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Christa Wüthrich is an independant journalist. She has worked as an author, teacher and IKRK delegate nationally as well as internationally.

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Strung out until you stop breathing

Strung out until you stop breathing

The number of adolescents and young people that get high on prescription drugs is increasing. These users are hardly aware of the risks. The consequences are fatal. 

Mixing sleeping pills, cough syrup and Sprite – is that even dangerous? And can pills, which rappers affectionately call “Xanny,” really lead to death? For many young people, prescription tranquilizers and painkillers seem to be a “harmless” way to get high. But they are wrong.

A 15-year-old dies in Basel, Switzerland on October 5, 2020. The media say a cocktail of prescription drugs was involved. On August 16, 2020, two young people are found dead in the canton of Zurich. They also appear to have taken a combination of prescription tranquilizers and painkillers. In December 2019, the German newspaper “Die Zeit” publishes a report on young pill addicts in the agglomeration of Basel. In September 2019, the Lucerne public prosecutor’s office announces that approximately 50 young people aged 16 to 21 are part of a drug user and dealer ring. The teenagers deal in prescription drugs, among other things. Two young adults die of a prescription drug overdose in 2019. When asked about 2018, the public prosecutor confirms another three prescriptions-related deaths.

Altered perception of time and space
In the cases just mentioned, benzodiazepines – or “benzos” for short – are highly likely to play a decisive role. Benzodiazepines are the active ingredients in prescription sleeping pills or tranquilizers such as Valium. Prescribed a lot, these psychotropic drugs are known for their calming, anxiety-reducing, but also euphoric effect. Heavy thoughts aren’t so heavy any more. Problems vanish in a hazy sense of weightlessness. Everything feels fine. In medical terms, the benzodiazepines are “docking” onto the brain’s receptors and dampening the transmission of stimuli. The drug disrupts or completely suppresses a person’s sense of time and space while also inhibiting the ability to recall memories. The prescription drug Xanax – highly addictive in just a few weeks – is extremely prevalent among young people. When users stop taking it, the body experiences a “rebound effect,” i.e., suppressed emotional states bounce back stronger than ever. 

“There is increasing evidence that adolescent prescription abuse is no longer a marginal phenomenon, but it also isn’t the norm yet,”

Opioids, also known as downers, continue to make the list of intoxicating drugs used by adolescents. These are narcotics like morphine or codeine that are normally used to treat pain. Codeine is also an active ingredient in cough syrup. Mixing benzodiazepines and opioids and taking them with alcohol, for example, amplifies and modifies the effects of these drugs. This may result in profound sedation, respiratory depression, coma, and ultimately death. 

Prescription Drug abuse among adolescents has doubled 
“We have known for a long time that adolescents take large doses of codeine-based cough syrup to get high,” says Domenic Schnoz, head of Zurich’s Office for the Prevention of Addictive Substance Abuse. “But what’s new for us is that young people are taking opioids and benzodiazepines and in some cases mixing them with alcohol.” The Health Behavior in School-aged Children (HBSC) study is the only representative survey on this. The most recent findings (2018) show that 4.5 percent of 15-year-old boys and 4.1 percent of girls of the same age have already taken medicines at least once in their lives to experience psychoactive effects. In 2010, the number of boys was 2.4 percent which has almost doubled in eight years. Since some young people probably hide or gloss over their prescription consumption, Schnoz presumes that a considerable number of cases remain unreported.

A fake Xanax tablet: Instead of the benzodiazepine alprazolam, it contains etizolam which is about one and a half times stronger than alprazolam. Taking it is not recommended. Photo: DIZ

“Apart from the HBSC study, scientific facts on adolescent prescription drug abuse are lacking,” says addictive substance expert Domenic Schnoz. Existing information is based on police investigations, specialist opinions, feedback from addiction counseling centers and individual statements from young users. Pressure to perform, loneliness, boredom, problems in school or with family, peer pressure, curiosity or the urge to copy others are some of the reasons why adolescents take prescription tranquilizers and painkillers. The list is as long and varied as the questions that remain open for experts.

“Apart from the HBSC study, scientific facts on adolescent prescription drug abuse are lacking.”

“Because without facts and figures, there are no answers,” says Schnoz emphatically commenting on the current situation. An application for funding to study the effects of drug combinations has been submitted to the Swiss Federal Office of Public Health and is currently pending.
“There is increasing evidence that adolescent prescription abuse is no longer a marginal phenomenon, but it also isn’t the norm yet,” explains Schnoz. It’s too early to speak of a “trend in taking drug combinations.” Experts on addictive drugs therefore warn against overhyping the topic and thereby giving young users an attractive media platform.        

An intense look at drug abuse
According to the numbers cited in the current HBSC study, at least one teenager in every grade at school abuses prescription drugs. When asked about the problem, none of the high schools contacted – whether in Basel, Zurich or St. Gallen – wanted to comment. Aldo Magno, head of Lucerne’s cantonal department for high school education, reacts differently.     

A fake Xanax tablet: Instead of alprazolam, it contains flubromazolam. This is a potent new psychoactive substance. Mixing it with other drugs can result in unconsciousness and life-threatening respiratory depression. Photo: DIZ

“We have taken a deep look at the issue,” he says. The decision to prioritize the matter wasn’t entirely voluntary: In summer 2019, the Lucerne police started investigating a young ring of users and dealers; the investigation implicated Lucerne’s Colleges. “The police stressed that they were deeply shocked and alarmed by the extent of the dealing and using,” says Magno. “We communicated our horror and concern and accordingly informed the school administrations and colleges.” The teachers were instructed to watch out for unusual behavior such as frequent trips to the bathroom during class. In addition, the situation was addressed in the classroom. However, Magno makes one thing clear: “Even though our teachers are very open-minded, attentive and sensitive to students’ needs, their priority is to teach the curricula, not monitor the use of drug cocktails among the student body.”  

“Even though our teachers are very open-minded, attentive and sensitive to students’ needs, their priority is to teach the curricula, not monitor the use of drug cocktails among the student body.” 

A school’s overall attitude towards drug prevention is crucial. “Prevention does not run itself and doesn’t just happen,” says Aldo Magno. “It’s up to us to adopt the canton’s preventative measures, to keep asking questions and to proceed with open eyes.” The Lucerne police plans to visit all high school classrooms for preventative purposes and to provide information – in uniform and with a clear message: Prescription drug abuse is damaging, punishable by law and has serious consequences.    

“Juvenile criminal law prioritizes the protection and education of young persons who have committed a criminal offense over their punishment,” explains Hans Melliger, head of Jugendanwaltschaft, a youth advocacy organization in the canton of Aargau. “We determine whether protective measures can be taken to prevent future crimes and what kind of measures to take. Whenever possible, we try to keep young people in their familiar environment, be it their home, their school or their job training site, and we also introduce outpatient support structures”, says Melliger. If this doesn’t work, inpatient measures are considered. To properly manage a withdrawal from prescription drugs requires the added intervention of psychiatric support. 

Friends, acquaintances or family members as suppliers
It’s easy to get prescription tranquilizers and painkillers. The image of a dealer waiting for his customers on a dark corner has become obsolete, as has the stress of getting drugs. Today’s suppliers include friends and acquaintances. There is the 15-year-old who sells some of her doctor-prescribed Ritalin tablets to schoolmates to buy clothes – or the 17-year-old who consumes prescription psychotropic drugs from his parents’ medicine cabinet and sells the rest. A 10 mg Ritalin tablet costs about 35 cents in the pharmacy and is re-sold for 5 francs. And there’s yet another place to get broad variety of medicines: forums on social platforms on the web or the dark web.   

A fake Xanax tablet: Instead of alprazolam, it contains flualprazolam. There hasn’t been a lot of research on this and it is not used as a medication. The risk of overdosing exists. Photo: DIZ

The sale is conveniently carried out “online.” The goods are delivered to your home or handed over in person. Counterfeit prescriptions can also be used to obtain pills at a pharmacy. “It’s no longer uncommon to see young adults enter a pharmacy with a prescription for psychotropic drugs,” says Karin Häfliger. Living in Lucerne, she owns and manages a pharmacy in Emmenbrücke and is on the board of the Lucerne Pharmacists Association. “It’s important to examine each case individually,” she adds. “But we also have to keep an eye out for digitally created prescriptions since they are really easy to falsify or copy.” There are no official statistics on fake prescriptions, but the pharmacists have issued individual estimates which vary based on pharmacy location.             

“But we also have to keep an eye out for digitally created prescriptions since they are really easy to falsify or copy.”

“Since drugs are assigned to various dispensing categories, it isn’t easy to illegally buy prescription drugs,” stresses Häfliger. With the revised 2019 Swiss Therapeutic Products Act, for example, pharmacists can only dispense codeine-based cough syrup to persons with a prescription or after a personal consultation. The pharmacist must rule out the potential for addiction. The recipient’s name is registered and the drug is dispensed in a documented manner. Swissmedic closely controls and monitors the procedures pharmacies follow to dispense opioids such as morphine or Ritalin. “These narcotics definitely aren’t just prescribed or dispensed,” says pharmacist Häfliger. But in Germany or the US, the situation is quite different.        

Switzerland doesn’t compare to Germany or the US           
The US has been up against an opioid crisis for years. One of the main reasons for this crisis is the liberal way in which opioid painkillers are prescribed. In Germany, the song “Tilidine” and rapper Capital Bra’s confession of being addicted to this drug triggered a surge in its popularity. Tilidine is a strong prescription painkiller belonging to the opioid class of drugs. Consumption among 15-to-20-year-olds increased thirty-fold within two years – to three million doses daily. In Switzerland, such a scenario would be unimaginable. “Here, tilidine is an ingredient in Valoron drops, which are very rarely prescribed,” says Häfliger. “I haven’t seen a single case of it in the past ten years. A prescription for it would be checked very carefully.”

“It’s no longer uncommon to see young adults enter a pharmacy with a prescription for psychotropic drugs.”

Rapper Capital Bra is no exception in the music industry. The hip-hop scene is known for its glorification of Xanax which rappers call Xanny. It is omnipresent in the songs and therefore in young people’s personal playlists as well as in public music charts. The music streaming service, Spotify, even offers a special “Xanax & Chill” playlist. The glorification of sedatives and pain relievers doesn’t stop with the music industry. In the Netflix series “How to Sell Drugs Online (Fast),” teenagers build an online shop for party drugs and get rich in the process. According to Netflix, the series is one of last year’s most watched German original series. In German-speaking countries there is hardly a teenager who isn’t familiar with the series or doesn’t admire it. The story is actually based on a true story. In 2013, an 18-year-old starts an online drug shop in his childhood bedroom in Germany. In 15 months, he sells a ton of drugs on the internet, raking in about 4.3 million Swiss francs. In 2015, he is sentenced to 7 years in prison. 

A real Xanax tablet: It contains 2 mg alprazolam. Concomitant use with opioids can result in severe sedation, respiratory depression, coma, and death. Photo: DIZ

Maybe a “good rush,” maybe death

At Zurich’s Drug Information Center, users can have addictive substances tested anonymously and free of charge. The center issues a warning for over 40 percent of all samples – including prescription drugs. Joël Bellmont, the center’s deputy head, discusses the center’s work

Zurich’s Drug Information Center analyzes some 2,400 samples of various intoxicating substances every year. How often are prescription drugs involved?
Joël Bellmont: “So far, prescription drugs haven’t been a big issue for us. The ingredients are usually clearly stated on the packaging. The situation is different for ‘fake’ drugs.”

What kind of drugs are these?
“These are prescription drugs ordered on the black market. They reach users in packaging that isn’t original and that doesn’t list the contents. The ingredients and dosage are unclear. It might be a counterfeit pill. In situations like this, we recommend having the substance analyzed. The same thing applies to ready-mixed ‘shots.’

What is the biggest danger a person faces when consuming a drug combination?  “When someone consumes a mixture of drugs, nobody can predict how the body will react. Depending on which drugs are combined, the drug effect profile changes or intensifies. In addition, people have different tolerance levels. A ready-mixed shot may simply trigger an intoxicating flash, but it might also lead to respiratory paralysis and ultimately death.”

Zurich’s Drug Information Center analyzes 45 samples per week. Where did the buyers purchase these substances?
“We don’t have any exact numbers on this. The vast majority rely on private contacts and social networks. Approximately 10 percent of our customers buy the substances on the dark web, where finding drugs takes time, is risky, and isn’t really worth it for personal use. The buyer must have an anonymous, encrypted email address, have bitcoins handy, and be okay with having the substances sent to him or her. The goods can be intercepted by customs or – for young people who still live at home – confiscated by their parents.”

published, January 2021, Journal “Bildung Schweiz” (01/2021)

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