Simultaneous co-ingestion of prescription stimulants, alcohol and other drugs: a multi-cohort national study of US adolescents

Simultaneous Substance Use With Alcohol in a Community-Based Sample of Young Adults

Objective: Simultaneous substance use is associated with worse outcomes than concurrent use. Further investigations into simultaneous use are warranted because there is limited knowledge about the co-use of substances other than alcohol and cannabis. Study aims were to examine: (1) the prevalence of simultaneous use of substances with alcohol, (2) the extent to which use patterns are related to key correlates (i.e., psychological functioning, sensation seeking), and (3) differences by college status. Methods: Participants were 623 young adult drinkers who were recruited online to complete a one-time survey. Results: Cannabis (54.3%), tobacco (53.7%), and stimulants (46.5%) were most frequently used with alcohol. Moderation analyses showed the positive association between simultaneous use and psychological distress was stronger for students whereas the positive association with sensation seeking was stronger for nonstudents. Conclusions: Results highlight the need for future research and intervention efforts that consider the link between simultaneous use and psychological wellbeing while acknowledging that educational attainment may differentially influence these factors.

Investigating the co-occurrence of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation

This study investigated the co-occurrent association of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation. Data came from the 2019 Youth Risk Behavior Survey. The sample was comprised of adolescents ages 14-18 who reported suicidal ideation during the past year (n = 2,562). Multinomial logistic regression was used to examine the co-occurring association of marijuana use and prescription opioid misuse with multiple suicide attempts. Of the 2,562 adolescents who experienced suicidal ideation, 19.2 % also attempted suicide multiple times during the past year and 19.0 % reported ever using marijuana and misusing prescription opioids, 8.8 % misused prescription opioids only, and 33.3 % used marijuana only. In the multivariate model, for adolescents who used marijuana and misused prescription opioid, the risk of attempting suicide once was 1.77 times higher (RRR = 1.77, 95 % CI = 1.22-2.59) and the risk of multiple suicide attempts was 3.23 times higher (RRR = 3.23, 95 % CI = 1.95-5.33) when compared to adolescents who had never used marijuana nor misused prescription opioid. The risk of multiple suicide attempts was greater for bisexual and racial/ethnic minority adolescents and adolescents who felt sad or hopeless. Interventions that prevent prescription opioid misuse among adolescents may be effective in mitigating suicide attempts.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

Prescription Drug Misuse with Alcohol Coingestion among US Adolescents: Youth Experiences, Health-related Factors, and Other Substance Use Behaviors

BACKGROUND

While alcohol use and prescription drug misuse (PDM) are common among adolescents, there is relatively little research on coingestion. This is disquieting as polysubstance use has become a major contributing factor in drug overdose deaths among young people in the United States.

METHODS

The current research uses multiple years of data from the National Survey on Drug Use and Health (2015-2019) to assess characteristics associated with coingestion among adolescents aged 12 to 17 years ( N = 57,352). Multinomial logistic regression analysis is used to identify characteristics associated with past 30-day PDM with and without alcohol coingestion. The primary objective is to determine how youth experiences with parents, involvement in conventional activities, religiosity, social support, and school status are associated with coingestion.

RESULTS

Among adolescents who report past 30-day PDM, 18.6% coingest with alcohol and 77.5% of adolescents who coingest report at least one substance use disorder. Several youth experiences were significantly associated with opioid coingestion including increased conflict with parents (relative risk ratio [RRR], 1.27; 95% confidence interval [CI], 1.07-1.48), lower levels of religiosity (RRR, 0.72; 95% CI, 0.52-0.98), less social support (RRR, 0.36; 95% CI, 0.18-0.69), and not being in school (RRR, 3.86; 95% CI, 1.33-11.17). In addition, emergency department visits, depression, and other substance use behaviors were also significantly associated with coingestion.

CONCLUSIONS

Findings demonstrate a strong connection between coingestion and substance use disorder among US adolescents. The findings from the current study can inform prevention and intervention efforts by identifying youth experiences and health-related factors that are associated with coingestion.

Factors Influencing Racial and Ethnic Differences in Prescription Opioid Misuse Among Young Adolescents in the USA, 2009-2019

BACKGROUND

Prescription opioid misuse (POM) is an important public health concern. Not many studies have evaluated factors influencing racial and ethnic differences in POM exclusively in young adolescents. We evaluated factors influencing the racial and ethnic differences in POM in a nationally representative sample of 8th- and 10th-grade (12-15 years old) US adolescents.

METHODS

Data were from 107,786 adolescents who participated in the 2009-2019 Monitoring the Future survey. Logistic regression and mediation analysis were used to identify risk factors for POM and evaluate mediators of the association of race and ethnicity on the frequency of POM in the past year.

RESULTS

From 2009 to 2019, the prevalence of POM in the past year decreased from 3.2% to 1.8% (p = 0.032), with significant differences in POM trends by race and ethnicity. Overall, the prevalence was higher among non-Hispanic White adolescents (3.2%) than Hispanic (2.5%) and non-Hispanic Black adolescents (1.6%), p < 0.001. After adjustment for demographic, substance use, lifestyle, and family-related factors, the odds of POM were lower among Black (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.66-0.98) and Hispanic adolescents (OR = 0.64, CI: 0.55-0.74) compared to White adolescents. Illicit drug use and misuse of other prescription drugs together explained 77.2% and 47.3% of the racial and ethnic disparities in POM among Black and Hispanic adolescents, respectively.

CONCLUSION

In this study, significant racial and ethnic differences in the trends of POM were observed. Illicit drug use and misuse of other prescription drugs substantially explained the racial and ethnic disparities in POM among young adolescents.

Prescription drug and alcohol simultaneous co-ingestion in U.S. young adults: Prevalence and correlates

Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between prescription and illicit stimulant and opioid use in the United States, 2015-2020

INTRODUCTION

Overdose deaths involving opioids and stimulants continue to reach unprecedented levels in the United States. Although significant attention has been paid to the relationship between prescription and illicit opioid use, little work has focused on the association between prescription and illicit stimulant use. Thus, this study explores characteristics of those who use or misuse prescription stimulants and/or opioids and associations with use of cocaine, methamphetamine, and heroin.

METHODS

We used 2015-2020 data from the National Survey on Drug Use and Health. Using adjusted multivariable logistic regression, we estimated the associations between past year prescription stimulant or prescription opioid prescribed use and misuse; various demographic characteristics; and past-year cocaine, methamphetamine, or heroin use.

RESULTS

From 2015 to 2020, 4.9 and 9.8 million US adults annually reported misusing prescription stimulants and opioids, respectively. Individuals who misused prescription stimulants were more likely to be ages 18-25 (45.8 %; 95 % CI: 44.0-47.5) than individuals who misused prescription opioids (21.7 %; 95 % CI: 20.7-22.7). We observed higher rates of cocaine use among individuals reporting prescription stimulant misuse (12.0 %; 95 % CI: 11.0-12.9) compared to those reporting prescription opioid misuse (5.7 %; 95 % CI: 5.1-6.3, p < 0.001). Heroin use was more common among individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.2) than prescription stimulant misuse (0.6 %; 95 % CI: 0.4-0.7, p < 0.001). However, rates of methamphetamine use among individuals with prescription stimulant misuse (2.4 %; 95 % CI: 1.9-3.0) did not differ from individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.5, p = 0.67).

CONCLUSIONS

Prescription stimulant misuse, compared to prescription opioid misuse, was associated with higher levels of cocaine use but not methamphetamine use. Treatment providers should consider screening for other substance use disorders among people who report prescription stimulant use or misuse. Additional research should seek to understand the mechanism underlying the different associations between prescription stimulant misuse and cocaine or methamphetamine use.

Misuse of Prescription Opioids and Suicidal Behaviors Among Black Adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

PURPOSE

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few have investigated the effects of prescription opioid misuse on suicidal behaviors among Black adolescents. The objective of this study was to investigate the cross-sectional association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among Black adolescents.

METHODS

Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4798 Black adolescents aged 14-18 years (51.2% female) was analyzed using binary logistic regression. The outcome variables investigated were suicidal ideation, suicide plan, and suicide attempt, and the main explanatory variable was prescription opioid misuse.

RESULTS

Of the 4798 Black adolescents, 15% reported ever misusing prescription opioids; 16.2% experienced suicidal ideation; 14% made a suicide plan; and 11.3% attempted suicide during the past 12 months. In the multivariate logistic regression models, Black adolescents who misused prescription opioids had 1.39 times higher odds of making a suicide plan and 1.65 times higher odds of making a suicide attempt during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant factors associated with suicidal behaviors include female sex, school bullying, cyberbullying, depressive symptoms, and illicit drug use. In addition, physical activity had a protective effect on suicide attempt.

CONCLUSION

The findings of the present study demonstrate the effects of prescription opioid misuse and its association with suicidal behaviors among Black adolescents.

Negative Consequences Related to Nonmedical Prescription Stimulant Use: Development and Psychometric Validation of the Prescription Stimulant Consequences Questionnaire

Nonmedical prescription stimulant use (NPS) is prevalent among undergraduates and associated with several negative consequences. However, no validated measures exist assessing NPS-related consequences. The present study aimed to develop and psychometrically validate a Prescription Stimulant Consequences Questionnaire (PSCQ) for use among college students. A multisite sample of college students endorsing NPS ( N = 715, 68.4% female) completed the PSCQ and measures of NPS frequency and correlates of NPS via an online survey. Exploratory factor analysis supported a 27-item measure, with three factors (i.e., Compulsive Behavior, Risky Behaviors, and Physical and Mental Health) and a total score. Each PSCQ factor and total score demonstrated good internal consistency, and were significantly positively associated with all NPS frequency indicators, route of administration, alcohol-related problems, sleep problems, and depressive/anxiety symptoms. Findings demonstrate support for the psychometric validity and reliability of the newly developed PSCQ, which may demonstrate potential as a screening and outcome measure for intervention.

Within-Person Predictors of Same-Day Alcohol and Nonmedical Prescription Drug Use Among Youth Presenting to an Urban Emergency Department

OBJECTIVE

Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets.

METHOD

At an urban emergency department, research assistants recruited youth ages 14-24 reporting past-6-month substance use (n = 599; 58.8% male). Participants self-administered validated measures of alcohol consumption, cannabis use severity (quantity and consequences), mental health symptoms, and social influences at baseline and at four biannual follow-ups. In addition, participants completed Timeline Followback calendars that assessed same-day use of alcohol and prescription drugs. We used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency.

RESULTS

Between 6.0% (baseline) and 8.6% (6-month follow-up) of youth reported same-day alcohol use and NMPDU across follow-ups. Within-person increases in alcohol consumption, cannabis use severity, and depression and anxiety symptoms all corresponded to greater same-day alcohol and NMPDU frequency, with consistent findings across genders. Increased positive peer behaviors corresponded to decreased same-day use frequency among males but not females. Decreased parental support and increased delinquent peer exposures corresponded to greater same-day use frequency among females but not males.

CONCLUSIONS

Substance use and mental health symptom escalation are robust predictors of greater same-day use frequency, whereas the roles of social factors appear gender-specific. Interrupting worsening trajectories of substance use and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same-day use frequency.

Characterizing prescription stimulant nonmedical use (NMU) among adults recruited from Reddit

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Adults reporting past 5-year non-oral prescription stimulant NMU were studied.

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Non-oral NMU preferences were snorting (59%) injecting (4%) or smoking (1%).

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Polysubstance use was reported by 79.1% of the sample.

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Route of administration and motivation for prescription stimulant NMU were related.

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Prescription stimulant oral and intranasal NMU was to enhance performance.

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Prescription stimulant intravenous and smoking NMU was to get high.

Objective

Increased prescription stimulant nonmedical use (NMU) is part of a growing polysubstance use landscape. The purpose of the present study was to characterize prescription stimulant NMU among adults reporting past 5-year non-oral prescription stimulant NMU.

Methods

Adults who reported non-oral prescription stimulant NMU within the last 5 years were recruited by banner ads placed on the Reddit website between February and September 2019. Types of prescription stimulants used, routes of administration, preferred routes of administration, motivations for prescription stimulant NMU, concurrent substances used simultaneously during prescription stimulant NMU, illicit substances used and factors impacting prescription stimulant NMU were queried.

Results

Respondents (n = 225) were male (86.2%), non-Hispanic (92.4%), white (78.2%), between 18 and 24 (48.0%) or 25–34 (43.1%) years with some amount of college education (81.3%). Most reported lifetime intranasal (93.8%) or oral use (85.2%). Prescription stimulants were diverted: 64.5% reported the prescription stimulants were given to them by a family or a friend and 10.5% reported that they had stolen these medications from a family or friend. Preferred route of administration was oral use (70.2%). Motivations to use were stratified by route of administration: intranasal (55.6%) or oral (63.0%) use was primarily endorsed as an attempt to enhance performance at work or at school; use by injection (57.1%) or smoking (62.5%) was primarily endorsed to get high. Most of the sample reported concurrent drug use (79.1%) including tobacco (57.3%), marijuana (52.0%), caffeine (47.6%) or alcohol (41.8%), among others. When excluding licit substances, 30.7% reported using 1 illicit substance concurrently with prescription stimulants and 25.3% reported using 2 or more illicit substances concurrently with prescription stimulants. Whether participants would undertake prescription stimulant NMU was determined by their work/school schedules or the location of the NMU (48.9%) whereas the route of administration employed was primarily influenced by the desired feeling or effect (56.9%).

Conclusions

Adults reporting lifetime non-oral prescription stimulant NMU engage in substantial risky behaviors that in addition to alternate routes of administration include polysubstance use, diversion and concurrent substance use.

Predicting college student prescription stimulant misuse: An analysis from ecological momentary assessment

Prescription stimulant misuse (PSM) is common in young adult college students, at over 10% in the past year, and it is associated with other substance use and risk behaviors. Research focused on the real-time drivers of PSM is absent, impeding prevention and intervention. This research aimed to fill that gap by examining the relationships between affect, global stress, or academic stress and PSM via ecological momentary assessment (EMA); we also investigated baseline predictors of PSM frequency during the 21-day EMA period. Forty-one full-time college students (mean age: 20.5, 66% female) who endorsed current PSM (≥ 6 past-year episodes) participated. Participants were asked to complete EMA questions in response to 3 daily investigator-initiated prompts and after every PSM episode. Assessments were selected based on affect regulation (e.g., positive affect [PA], negative affect [NA]) and drug instrumentalization (e.g., academic stress and/or demands) theories of substance use. Mixed-effects linear models examined EMA data, and negative binomial regression analyses examined baseline predictors of PSM episode frequency. PA was higher on PSM days and increased post-PSM, whereas NA was unrelated to PSM. Although global and academic stress were largely unrelated to PSM, when the motive endorsed for PSM was "to study," pre-PSM ratings of academic demand and stress were significantly higher. Finally, a history of recreational motives (e.g., to get high) or higher levels of attention-deficit/hyperactivity disorder symptoms predicted a greater number of PSM episodes over the EMA period. The results offered mixed support for both affect regulation and instrumentalization as applied to PSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prescription Stimulant Misuse and Diversion Events Among College Students: A Qualitative Study

Prescription stimulant misuse and diversion are interrelated behaviors: diversion increases the availability of stimulants for misuse, and persons who misuse are also more likely to divert. To date, research has examined these behaviors using a primarily quantitative lens. We led a qualitative investigation to better understand misuse and diversion events. Data are from a diverse southern California campus where we interviewed students who misuse and/or divert prescription stimulants (32 total interviews: 16 interviews with students who had a history of misuse, and 16 different interviews with students who had a history of diversion). We analyzed interview data inductively. We identified the following themes about misuse and diversion events, several of which intersected during interviews: medication surplus, diversion and misuse hubs, ease of behavior performance, academic stress, and other drugs commonly involved. For diversion, altruism and monetary gain were juxtaposed themes. Across themes, friends and family were influential figures. Implications for prevention, intervention, and future research directions are discussed.

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older

OBJECTIVE

To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older.

METHODS

Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion.

RESULTS

Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM.

CONCLUSIONS

US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.

Alcohol-related cognitions: Implications for concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse among young adults

INTRODUCTION

This study examined the associations between alcohol-related cognitions within the social reaction pathway of the Prototype Willingness Model and concurrent (use of two or more substances within a specified time period) use of 1) alcohol and marijuana and 2) alcohol and prescription stimulant misuse.

METHODS

A convenience sample of 1,062 emerging adults in the U.S. (18-20 years old; 54.5% female) who reported past 3-month alcohol use completed a baseline survey as part of a larger randomized controlled trial.

RESULTS

Results indicate that controlling for age, biological sex, race, ethnicity, and college enrollment, perceived descriptive norms and willingness to drink were associated with past 3-month concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse. However, alcohol prototype similarity and alcohol-related perceived vulnerability were not associated with either concurrent use outcome examined.

DISCUSSION

These findings suggest that alcohol-related perceived descriptive norms and willingness to drink are associated with concurrent substance use among young adults. Thus, it is possible that existing efficacious alcohol interventions that target descriptive norms and willingness to drink may have the added benefit of also reducing concurrent substance cognitions and ultimately use.

Poly-prescription drug misuse across the life course: Prevalence and correlates across different adult age cohorts in the U.S

BACKGROUND

Most research on prescription drug misuse (PDM) focuses on the misuse of specific classes of psychoactive prescription drugs among adolescents or young adults. The current research addressed important gaps in the literature by assessing poly-prescription drug misuse (poly-PDM), the misuse of more than one class of psychoactive prescription drug, across different adult age cohorts.

METHODS

We used the 2015-2018 National Survey on Drug Use and Health to examine the prevalence of past-year poly-PDM and specific combinations of PDM. Multinomial logistic regression was used to identify demographic, health-related factors, and substance use behaviors that were significantly associated with poly-PDM.

RESULTS

The prevalence of poly-PDM decreases with age and is common among individuals who engage in PDM. Slightly more than one in four respondents in age cohorts 18-25 (31.66%, 95% CI = 30.35, 33.00) and 26-34 (29.92%, 95% CI = 25.82, 30.12) who engage in PDM, misused more than one class of prescription drug. Additionally, poly-PDM was identified as a high-risk type of PDM as roughly 60% of adults younger than 65 who endorse poly-PDM reported having a substance use disorder (SUD). While certain characteristics (i.e., race/ethnicity, marital status, depression, suicidal ideation, illegal drug use, and SUD) were consistently associated with poly-PDM across age cohorts, other characteristics (i.e., sexual identity, income, and justice involvement) varied across age cohorts. Finally, a comparison of poly-PDM to single PDM showed, in all age cohorts, that having an SUD was associated with an increased likelihood of poly-PDM, while Black adults were less likely than whites to report poly-PDM.

CONCLUSIONS

By identifying prevalence and correlates of poly-PDM across adult age cohorts, the current research has significant implications. Understanding stability and heterogeneity in the characteristics associated with poly-PDM should inform interventions, identify at-risk groups, and shape public health approaches to dealing with high-risk substance use behavior.

Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana

Nonmedical use of prescription stimulants (NPS) continues to be a concern on college campuses. Previous research demonstrates a strong link between NPS and use of other substances, particularly alcohol and marijuana among college students. Simultaneous use of NPS with other substances has become an increasing concern. Given the high rates of NPS and simultaneous NPS with other substances, research examining substance use patterns and motives among students is warranted. Method: This study evaluated group differences in alcohol and marijuana use patterns, consequences, and motives among college students: a) with no NPS history (No NPS); b) engaged in NPS with no simultaneous use (Non-Sim NPS); and c) engaged in simultaneous NPS with alcohol and/or marijuana (Sim NPS). Participants included 1,108 students from three universities who reported past-year marijuana and alcohol use. Results: Overall, 32.8% reported lifetime NPS with 12.5% indicating NPS in the previous 3 months, of which 51.1% reported simultaneous NPS with alcohol and 40.2% with marijuana. Significant group differences for all drinking and marijuana outcomes were found, with heaviest rates among the Sim NPS group, followed by the Non-Sim NPS group, and the No NPS group. The Sim NPS group reported greater motives for using marijuana to alter the effects of other substances. Conclusions: College students engaged in simultaneous NPS with alcohol and marijuana are a high-risk group that should be the focus of prevention and intervention programs in the campus setting.

Prescription Stimulant Use and Associated Risk Factors for Non-oral Use among 10 to 18 Year Olds

Non-medical use, especially non-oral use, of prescription stimulants is a public health concern. This study analyzed data from the National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS). Users (n = 723) were categorized as oral medical only users (n = 330, 45.6%), any oral non-medical users (n = 270, 37.3%), and any non-oral users (n = 123, 17.0%). The associations between patterns of stimulant use and risk factors were examined using logistic regression. Of the 123 any non-oral users, 79 reported using stimulants intranasally and orally, which was the most prevalent pattern of non-oral use. Among any non-oral users, the most common source of stimulants was from school (63.4%). Non-oral users primarily used stimulants to get high (74.4%) compared to 27.1% among other users. Negative consequences significantly associated with any non-oral use but not with oral non-medical use included needing stimulants to "feel ok," having trouble with teachers, bosses or friends due to stimulant use, and having anxiety and depression symptoms. In this study, non-oral use of prescription stimulants was associated with additional risks of adverse mental health outcomes compared to medical only use and other forms of non-medical use. Stimulant non-oral use interventions should emphasize the risks of intranasal use of stimulants.

Illicit drug use and the genetic overlap with Cannabis use

BACKGROUND

The use of illicit substances is correlated, meaning that individuals who use one illicit substance are more likely to also use another illicit substance. This association could (partly) be explained by overlapping genetic factors. Genetic overlap may indicate a common underlying genetic predisposition, or can be the result of a causal association.

METHODS

Polygenic scores for lifetime cannabis use were generated in a sample of Dutch participants (N = 8348). We tested the association of a PGS for cannabis use with ecstasy, stimulants and a broad category of illicit drug use. To explore the nature of the relationship: (1) these analyses were repeated separately in cannabis users and non-users and (2) monozogytic twin pairs discordant for cannabis use were compared on their drug use.

RESULTS

The lifetime prevalence was 24.8 % for cannabis, 6.2 % for ecstasy, 6.5 % for stimulants and 7.1 % for any illicit drug use. Significant, positive associations were found between PGS for cannabis use with ecstasy use, stimulants and any illicit drug use. These associations seemed to be stronger in cannabis users compared to non-users for both ecstasy and stimulant use, but only in people born after 1968 and not significant after correction for multiple testing. The discordant twin pair analyses suggested that cannabis use could play a causal role in drug use.

CONCLUSIONS

The genetic liability underlying cannabis use significantly explained variability in ecstasy, stimulant and any illicit drug use. Further research should further explore the underlying mechanism to understand the nature of the association.

Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students

BACKGROUND AND OBJECTIVES

The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co-occurring substance use disorders (SUD) compared with those without co-occurring SUDs.

METHODS

Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ² test, and the Wilcoxon rank-sum test.

RESULTS

College students who endorsed NMUPS with co-occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use.

DISCUSSION AND CONCLUSIONS

Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants.

SCIENTIFIC SIGNIFICANCE

The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476-484).

Prescription Drug Misuse: Taking a Lifespan Perspective

Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.

Predictors of Substance Use Latent Classes Among American Indian Youth Attending Schools On or Near Reservations

BACKGROUND AND OBJECTIVES

Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group.

METHODS

In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors.

RESULTS

For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related.

DISCUSSION AND CONCLUSIONS

Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12.

SCIENTIFIC SIGNIFICANCE

Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth.

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults. Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews. Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways. Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.

Prescription Stimulants: From Cognitive Enhancement to Misuse

The nonmedical use of prescription stimulants has become increasingly pervasive among transitional age youth (TAY), aged 16 years to 26 years. Although therapeutically administered stimulants are regarded as safe and effective in TAY with attention-deficit/hyperactivity syndrome (ADHD), stimulant misuse is of concern due to prevalence, behavioral health and substance use correlates, and negative short-term and long-term outcomes. Although academic motivations primarily drive misuse, it is unclear whether prescription ADHD stimulants enhance cognition. Providers are advised to exercise precautions when prescribing ADHD medications, enhance surveillance for misuse, and screen those with misuse for ADHD and other psychopathology, executive dysfunction, and substance use disorders.

Examining the association between bullying victimization and prescription drug misuse among adolescents in the United States

BACKGROUND

Although studies have examined the association between bullying victimization and adolescent substance behaviors, there is a dearth of research investigating the association between bullying victimization and prescription drug misuse. The objective of this study was to examine the cross-sectional association between bullying victimization and prescription drug misuse among adolescents.

METHODS

Data for this study came from the 2017 Youth Risk Behavior Survey. A sample of 9974 adolescents aged 14-18 years (50.1% female) were analyzed using binary logistic regression with prescription drug misuse as the outcome variable and bullying victimization as the main explanatory variable.

RESULTS

Of the 9,974 adolescents, 13.1% misused prescription drugs. One in ten adolescents were victims of both school bullying and cyberbullying, 5.1% were victims of only cyberbullying, 9% were victims of only school bullying, and 75.8% experienced neither school bullying nor cyberbullying victimization. In the binary logistic regression model, adolescents who experienced both school bullying and cyberbullying victimization had 1.66 times higher odds of misusing prescription drugs (AOR = 1.66, p < .001, 95% CI = 1.34-2.06) and adolescents who experienced only school bullying victimization had 1.30 times higher odds of misusing prescription drugs (AOR = 1.30, p < .05, 95% CI = 1.02-1.64). Being lesbian, gay, or bisexual; feeling sad or hopeless; cigarette smoking; binge drinking; cannabis use; and illicit drug use were statistically significantly associated with prescription drug misuse.

CONCLUSIONS

Understanding the association between bullying victimization and prescription drug misuse could contribute to early identification of adolescents who may misuse prescription drugs.

Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14-18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents.

The characteristics and patterns of utilization of healthcare services among Omanis with substance use disorders attending therapy for cessation

BACKGROUND

It is indicated that Oman is witnessing an increase in issues pertinent to alcohol and psychoactive substance use.

AIM

The aim of this study was to identify the characteristics of Omanis with substance use disorder attending a specialized hospital in Oman and the pattern of their utilization of healthcare services. A related aim was to ascertain the age group most vulnerable to alcohol and substance use in Oman.

METHOD

A cross-sectional study was conducted in a tertiary care center specialized for treatment of those engaging in substance use in Oman. The participants in the study were selected from a convenience sample among patients seeking consultation at the center for alcohol and substance use. A six-part questionnaire was designed to obtain information regarding socio-demographic background, clinical history, healthcare utilization and perceived hurdles to access. Chi-square analyses were used to evaluate the significance of differences among categorical data. Logistic regression modelling was used to obtain measures of association after adjusting for confounding factors.

RESULTS

Among the patients (n = 293) seeking cessation therapy, 99% were male and less than 30 years of age. Peer influences on the initiation of substance use were significant. Most patients had a history of polysubstance use, including intravenous substance use. Cannabis and alcohol were the first substances consumed by most patients and Hepatitis C and psychiatric disorders were found to be the most common co-morbidities. The participants that reported use of cannabis and benzodiazepines were more likely to perceive "improvement" upon receiving treatment.

CONCLUSION

This study indicated that males below 30 years of age with a history of polysubstance use were likely to attend a hospital specialized in treating substance use disorder in Oman. This study identified information regarding socio-demographic background, risk factors and perceived hurdles to healthcare that could serve as groundwork for further studies conducted on newly emerging issues of substance use in Oman.

Prevalence of nonmedical use and routes of administration for prescription stimulant medications among adults in a substance abuse treatment population

The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV^®) as part of the clinical intake process between January 2013 and March 2016. A cross-sectional observational study examined prevalence and prescription-adjusted prevalence of past 30-day NMU of prescription stimulants and compound-specific use by ROA (oral, snort, smoke, inject, other oral, and alternate ROA). Compounds of interest were amphetamine extended-release (ER), amphetamine immediate-release (IR), amphetamine mixed salts, methylphenidate ER, and methylphenidate IR. Of 198,411 respondents, 4,185 reported prescription stimulant NMU, prevalence ranged from 0.33% for methylphenidate IR to 1.61% for amphetamine mixed salts. Prescription-adjusted prevalence of NMU was highest for methylphenidate IR (0.51%) and lowest for amphetamine ER (0.28%). The most common ROA was oral, swallowed whole followed by snorting. There was a greater probability of nonmedical prescription stimulant use among respondents with higher drug severity ratings. Results suggest that one should not overlook the impact of prescription stimulant NMU in adults in treatment for substance use problems. NMU of prescription stimulants was associated with riskier routes of administration than reported for college student samples. A pattern of high-risk alternate ROA and increasing drug problem severity has important implications of substance use evaluation.

Personality and prescription drug use/misuse among first year undergraduates

Emerging adults (18-25 year olds) endorse the highest rates of prescription drug misuse. Attending college or university may confer additional risk. Previous research suggests that personality is an important predictor of many addictive behaviours. Four traits have been consistently implicated: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Published studies on personality as a predictor of prescription drug abuse are limited, however, by a primary focus on overall prescription drug use, inconsistent operationalisation of misuse, and failure to control for alcohol use. Sample sizes have been small and non-specific. We sought to better understand how personality predicted the overall use, the medically-sanctioned use, and the misuse of prescription sedatives/tranquilizers, opioids, and stimulants. A large (N = 1755) sample of first year Canadian undergraduate students (mean age = 18.6 years; 68.9% female) was used. We predicted that: anxiety sensitivity would be related to sedatives/tranquilizers, hopelessness to opioids, sensation seeking to stimulants, and impulsivity to all three. Save for the impulsivity to opioid use path, predictions were fully supported in our "any use" model. For medically-sanctioned use: anxiety sensitivity predicted sedative/tranquilizers, hopelessness predicted opioids, and impulsivity predicted stimulants. For misuse: anxiety sensitivity (marginally) predicted sedatives/tranquilizers, sensation seeking predicted stimulants, and impulsivity predicted all three. Our models support using personality-matched interventions. Specifically, results suggest targeting anxiety sensitivity for sedative/tranquilizer misuse, sensation seeking for stimulant misuse, and impulsivity for unconstrained prescription drug misuse. Interventions with early coping skills that pertain to all four traits might be useful for preventing prescription drug uptake and later misuse.

Leveraging user perspectives for insight into cannabis concentrates

BACKGROUND

The US has seen an increase in the popularity of highly concentrated forms of cannabis (hereafter concentrates) and too little is known about the potential risks associated with their use.

OBJECTIVES

The present study aims to better understand the patterns and outcomes of concentrates use through the perspectives of young adult users.

METHODS

Participants (N = 234, 27.9% female) aged 18-35 years were recruited using SurveyMonkey Audience® and had ingested concentrates at least once in the past 6 months. They were queried on concentrates use patterns (e.g., frequency, medical/recreational) and the effects experienced after using concentrates (e.g., physiological/psychological, strength/duration).

RESULTS

A total of 27.8% of participants reported frequent use of concentrates (≥10 days in past month). Those who used for medical purposes or lived in states where use is legal were more likely to use concentrates frequently. While most (64.2%) did not report experiencing potentially serious side effects, some reported a sense of altered reality/confusion (23.3%), rapid heartbeat (11.2%), lung pain (9.9%) and severe paranoia (6.9%). Among those who used concentrates in the past month (N = 168), 72.6% used concentrates with other cannabis forms, 57.7% used along with alcohol, and 22.6% used with other drugs.

CONCLUSION

Continued research on concentrates use in the US is needed. Research-informed policies that foster safe and responsible use of concentrates are necessary to protect users, especially those who use concentrates frequently, from potential negative side effects.

High-intensity drinking and nonmedical use of prescription drugs: Results from a national survey of 12th grade students

BACKGROUND

Nearly 10% of U.S. 12th graders report high-intensity drinking (10+ or 15+ drinks in a row), but the extent to which these drinkers also engage in nonmedical use of prescription drugs (NMUPD) is largely unknown. This study examined the associations between different thresholds of past two-week high-intensity drinking and past-month NMUPD among U.S. 12th graders.

METHODS

The sample consisted of eleven nationally representative cross-sections of 12th graders in the Monitoring the Future study (2005-2015) who answered questions on past two-week drinking behaviors and past-month nonmedical use of prescription opioids, sedative, stimulants, and tranquilizers (N=26,502 respondents).

RESULTS

High-intensity drinking during the past two-weeks was associated with an increased risk of past-month NMUPD. The odds of NMUPD were four times larger among 12th graders who indicated drinking 15 or more drinks on at least one occasion (AOR=4.43, 95% CI=3.18, 5.01) relative to those who had 0-4 drinks during the past two-weeks, after adjusting for relevant covariates. These associations were similar across different classes of prescription drugs and tended to be stronger among non-white respondents. A sub-analysis revealed simultaneous co-ingestion of alcohol and NMUPD was more prevalent among high-intensity drinkers.

CONCLUSIONS

More than 1 in every 4 U.S 12th graders who engage in high-intensity drinking (15+ drinks in a row) also report NMUPD. Given the greater likelihood of simultaneous co-ingestion of alcohol and prescription drugs among high-intensity drinkers, adolescent substance use interventions need to address the risks associated with mixing alcohol and prescription drugs.

Multiple DSM-5 substance use disorders: A national study of US adults

OBJECTIVE

Our aim is to determine the lifetime and past-year prevalence estimates of multiple Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) substance use disorders (SUDs) among U.S. adults.

METHODS

The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions featured in-person interviews with a nationally representative sample of adults aged 18 and older.

RESULTS

The majority of past-year nonalcohol DSM-5 SUDs had at least 1 other co-occurring past-year SUD, ranging from 56.8% (SE = 3.4) for past-year prescription opioid use disorder to 97.5% (SE = 2.7) for past-year hallucinogen use disorder. In contrast, only 15.0% (SE = 0.6) of past-year alcohol use disorders had a co-occurring past-year SUD. The odds of past-year multiple SUDs were greater among males, younger adults, African-Americans, and those with mood, personality, posttraumatic stress, or multiple psychiatric disorders.

CONCLUSIONS

Assessment, diagnosis, and treatment often focus on individual substance-specific SUDs rather than multiple SUDs, despite evidence for substantial rates of polysubstance use in clinical and epidemiological studies. There are notable differences in the prevalence of multiple SUDs between alcohol use disorders and other nonalcohol SUDs that have important clinical implications; for example, multiple SUDs are more persistent than individual SUDs. These findings suggest that clinical assessment and diagnosis should screen for multiple SUDs, especially among adults with nonalcohol DSM-5 SUDs.

Adolescents' Prescription Stimulant Use and Adult Functional Outcomes: A National Prospective Study

OBJECTIVE

To assess the prospective 17-year relationship between the medical and nonmedical use of prescription stimulants during adolescence (age 18 years) and educational attainment and substance use disorder (SUD) symptoms in adulthood (age 35 years).

METHOD

A survey was self-administered by nationally representative probability samples of US high school seniors from the Monitoring the Future study; 8,362 of these individuals were followed longitudinally from adolescence (age 18, high school senior years 1976-1996) to adulthood (age 35, 1993-2013).

RESULTS

An estimated 8.1% reported medical use of prescription stimulants, and 16.7% reported nonmedical use of prescription stimulants by age 18 years. Approximately 43% of adolescent medical users of prescription stimulants had also engaged in nonmedical use of prescription stimulants during adolescence. Among past-year adolescent nonmedical users of prescription stimulants, 97.3% had used at least one other substance during the past year. Medical users of prescription stimulants without any history of nonmedical use during adolescence did not differ significantly from population controls (i.e., non-attention-deficit/hyperactivity disorder [ADHD] and non-stimulant-medicated ADHD during adolescence) in educational attainment and SUD symptoms in adulthood. In contrast, adolescent nonmedical users of prescription stimulants (with or without medical use) had lower educational attainment and more SUD symptoms in adulthood, compared to population controls and medical users of prescription stimulants without nonmedical use during adolescence.

CONCLUSION

Nonmedical use of prescription stimulants is common among adolescents prescribed these medications. The findings indicate youth should be carefully monitored for nonmedical use because this behavior is associated with lower educational attainment and more SUD symptoms in adulthood.

Adolescents' future orientation and nonmedical use of prescription drugs

INTRODUCTION

How adolescents think about their future (i.e., future orientation) impacts their risk-taking behavior. The purpose of the present analysis was to explore whether future orientation (future planning, perceived risk to future goals, and positive future expectations) was associated with nonmedical use of stimulants and analgesics in a sample of high school students.

METHODS

Information on future orientation and nonmedical use of prescription drugs (NMUPD) were collected using a paper-and-pencil survey from a sample of 9th-12th grade students in a Midwestern school.

RESULTS

Higher perceived risk to future goals and positive future expectations were associated with a lower likelihood of self-reported nonmedical use of stimulants (n=250; OR=0.46, 95% CI: 0.26, 0.83; OR=0.15, 95% CI: 0.05, 0.47, respectively). Only higher perceived risk to future goals was associated with a lower likelihood of self-reported nonmedical use of analgesics (n=250; OR=0.40, 95% CI: 0.24, 0.68). In a follow-up analysis limited to students who endorsed alcohol or marijuana use, perceived risk to future goals remained associated with a lower likelihood of nonmedical use of stimulants and analgesics.

CONCLUSIONS

Results suggest that risk perception might be a salient protective factor against both nonmedical use of stimulants and analgesics. Overall, the differential impact of conceptualizations of future orientation might depend on the class of prescription drug used, demonstrating a need to consider prescription drugs individually in the development of future studies and interventions.

Developmental course of non-medical use of prescription drugs from adolescence to adulthood in the United States: national longitudinal data

AIMS

To identify the developmental course of non-medical use of four separate prescription drug classes (opioids, sedatives, stimulants and tranquilizers) by examining the general functional growth and related covariates during the transition from adolescence to adulthood in the United States.

DESIGN

Nationally representative probability samples of high school seniors were followed longitudinally across five waves (waves 1, 2, 3, 4 and 5: modal ages 18, 19/20, 21/22, 23/24 and 25/26 years, respectively).

SETTING

Data were collected via self-administered questionnaires to high school seniors and young adults in the United States.

PARTICIPANTS

The sample consisted of nearly 72 000 individuals in 30 cohorts (high school senior years of 1977-2006) who participated in at least one wave.

MEASUREMENTS

Self-reports of annual non-medical use of prescription opioids, sedatives, stimulants, and tranquilizers.

FINDINGS

The annual non-medical use of prescription opioids, sedatives, stimulants and tranquilizers was highest at wave 1 over the five waves. There was a consistent descending path (linear and quadratic slopes, P < 0.001) in annual non-medical use from baseline across all four prescription drug classes (e.g. opioids linear slope = -0.043 and opioids quadratic slope = 0.034, P < 0.001). While the annual non-medical use of stimulants declined over time (linear slope = 0.063, P < 0.01; quadratic slope = -0.133, P < 0.001), the same decrease was not observed for the annual non-medical use of prescription opioids, sedatives or tranquilizers when controlling for socio-demographic and substance use behaviors at baseline. The covariates associated with the general functional growth differed across the four prescription drug classes.

CONCLUSIONS

The non-medical use of prescription opioids, sedatives, stimulants and tranquilizers appears to peak during late adolescence, suggesting preventive intervention efforts should be initiated in early adolescence. The developmental course of non-medical use is not the same among all four classes of prescription drugs, suggesting that each drug class warrants individual research.

Nonmedical Use of Prescription Drugs and Sexual Risk Behaviors

BACKGROUND

Substance use is associated with sexual risk behaviors among youth, but little is known about whether nonmedical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors.

METHODS

Data from the 2011 and 2013 national Youth Risk Behavior Surveys, cross-sectional surveys conducted among nationally representative samples of students in grades 9 to 12 were combined (n = 29,008) to examine the association between ever taking prescription drugs without a doctor's prescription and sexual risk behaviors (ever having sexual intercourse, current sexual activity, lifetime number of sexual partners, condom use, and alcohol or drug use before last sexual intercourse). Using logistic regression models (adjusted for sex, race/ethnicity, grade, ever injection drug use, and use of alcohol, marijuana, heroin, cocaine, methamphetamines, ecstasy, and inhalants), we estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).

RESULTS

Nonmedical use of prescription drugs (NMUPD) was associated with ever having sexual intercourse (aPR 1.16 [95% CI 1.11-1.22]), being currently sexually active (1.26 [1.20-1.33]), having ≥ 4 lifetime sexual partners (1.45 [1.34-1.57]), drinking alcohol or using drugs before last sexual intercourse (1.32 [1.17-1.48]), and not using a condom at last sexual intercourse (1.14 [1.05-1.23]). As the frequency of NMUPD increased, the association between NMUPD and each of the sexual risk behaviors increased in strength, suggesting a dose-response relationship.

CONCLUSIONS

NMUPD is associated with sexual behaviors that put high school students at risk for sexually transmitted infections. These findings can be used to inform clinical and school-based interventions developed to reduce drug use and sexually transmitted infections.

Posttraumatic Stress Symptoms and Nonmedical Prescription Drug Use Among College Students With Trauma Exposure

OBJECTIVE

Nonmedical prescription drug use, defined as using the drug without a prescription or in ways for which it is not prescribed, and traumatic event exposure are highly prevalent among college students. Despite evidence that posttraumatic stress symptoms could place college students at risk for nonmedical prescription drug problems, no studies have examined this relationship. This study was a preliminary examination of posttraumatic stress symptoms, lifetime nonmedical prescription drug use, hazardous use, and dependence symptoms among college students with trauma exposure.

METHODS

Participants were students attending a rural college in Virginia, recruited through psychology classes, flyers, LISTSERVs, and announcements at student events. All students who reported experiencing at least one traumatic event were included (N = 119); participants' mean age was 19.7 years (SD = 1.90), about half were women (n = 63, 53%), and most were Caucasian (n = 103, 87%).

RESULTS

Nearly 60% of participants (n = 71) reported using nonmedical prescription drugs at least once during their lifetime and were more likely than those with no use to report hazardous alcohol use (p < .01) and depressive symptoms (p < .05). There were no other significant differences between those who did and did not report use of nonmedical prescription drugs. Regression analyses showed that posttraumatic stress symptom frequency was positively associated with hazardous nonmedical prescription drug use, after controlling for gender, depressive symptoms, and hazardous alcohol use (p < .001). Posttraumatic stress symptom frequency was higher for those with any nonmedical prescription drug dependence symptoms (p < .001), but was unrelated to whether the student had ever engaged in nonmedical prescription drug use.

CONCLUSIONS

Findings suggest that consideration of the types of behaviors and problems a college student is experiencing related to nonmedical prescription drug use may be more relevant to posttraumatic stress symptom frequency than dichotomous measures of nonmedical prescription drug use alone. Further, the association between the frequency of posttraumatic stress symptoms and both hazardous nonmedical prescription drug use and dependence symptoms among college students with a trauma history deserves further investigation due to the resulting vulnerability to increasingly negative outcomes.

A Preliminary Investigation of Individual Differences in Subjective Responses to D-Amphetamine, Alcohol, and Delta-9-Tetrahydrocannabinol Using a Within-Subjects Randomized Trial

Polydrug use is common, and might occur because certain individuals experience positive effects from several different drugs during early stages of use. This study examined individual differences in subjective responses to single oral doses of d-amphetamine, alcohol, and delta-9-tetrahydrocannabinol (THC) in healthy social drinkers. Each of these drugs produces feelings of well-being in at least some individuals, and we hypothesized that subjective responses to these drugs would be positively correlated. We also examined participants’ drug responses in relation to personality traits associated with drug use. In this initial, exploratory study, 24 healthy, light drug users (12 male, 12 female), aged 21–31 years, participated in a fully within-subject, randomized, counterbalanced design with six 5.5-hour sessions in which they received d-amphetamine (20mg), alcohol (0.8 g/kg), or THC (7.5 mg), each paired with a placebo session. Participants rated the drugs’ effects on both global measures (e.g. feeling a drug effect at all) and drug-specific measures. In general, participants’ responses to the three drugs were unrelated. Unexpectedly, “wanting more” alcohol was inversely correlated with “wanting more” THC. Additionally, in women, but not in men, “disliking” alcohol was negatively correlated with “disliking” THC. Positive alcohol and amphetamine responses were related, but only in individuals who experienced a stimulant effect of alcohol. Finally, high trait constraint (or lack of impulsivity) was associated with lower reports of liking alcohol. No personality traits predicted responses across multiple drug types. Generally, these findings do not support the idea that certain individuals experience greater positive effects across multiple drug classes, but instead provide some evidence for a “drug of choice” model, in which individuals respond positively to certain classes of drugs that share similar subjective effects, and dislike other types of drugs.