Current Font Size: Adolescents are asking for contraceptives for their skin, Ritalin to cram for exams, or steroids to score at sport

Teenagers at elite schools are being exposed to a cocktail of pills and are at risk of developing a "quick-fix pill culture" to cope with problems.

This generation is likely to swallow handfuls of prescription drugs, whether or not they are medically needed, medical professionals report.

"I take a concentration of pills: Cataflam (anti-inflammatory), calming pills, Roaccutane for my skin and birth control pills for my skin. I go to a brain doctor twice a year and a physio twice a week," says a 17-year-old girl from a Johannesburg private school.

One of her friends says: "In the morning, I take a pill, a puff, a syrup, a skincare pill, I have an inhaler for the day and I go to the pulmonologist."

She is following doctor’s orders, but other students and parents think nothing of trying to give their doctors orders – demanding medicines or exaggerating symptoms to get what they want.

Joburg psychiatrist Dr Brendan Belsham says: "If a matric student and the parents have an agenda to get a script, they can come to the rooms and exaggerate the symptoms. as clinicians we need to be aware of this and the merits of each case.

"The diagnostic criteria for conditions like ADHD (attention deficit hyperactivity disorder) are subjective and you can be ticking the boxes, convinced a script is warranted when it may not be. Students may be wanting a quick fix to satisfy the social demand for better marks at the expense of doing practical things like time management and studying.

"I also have patients who tell me they sell their prescribed medicines to others for performance enhancement to study."

The pressures to perform in the classroom and on the field – and to look good – are among the reasons why adolescents are asking for contraceptives for their skin, the ADHD medicine Ritalin to cram for exams, or steroids to score at sport (and with girls). Peer pressure plays a critical role in driving up demand, which is higher among girls.

Family practitioner Dr Lorraine Becker says: "If one girl has very bad skin and it clears up (on hormonal treatment), then all her classmates want it. I often get boys saying they want Roaccutane for acne.

"I had a matric pupil who had never needed Ritalin. but when her friend got it, she wanted it, too. She said she needed it to concentrate better, but if she had never needed it in 18 years, she didn’t need it now.

"I think we are developing a pill culture and we have to guard against that."

Founder of the SA Depression and Anxiety Group, Zane Wilson, says the abuse of pills in SA happens in pockets compared to the US, where it is widespread: "there are some cases, but not a tsunami of them."

In the US, the abuse of prescription drugs and painkillers soared in the 1990s and is continuing to rise steeply. seven million Americans reported non-medical use of prescription drugs in 2009 – more than the number using cocaine, heroin, hallucinogens and inhalants combined. Non-medical use is intentionally taking the medicines in a way other than how they were prescribed.

Belsham says: "Anecdotally, we have a rising trend in this country, too. there is a social complacency towards chemicals, more in this generation than previously, though it is a problem in all age groups."

Students are also being exposed to stronger medicines and are familiar with brands. one parent says when she offered a girl a Panado, she asked for Myprodol instead. Myprodol is a stronger painkiller that requires a script.

"The number of prescriptions for some of these medicines has increased dramatically since the early 1990s: more than eight-fold for stimulants (such as Ritalin) and four-fold for opioids," the US National Institute on Drug Abuse told a congressional caucus last year. "Other contributors may be the perception that abusing prescription drugs is less harmful than illicit ones."

On top of the abuse of illegal drugs, the age-old problem of underage drinking is still widespread in South African schools.

Becker says: "The biggest problem is alcohol, but drugs are also a big problem. one boy told me that smoking dagga was a rite of passage when starting high school. this is hugely risky as it is a gateway drug."

A girl from a Catholic private school, which is strict about regulating tablets and drugs on the premises, thinks the abuse of medicines is influenced by peers, the school and parents’ attitudes. She says: "We are in a culture where people take pills from Panados to antibiotics, pills for skin and sleeping pills."

Some families are more pill-orientated than others, doctors observe. Becker says: "I treat generations of families and you see it from the grandparents and parents to the grandchildren. They are brought up in a culture where you take a pill to get better."

She says the campaign against steroid abuse by boys has made an impact and schools have clamped down on it.

Sports physician Dr Jon Patricios says that anabolic steroids are schedule 5 prescription drugs and being in possession of them is a criminal offence. "They are very rarely prescribed for teenagers," he says.

But despite awareness about steroid abuse, they are still in demand by boys. Patricios, who is president of the SA Sports Medicine Association, says: "They are used to cheat at sport, but also to build a ‘beach body’. this is one of the fastest growing drugs of abuse among teenage boys, but not as a prescription drug as much as black-market trade."

The stresses on adolescents living in an age of instant technology and image are aggravating this. but taking shortcuts, Belsham warns, erodes the character development needed to mature into adulthood.

HELP FOR KIDS

University of Cape Town psychiatrist Professor Dan Stein says South African teenagers may be abusing prescription drugs, but "disorders such as ADHD are under-treated".

"My anecdotal impression is that this (abuse) can occur in some more affluent areas, but most parents don’t want to treat kids with prescription meds, and this can lead to under-treatment of certain conditions. Overall, the data shows that, in SA, mental disorders are under-diagnosed and under-treated."

His colleague, Dr Brendan Belsham, says people must consult a professional if they need help.

"there is no substitute for proper medical advice. Don’t try a few Ritalin from a neighbour or try to twist the arm of your GP for a script. You need to be aware of the whole child."

He adds: "where medicines are indicated and, for example, an ADHD disability is treated in conjunction with lifestyle management, learners’ confidence can skyrocket."

From a family medicine perspective Becker agrees that mental health disorders are often undetected.

"Be very aware of your children," she says. "If you see any change of behaviour – being awake all the time, argumentative, withdrawn – you must investigate. Schools put pressure on students and adolescence can be a minefield. It’s hard for them."

Zane Wilson of the SA Depression and Anxiety Group says SA’s 29% of teens have attempted suicide and need treatment.

• For free counselling, call the Sadag line on 0800 567 567.

Thursday, 20 January 2011

Details of the death of a Bangor woman who died after suffering an ectopic pregnancy may be published in medical journals to warn doctors of the dangers of the condition.

the inquest into the death of Carla McAdam (28), who was seven months pregnant when she died in September 2008, heard the doctor who performed her first ultrasound scan “didn’t know what to look for”.

a leading consultant told the inquest that to have carried an ectopic pregnancy to seven months was so rare that she was considering publishing it in a medical journal to highlight the issue to other medical professionals, locally and nationally.

Senior coroner John Leckey said he hoped such a move “would go some way to providing comfort to the family that the lessons from Carla’s death will be passed throughout the |country”.

Giving evidence on Monday, clinical director of the South Eastern Health and Social Care Trust Dr Ann Hamilton, a consultant obstetrician, said trainee sonographers are not told how to identify a woman’s uterus when checking if a pregnancy is viable. instead they are taught to see if a foetus “looks like it’s in the uterus”.

it was revealed that senior house officer Dr Elizabeth McElrea had only four to five weeks’ experience when she carried out the initial scan.

Dr Hamilton was reluctant to say the ectopic pregnancy would have been picked up had a more senior doctor carried out the scan.

“I certainly accept it might have been different,” she said. “But the scan picture Dr McElrea took was shown around and everyone said they would have accepted that it was a uterine pregnancy.”

Dr Hamilton said a number of changes have been implemented at the Ulster Hospital in Dundonald following an internal review into Carla’s death, and that an ectopic pregnancy is now listed as a possible diagnosis on every pregnant woman’s chart, at any stage in the pregnancy.

“I think everything has been covered,” she said. “I think I have to say again how rare this case is.”

during the hearing, mr Leckey said doctors who released Carla from hospital just one month before she died, should be “ashamed of themselves”.

Carla was admitted to hospital in August 2008 after she collapsed in the shower with severe abdominal pain. Doctors initially examined her for signs of a placental abruption or premature labour, but later believed she was suffering from a urinary tract infection and sent her home with antibiotics.

she was kept in the maternity unit of the Ulster Hospital for two nights and discharged when her symptoms appeared to have subsided, despite laboratory results coming back two hours before she was sent home showing no signs of a urinary infection.

“I think that’s shocking,” said mr Leckey. “If anyone thinks that’s good medical practice then I think they should be ashamed of themselves.”

he also lambasted the hospital for having “an obsession” with urinary tract infection diagnoses, while Carla’s ectopic pregnancy went unnoticed.

he added: “It’s a common theme that seems to be going through this (inquest); everyone seems to be talking about urinary tract infections.

“I get the impression that it’s an obsession in the hospital; everyone seems to be saying urinary tract infection because of a lack of diagnosis of anything else.”

he added: “Carla comes in after a collapse; that to me, as a lay person, is not suggestive of a urinary tract infection. it seems to me strange that you would say a collapse is a urinary tract infection.”

Dr Karen Woods, a specialist registrar in obstetrics and gynaecology, defended her position to discharge Carla, saying: “she was well, it appeared that whatever had caused the pain was resolved.”

the inquest continues.

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IMPORTANT HEALTH INFORMATION FOR BABY BOOMERS

many baby boomers suffer from a breathing disorder called COPD or “chronic obstructive pulmonary disorder”. According to recent research the number of baby boomers suffering from the condition is expected to increase as the boomers age.

A new large international study conclude that the incidences of COPD is likely to be a doubling of the previous estimates and that the majority of sufferers are undiagnosed and untreated

Smoking is the number one cause of COPD and it is imperative for people with breathing problems such as shortness of breath and wheezing to be tested for COPD, particularly if they have a history of smoking and are over 40.

Statements from medical professionals indicate that many suffer COPD in silence. it creep up on people and many blame their symptoms on aging.

Numbers published earlier this year by the medical journal The Lancet found that about 11.5 per cent of men and 8.5 per cent of women suffer from COPD.

“The devastating impact of COPD must be taken seriously.”

COPD is a gradual destruction of the lungs by noxious fumes and it is irreversible.

While COPD is not curable, the symptoms can be treated, especially if the condition is detected early. Early detection of COPD can significantly improve outcomes and quality of life for patients

There are puffers and inhalers similar to those used by people with asthma that help with breathing. (However, the conditions are very different: Asthma is lung inflammation, often triggered by allergies.)

People with COPD can also undertake exercise programs and pulmonary rehabilitation programs. In the advanced stages, sufferers can also use supplemental oxygen in a portable tank.

Do you have COPD?

Here is a brief Lung Health Test designed to help people recognize the symptoms of COPD.

People who are over 40

and are current or former smokers should visit their doctor if

they answer “yes” to any of the following questions:

Do you cough regularly?

Do you cough up phlegm regularly?

Do even simple chores make you short of breath?

Do you wheeze when you exert yourself, or at night?

Do you get frequent colds that persist longer than those of other people you know?

The doctor will perform a spirometry test, which involves blowing into a tube to measure lung function.

If you are a candidate for COPD you should see your doctor as soon as possible.

Source: The Lung Association

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