By Dr. Dean Elbe, PharmD, BCPP (biography and disclosures)
Disclosure: Dean Elbe was the project leader for the development of the www.DrugCocktails.ca website which launched in September 2013.
What care gaps I have noticed
As reported in the 2013 McCreary Center Adolescent Health Survey, despite declining rates of use compared to previous surveys, it’s a fact that young people sometimes experiment with using substances such as alcohol, marijuana or street drugs.  While there are health risks with substance use of any kind, the risks can be even higher for youth who have chronic medical conditions and also take one or more medications on a regular basis. Intuitively it may seem that youth with chronic health conditions would be less likely to engage in substance use. In fact, the opposite is the case – it has been shown that youth with chronic illness are as likely or for females, more likely to engage in substance use.  Up until now, there wasn’t a widely available, credible, consistent single source of information for youth or health care professionals about potential interactions between prescription medications and substances of abuse.
Data that answers these questions or gaps
One answer to this problem is the new, “beautifully designed”, first-of-its-kind website, DrugCocktails.ca.
DrugCocktails.ca expands on the 2002 print publication “Cocktails”  and now covers almost 200 prescription and over-the-counter medications, and 10 substance categories. There are separate interactive versions for: 1) youth, providing practical plain language warnings and information; and 2) health care professionals and counselors working with youth, providing detailed medical information underlying the warnings.
Youth and professionals can type a medication name into the website, and learn about the risks of combining that medication with any of the 10 substance categories including alcohol, tobacco, marijuana, cocaine, opioids, stimulants and benzodiazepines. The website is harm reduction-focused, intuitive and easy- to-use. Warning icons that indicate “Serious Risk of Harm”, “Think First” or “Unknown Dangers” help youth and professionals identify risks of medication-substance combinations at a glance.
There is no “green light” anywhere in DrugCocktails.ca — it is never safe to arbitrarily mix medications and substances. The site provides information and highlights risks to help youth make safer, informed choices and contributes to improved health literacy among youth.
The research to compile the interaction data on the site was done by UBC pharmacy students as part of a directed studies project. Data was reviewed and youth-appropriate warnings were generated by Clinical Pharmacy Specialists at BC Children’s Hospital. Full references and links to PubMed abstracts (when available) are provided for professionals.
Courtesy of the Centre for Addiction Research of BC, photos, nicknames, health risks and general information about each of the substance classes covered on the website is also made available.
The best part is that DrugCocktails.ca is completely FREE to access for both youth and professionals, and does not collect personal information from youth. There is even a “Hide This Site” button youth can press if they are concerned someone is watching that they don’t want to know they were looking at a site about substance use.
The DrugCocktails.ca website was funded by BC Mental Health & Substance Use Services (BCMHSUS), an agency of the Provincial Health Services Authority (PHSA). It was developed in partnership with researchers from BCMHSUS, BC Children’s Hospital Pharmacy Department and Adolescent Medicine Program, PHSA, Children’s Hospital of Eastern Ontario and the University of Ottawa.
What I recommend (practice tip)
DrugCocktails.ca was developed to work on multiple platforms including desktop computers, tablets and smartphones (works best in “landscape” viewing mode). The next time you are asked a question about substance use by a youth who is taking one or more medications regularly, try visiting the DrugCocktails.ca website together. Type in the name of a medication (brand or generic name is OK – the site even uses suggestive search to overcome the problem of spelling the sometimes long or confusing drug names) and then look up the risks of the 10 different substance classes with that information. You can print out the information for their reference, or for your files, and can even flip over to the professional site (one time easy registration is required) if you want to delve more deeply into the details about how a given interaction occurs. You will be amazed at the rapport the use of the website can generate with youth by actually helping to answer their questions in this area. This can lead to important conversations about other ways to reduce the risk and harm from substance use.
References and/or Additional reading
- Smith A, Stewart D, Poon C et al. From Hastings Street to Haida Gwaii: Provincial results of the 2013 BC Adolescent Health Survey. Vancouver, BC: McCreary Centre Society, 2014. (View article)
- Suris JC, Parera N. Sex, drugs and chronic illness: health behaviours among chronically ill youth. Eur J Public Health 2005;15:484-8. (View article)
- Lyon T. New web tool helps youth (and adults) avoid dangerous drug combos. BC Medical Journal Blog. (View article) (accessed March 31, 2014).
- Collin KC, Paone M. Cocktails: Facts for youth about Mixing Medicine, Booze, and Street Drugs. Vancouver, BC: Children’s & Women’s Health Centre of British Columbia, 2002. (Request from CPSBC)