Prescription drug abuse and diversion among adolescents in a southeast Michigan school district

Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, United States
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 4.25). 04/2007; 161(3):276-81. DOI: 10.1001/archpedi.161.3.276
Source: PubMed

ABSTRACT To determine the prevalence of medical use of 4 classes of prescription medications relative to nonmedical use (illicit use), to examine the relative rates among the 4 drug classes, and to assess whether gender differences exist in the trading, selling, loaning, or giving away of medications.
A Web-based survey was administered to 7th- to 12th-grade students residing in 1 ethnically diverse school district; a 68% response rate was achieved.
During a 3-week period in May 2005, teachers brought students to their schools' computing center where students took the survey using a unique personal identification number to sign on to the survey.
There were 1086 secondary students, including 586 girls, 498 boys, 484 black students, and 565 white students.
Students were asked about their medical and nonmedical use of sleeping, sedative or anxiety, stimulant, and pain medications. Diversion of prescription medication was assessed by determining who asked the student to divert his or her prescription and who received it.
Thirty-six percent of students reported having a recent prescription for 1 of the 4 drug classes. A higher percentage of girls reported giving away their medications than boys (27.5% vs 17.4%, respectively; chi(2)(1) = 6.7; P = .01); girls were significantly more likely than boys to divert to female friends (64.0% vs 21.2%, respectively; chi(2)(1) = 17.5; P<.001) whereas boys were more likely than girls to divert to male friends (45.5% vs 25.6%, respectively; chi(2)(1) = 4.4; P = .04). Ten percent diverted their drugs to parents.
Physicians should discuss the proper use of prescription medications with their patients and their patients' families.

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    • "These results suggest diversion sources may provide insights regarding the risk for SUDs and studies that assess diversion should separate family from peer diversion sources. Finally, the finding that there were no reports of nonmedical users buying prescription opioids on the Internet, regardless of the SUD screening result, adds to a growing literature indicating adolescents and young adults are not currently purchasing prescription opioids via the Internet (Johnston et al., 2010; McCabe & Boyd, 2005; McCabe et al., 2007; Schepis & Krishnan, 2009). However, future research should continue to monitor the role of the Internet as a potential diversion source based on the feasibility of purchasing controlled medications online without a prescription (Califano, 2004; Forman, 2003). "
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    ABSTRACT: The objectives of this study are to examine the associations among a positive score on the CRAFFT (a substance use brief screening test for adolescents) and demographic characteristics, diversion sources, routes of administration, substance use behaviors and motivations associated with the use of prescription opioids without a legal prescription. In 2009-2010, a sample of 2744 middle and high school students from two Midwestern school districts in the United States self-administered a Web-based survey. Approximately 5.6% (n=148) of respondents reported past-year nonmedical use of prescription opioids (NMUPO). Of those reporting NMUPO, approximately 35.1% (n=52) screened positive for substance use disorders based on the CRAFFT. Multiple logistic regression analyses indicated that the odds of buying prescription opioids, obtaining opioids from multiple diversion sources, administering opioids intranasally, and using opioids to get high were greater for nonmedical users with a positive CRAFFT screen as compared to NMUPO with a negative CRAFFT screen. NMUPO with a positive screen was motivated primarily for recreational purposes, while NMUPO with a negative screen was motivated almost exclusively by pain relief. The CRAFFT brief screening test for adolescents can be used to identify a subgroup of NMUPO at the highest risk for a substance use disorder as well as a subgroup of NMUPO who would benefit from appropriate pain management.
    Addictive behaviors 02/2012; 37(5):651-6. DOI:10.1016/j.addbeh.2012.01.021 · 2.44 Impact Factor
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    • "Past year alcohol use and DSM-IV defined abuse, as well as the lifetime and past year use of various illegal substances was also assessed. Questions on the medical and nonmedical use of the four most commonly abused classes of psychoactive drugs (i.e., pain, sleeping, anxiety, stimulants) were abstracted from the Student Life Survey questionnaire developed by University of Michigan (McCabe et al., 2005; Boyd et al., 2006; McCabe et al., 2007). Market available trade names were used to increase identification and reduce information errors. "
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    ABSTRACT: Concerns about psychoactive prescription drug abuse among youth are growing worldwide, but the majority of published studies remain from the US and Canada impeding cross-cultural comparisons. This study examines the prevalence, sources, motivations and substance-use correlates of commonly abused medications among youth from Lebanon. An IRB-approved cross-sectional study was conducted (May 2010) at the American University of Beirut. Proportionate cluster sampling was used to generate a representative sample of AUB students (n=570). A self-filled anonymous questionnaire was administered. Lifetime medical and nonmedical prevalence of medications were (respectively): pain (36.9%, 15.1%), anxiety (8.3%, 4.6%), sleeping (6.5%, 5.8%) and stimulants (2.6%, 3.5%). Gender differences were not observed. Lebanese were least likely to report non-medical use. Nonmedical users mostly used the drugs for their intended purpose (e.g., sleeping to help in sleep, stimulants to increase alertness). Parents and pharmacists (without a doctor's prescription) were the top two sources of all medications, except for stimulants (friends predominated). Diversion was observed in about 20% of the medical users. Lifetime marijuana users and past year alcohol abusers were three times as likely to use any prescription drug nonmedically. In Lebanon, as in Western cultures, a considerable proportion of youth may be self-medicating. The absence of medical supervision coupled with motivations such as "to get high" renders this issue a high priority on the national youth agenda. Besides larger more comprehensive surveys, the findings signal the immediate need to reinforce relevant policies, and raise awareness among youth, parents, health professionals and other stakeholders.
    Drug and alcohol dependence 09/2011; 121(1-2):110-7. DOI:10.1016/j.drugalcdep.2011.08.021 · 3.28 Impact Factor
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    • "Physicians should instruct all patients who require controlled medications about the abuse potential of these medications, and the need to store their prescriptions in a secure location. Given that many individuals obtain diverted prescription medications for nonmedical use from friends, peers, and family members (Boyd et al., 2007; McCabe and Boyd, 2005), clinicians prescribing these medications should exercise caution, and periodically monitor their patients' behavior over the course of treatment. They should also consider limiting both the quantity of medication prescribed, as well as the number of refills, which in turn requires more frequent clinician–patient interactions and therapeutic monitoring. "
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    ABSTRACT: The objective of this study was to estimate the lifetime prevalence of diversion (i.e., trading, selling, giving away or loaning) of four classes of controlled medications (pain, stimulant, anti-anxiety, and sleeping) among adolescents, and to identify demographic and behavioral characteristics of adolescents who divert their own controlled medications. A web-based survey was self-administered by 2744 secondary school students from two southeastern Michigan school districts in 2009-2010. The sample consisted of 51% females, 65% Whites, 29% African-Americans, 4% Asians, 1% Hispanics and 1% from other racial categories. Thirty-three percent of the students had ever been prescribed at least one controlled pain, stimulant, anti-anxiety, or sleeping medication. Approximately 13.8% (n=117) of lifetime prescribed users of controlled medications (n=848) had ever traded, sold, given away or loaned their medications. Multiple logistic regression analyses indicated that being approached to divert medications, nonmedical use of prescription medications, externalizing behaviors, and being non-White were significantly associated with the diversion of controlled medications. Multiple logistic regression analysis indicated that the odds of substance use and abuse for lifetime prescribed users who diverted their controlled medications were significantly greater than prescribed users who never diverted. The findings indicate that approximately one in seven prescribed users had diverted their controlled medications in their lifetimes. Being approached to divert medications and substance use are more prevalent among adolescents who diverted their controlled medications. Careful assessments, diligent prescribing and monitoring of controlled medications, and continual patient education could be useful in reducing medication diversion.
    Drug and alcohol dependence 06/2011; 118(2-3):452-8. DOI:10.1016/j.drugalcdep.2011.05.004 · 3.28 Impact Factor
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