According to recent studies, more than seventy percent of adolescents who abuse psychoactive substances also have one or more psychiatric disorders. Many of them continue to use illicit substances while on a regimen of prescribed medication, and there is clear potential for dangerous interactions.
Although there is a prevailing theory that teen substance abuse is actually an attempt to self-medicate underlying psychiatric issues, a recent meta-analysis contradicts this, concluding, however, that use of street drugs can in fact exacerbate the issues being treated. Therefore, even in the absence of problematic interaction, adding street drugs to a prescribed regimen is a bad strategy.
A clinically significant interaction between two drugs is defined as an event in which the therapeutic and/or toxic effects of one drug are altered as a consequence of the ingestion of another. Unintended drug reactions are a significant cause of death, and drug interactions are a major contributor. One review of deaths in the US between 1983 and 2004 reported a marked increase in deaths due to medications mixed with street drugs and/or alcohol. As new drugs are developed, more adverse interactions are expected, as there is now way to test for dangerous combinations prior to FDA approval (testing would be dangerous, illegal, and unethical).
Among the potential adverse consequences of mixing medications with street drugs are:
- Drugs of abuse can interfere with the mechanisms of prescribed medications, leaving the individual’s underlying condition under-treated while complicating the issue with the cumulative and separate effects of drug abuse
- Street drugs can increase the risk of potential side effects of prescribed medications, which in turn can enhance the toxicity of the street drugs
- Use of street drugs can distort the outcomes of professional attempts to manage depression, anxiety, etc., such that appropriate medication and dosage can be more difficult to determine.
In one instance, earlier this year in East Bridgewater, MA, a 15-year-old girl died as a result of a relatively obscure drug called 251–NBOMe, or “N-Bomb.” This psychedelic drug, sometimes substituted for LSD, affects serotonin levels in the brain—the same neurotransmitters affected by medication the teen had been taking for a diagnosed psychiatric condition. The drug isn’t controlled in Massachusetts and is difficult to detect. Although the death was not attributed to a drug interaction, the compounding of mechanisms affecting delicate serotonin balances is clearly problematic.
More commonly, interactions between tranquilizers—especially in the benzodiazepine class—and alcohol are potentially fatal. The combination impairs judgment, leading to automobile accidents and other mishaps, and it can depress the central nervous system to the point of respiratory arrest, including choking on one’s own vomit. There is a current trend among teens to mix alcohol and Xanax. Also, prescription medications like Adderall and Ritalin, when combined with alcohol, cannabis, or especially with other stimulants like cocaine, can lead to adverse effects, hospitalization, or even death.
Most addicts suffer from co-existing mental disorders, and the effort to manage dosages, mood swings, and the accumulating difficulties of everyday living becomes increasingly burdensome. Treatment for addiction should include a medical approach to co-morbid issues: at the very least, freedom from addiction can optimize the outcome of treatment for other mental health issues.