Abuso de drogas en adolescentes

Adolesc Med 17 (2006) 283 – 318

Adolescent Abuse of Other Drugs
Jeffery P. Greene, MDa,T, Dale Ahrendt, MDb, Elisabeth M. Stafford, MDa
a

Adolescent Medicine Section, San Antonio Military Pediatric Center, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA b Uniformed Services University of the Health Sciences, Wilford Hall Air Force Medical Center, 859MDOS/MMNP, 2200 Berquist Drive, Suite 1, Lackland AFB, TX 78236, USA

This article provides a general overview of other drugs of abuse within the adolescent population. Stimulants, hallucinogens, club drugs, inhalants, sedativehypnotics, tranquilizers, opiates, and ergogenic drugs are included. Epidemiology, pharmacology, clinical aspects, laboratory, and treatment issues are addressed. Attentionis focused on most commonly used drugs or representative drugs within each category. Review of alcohol, marijuana, and tobacco abuse can be found elsewhere in this issue. The Monitoring the Future survey of drug abuse captures data from nationally representative samples of students in United States secondary schools, both public and private. Surveys in 2002 and 2003 show a general decline for anumber of drugs in comparison with previous years, most notably marijuana and Ecstasy (3,4-methylenedioxymethamphetamine [MDMA]). Ecstasy use had been significantly escalating since 1998 with a peak in 2001. Disapproval of Ecstasy rose sharply among high school students between 2001 and 2003 with vigorous national campaigns highlighting the dangers of this ‘‘club drug.’’ A sharp fall in use in 2003is noted as perceptions of risk have increased [1,2]. Trends in illicit drug use excluding marijuana among high school students over time are presented in Fig. 1. Over the last several years, the proportion of 12th graders using ‘‘any illicit drug’’ has remained fairly constant. Only eighth graders have shown some gradual decline in use. In 2002 and continued in 2003, however, all three gradesT Corresponding author. E-mail address: jeffery.grenee@cen.amedd.army.mil (J.P. Greene). 1547-3368/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.admecli.2006.03.007 adolescent.theclinics.com

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Fig. 1. Percentage that used any illicit drug other than marijuana in lifetime. (From Johnston LD, O’Malley PM, Bachman JG, et al. Monitoringthe future national survey results on adolescent drug use: overview of key findings, 2003. NIH Publication No. 04–5506:9. Rockville (MD): National Institute on Drug Abuse; 2004.)

sampled (8th, 10th, and 12th) showed decline in this category in all three prevalence periods (lifetime, past year, past month). Drug use trends holding steady in 2003 include hallucinogens other than lysergic aciddiethylamide (LSD); heroin; narcotics other than heroin; crack and powder cocaine; and the ‘‘club drugs’’ flunitrazepam, g-hydroxybutyrate (GHB), and ketamine. The only drug showing clear evidence of increase in 2003 was inhalant use by eighth graders. Overview of illicit drug use prevalence among adolescents and young adults for 2002 to 2003 National Survey of Drug Abuse and Health is presented inTables 1 and 2 [3]. Of note, oxycodone and hydrocodone bitartrate–acetaminophen, classed as narcotics other than heroin, showed some evidence of increased use in all three grades sampled. Although absolute numbers increased, levels did not reach statistical significance compared with prior years. With significant addictive potential of these drugs, close attention must be given to these usagepatterns. Data from the 2003 National Survey of Drug Abuse and Health indicate that the most dramatic increases in the illicit use of prescription medications among the United States population are occurring among 12- to 17-year-old and 18- to 25-year-old segments. Prescription medications of concern include barbiturates, tranquilizers, narcotics other than heroin, and stimulants. Accumulating data...