Extramedical Use of Prescription Pain Relievers by Youth Aged 12 to 21 Years in the United States

College of Human Medicine, Michigan State University, East Lansing.
JAMA Pediatrics (Impact Factor: 5.73). 05/2012; 166(9). DOI: 10.1001/archpediatrics.2012.209
Source: PubMed


OBJECTIVE: To identify when youth are most likely to start using prescription pain relievers to get high or for other unapproved indications outside the boundaries of what a prescribing physician might intend (ie, extramedical use). DESIGN: Cross-sectional surveys of adolescent cohorts, 2004 to 2008. SETTING: The United States. PARTICIPANTS: Large nationally representative samples of youth in the United States who had been assessed for the 2004 through 2008 National Survey on Drug Use and Health, yielding data from 138 729 participants aged 12 to 21 years. MAIN OUTCOME MEASURES: Estimated age-specific risk of starting extramedical use of prescription pain relievers, year by year, and confirmation of age at peak risk by tracing the experience of individual cohorts during this period. RESULTS: The estimated peak risk of starting extramedical use of prescription pain relievers occurs in midadolescence, well before the college years. The age at peak risk is 16 years, when an estimated 2% to 3% become newly incident users. Smaller risk estimates are observed at age 12 to 14 years and at age 19 to 21 years. CONCLUSIONS: For initiatives to prevent youth from using prescription pain relievers to get high or for other unapproved indications, a focus on the last year of high school and the post-secondary school years may be too little too late. Practice-based approaches are needed in addition to public health interventions based on effective alcohol and tobacco prevention programs during the earlier adolescent years.

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    • "At the center of this growing crisis are prescription opioids, with over 12 million Americans having used this pharmaceutical class for nonmedical purposes. Adolescent populations are particularly vulnerable to opioid misuse and abuse, with early initiation increasing the likelihood of future addiction (Compton and Volkow, 2006; McCabe, 2012, 2011, 2009; Meier, 2012). In turn, these nonmedical user are estimated to cost society over $53 billion each year through their greater burden on health and service systems as well as increased rates of disability (Birnbaum et al., 2011; Coben et al., 2010; Hansen et al., 2011a; Johnston et al., 2010; SAMHSA, 2009). "
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    ABSTRACT: Purpose Prescription drug abuse has reached epidemic proportions. Nonmedical prescription opioid use carries increasingly high costs. Despite the need to cultivate efforts that are both effective and fiscally responsible, the cost-effectiveness of universal evidence-based-preventive-interventions (EBPIs) is rarely evaluated. This study explores the performance of these programs to reduce nonmedical prescription opioid use. Methods Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions (2002–2010). Within the intervention communities, prevention teams selected a universal family and school program from a menu of EBPIs. All families were offered a family-based program in the 6th grade and received one of three school-based programs in 7th-grade. The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program was assessed using propensity and marginal structural models. Results This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use. Further, findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs. Conclusions Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use should be further considered when developing comprehensive responses to this growing national crisis.
    Full-text · Article · May 2014 · Preventive Medicine
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    • "The current study aims to extend these findings focusing on a comparison of prevalence estimates across these two surveys for a branded prescription opioid product, oxycodone, which has been a focus of concern for abuse in adolescent and adult populations (Meier et al., 2012; Martins et al., 2009). Oxycodone serves as an accessible example because it is the only specific opioid product for which both surveysprovide estimates of past year prevalence, and findings based on this product are likely to be relevant to other specific products. "
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    ABSTRACT: There is a growing need to understand trends in nonmedical use of prescription pain relievers as a class, as well as specific opioid products. Surveys such as monitoring the future (MTF) and the National Survey on Drug Use and Health (NSDUH) are important tools for understanding trends in abuse of prescription and illegal drugs. This report compares discrepancies in prevalence between these surveys for a specific opioid product (oxycodone) relative to other drugs. Trends in past-year use of marijuana, cocaine, and nonmedical use of oxycodone and any prescription pain reliever were estimated for each survey for a five year period (2005-2010) for adolescents in 12th grade. The proportion of nonmedical pain reliever users who abused oxycodone was estimated for each survey. Prevalence of past-year oxycodone nonmedical use was steady over time for both surveys, but 2.5-3 times higher in the MTF compared to the NSDUH. Trends in prevalence of marijuana and cocaine use were similar across surveys, although prevalence estimates for each were on average 18% higher in the MTF. In contrast, prevalence estimates for any nonmedical prescription pain reliever use were on average 15% lower in MTF. The proportion of nonmedical prescription pain reliever users who used oxycodone was 42% in the MTF versus 19% in the NSDUH. The discrepancy between surveys in prevalence estimates for nonmedical use of oxycodone exceed those for other drugs, pointing to the importance of visual aids and items used to measure the nonmedical use of specific products.
    Full-text · Article · Oct 2013 · Drug and alcohol dependence
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    • "The nonmedical use of Rx opiates and other controlled drugs by adolescents and young adults has surpassed all illicit drugs except marijuana [1]. A recent report found that, for youth, the peak risk in nonmedical use of prescription pain relievers occurred at the age of 16 years, not during the postsecondary school years as previously suspected [2]. According to the Monitoring the Future Study, the nonmedical use of several prescription medications by 12th graders in the United States is at its highest level in the past 15 years [3]. "
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    ABSTRACT: Purpose. The objective of this study was to document the number of controlled substance prescriptions filled by adolescents and young adult patients in the 2 years prior to presentation for opiate dependence treatment. Methods. Opiate-dependent youth () presenting to our Medication-Assisted Treatment for Addiction program from January 1, 2008 to June 30, 2010 were identified via electronic medical record. Subjects were further classified based on their opiate use as dependent to heroin-only, prescription (Rx) opiate-only, or combined heroin + Rx opiate only. The Ohio Automated Rx Reporting System (OARRS) was used to identify each subject's controlled substance prescription history. Negative binomial regression was used to examine the relationships between patient characteristics and the total number of prescriptions filled. Results. Twenty-five percent of subjects had filled ≥6 prescriptions, and 15% had filled ≥11 prescriptions. The mean number of prescriptions filled was 5 (range: 0–59). Thirteen percent had filled ≥6 opiate/narcotic prescriptions, and 8% had filled ≥11 prescriptions. Conclusions. A subset of opiate-dependent youth had filled multiple opiate/narcotic prescriptions providing some evidence that physician-provided prescriptions may be a source of opiate abuse or diversion for a minority of opiate-dependent adolescents and young adults.
    Full-text · Article · Feb 2013
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