viewed peers who abuse alcohol as dangerous also tended to fear and avoid them.

A surprising finding was that the participants' contact with mentally ill persons led to more discrimination, unlike the results from adult studies that showed familiarity with mental illness was likely to diminish stigma. The researchers suggested that further studies be carried that might explain these differences.

"Research like this is a necessary first step for developing anti-stigma programs meant to target American teens," the authors conclude. They suggest that modifying negative attitudes at a young age can prevent youngsters from developing into adults who discriminate against people with mental illness, which can lead to social injustice.

Corrigan PW, Demming Lurie B, Goldman HH, et al.: How adolescents perceive the stigma of mental illness and alcohol abuse.Psychiatric Services 2005; 56(5):544-550.E-mail: p-corrigan2@northwestern.edu.


OxyContin acting as pathway drug for adolescent heroin addiction


Reports from around the country indicate that teenagers who abuse OxyContin, a powerful prescription narcotic, are switching to heroin, either snorting it or injecting it. When they need more OxyContin than they can afford, they can find heroin, and pay less for it.

OxyContin, when swallowed whole, works as a time-release pain medication. But when crushed, the medication takes effect all at once instead of over time, causing euphoria. OxyContin in its own right led to a wave of addiction, and in some cases, tragic deaths, especially when taken with alcohol.

While chewing OxyContin does bring a rush, the biggest rush is from snorting it. "I've been told that once you snort it, you never chew again," says Massachusetts State Senator Steven A. Tolman, chair of the legislature's Mental Health and Substance Abuse Committee.

The Massachusetts Department of Public Health held a summit May in Chelsea, Mass., which was the result of a year-long research project on prescribing opiates. Doctors, pharmacists, and teens worked together on an education message on the dangers of crushing OxyContin, according to a report in the Boston Globe. The Massachusetts research project has resulted in a series of pamphlets for doctors, urging them to ask patients about alcohol use before prescribing opiates.

Teens obtain the OxyContin pills surreptitiously from a family member and then graduate to buying them on the street. Street OxyContin is more expensive than heroin, and it's not a big jump for adolescents to buy heroin instead of OxyContin from their street source.

The concern about OxyContinheroin is national. "OxyContin use is reported by 5 percent of high school seniors," says Wilson Compton,M.D., director of the division of epidemiology services and prevention research at the National Institute on Drug Abuse (NIDA). "That's a frightening statistic."

Compton is particularly concerned about the fact that these teens are starting with OxyContin. "The idea that people are starting with prescriptions and progressing to heroin is something that is startling to all of us," he says.

There's no clear evidence on who is getting OxyContin from where. There are reports that in Ohio, young people began with OxyContin and progressed to injecting heroin, says Compton. In other parts of the country,the progression might be to snorting heroin, and then to injecting. Or it may stop at snorting.

A 'pathway' to injection

Compton is reluctant to call OxyContin a "gateway" drug because it is very unlikely that someone who didn't use any drugs previously would use this first. "They're also using marijuana, alcohol, and tobacco," he says. But it is a "new pathway" to injection drug use, he says.

For OxyContin itself, it's not unusual that drug abusers would progress from chewing to inhaling, says Compton. "Drug users are remarkably inventive and will try all sorts of routes of administration," he says.

Once someone starts using OxyContin and heroin, how fast do they move to needing heroin on a daily basis? "There is tremendous variation in these trajectories," says Compton. "Many people will use these intermittently and eventually stop on their own and not use. For full-blown addiction, it's a progression over months."

When taken as directed - swallowed whole - OxyContin has a "long duration of action," says Compton. "But when it's crushed, it has a much more rapid onset, and the period of action is just a few hours." OxyContin, even taken alone, can be fatal, he says. When combined with alcohol, this danger is even more pronounced due to respiratory depression, he says. (Compton notes that another prescription painkiller, Vicodin, is also popular with young drug users, and can also lead to heroin use.)

The problem has reached the point at which some legislators want OxyContin severely restricted or even banned. Massachusetts State Senator Tolman is extremely concerned about the OxyContin-heroin link. "I am totally convinced, from talking to people who were or are on OxyContin or heroin, that there are a lot of people out there who are addicted but not telling anyone," he says. "The hardest part is telling their mom and dad."

Tolman has made a point of reaching out to these young people. "What I want to say to them is this: If you are addicted to OxyContin or heroin - or any substance - we can get you the proper help." What these young people really want, he says, is to "become their old self again."

But finding treatment for these teens in treatment may not be that simple. "Where will we put them all?" is the big question raised when Tolman brings up this problem with members of Massachusetts Gov. Mitt Romney's administration, which has put OxyContin-heroin at the top of its drug prevention priorities.

OxyContin facts

During 2004, 1.7 percent of 8th graders, 3.5 percent of 10th graders, and 5 percent of 12th graders reported using OxyContin within the past year, according to the Monitoring the Future Survey.

According to the 2003 National Survey on Drug Use and Health, about 2.8 million people ages 12 or older had used OxyContin not pursuant to a prescription at least once in their lifetime. This was up from 1.9 million lifetime users in 2002.

OxyContin diversion and abuse emerged at 13 of the 20 Pulse Check sites, according to the November 2002 Pulse Check: Trends in Drug Abuse. These sites were Baltimore; Billings, Mont.; Boston; Chicago;Columbia, S.C.; Denver; Detroit; Memphis, Tenn.; Miami; New Orleans; Philadelphia; Portland, Ore.; and Seattle.(Source: Office of National Drug Control Policy)


The Brown University Child and Adolescent Behavior Letter, July 2005
Reproduced with permission of Manisses Communications Group, Inc
For subscription information contact Manisses at:
208 Governor St Providence, RI02906 USA
Phone 1-401-861-6020
Fax 1-401-861-6370
E-mail:
manissescs@manisses.com.

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