Motivational subtypes of nonmedical use of prescription medications: results from a national study

Initial validation of the expectancies for Benzodiazepine Analgesia Scale

Chronic pain populations exhibit greater prevalence of benzodiazepine (BZD) prescription (vs. the general population) and greater likelihood of BZD use not as prescribed and dependence symptoms. Individuals report taking BZDs for pain relief, potentially contributing to maintenance/escalation of BZD use and hazardous couse with prescription opioids. Identifying cognitive factors underlying pain-BZD use relations represents a critical step toward understanding the role of pain in BZD use trajectories. Outcome expectancies for substance-related analgesia have been implicated in pain-substance use comorbidity (e.g., alcohol), and there is reason to believe these processes may extend to BZD use. The present study aimed to examine psychometric properties of a newly adapted Expectancies for Benzodiazepine Analgesia (EBA) scale and probe associations between EBA scores and prescription opioid use behaviors. Participants were 306 adults (38.9% females) endorsing chronic pain and current BZD prescription who completed an online survey. Results provided initial support for psychometric validity of the EBA: evidence of single-factor structure with good model fit (Bollen-Stine bootstrap p = .101), excellent internal consistency (α = .93), and evidence of concurrent validity via correlations with pain variables, likelihood of BZD use not as prescribed, BZD dependence symptoms, and self-reported BZD use for pain relief. Exploratory findings among participants prescribed opioids indicated positive covariation between EBA scores and behaviors associated with higher risk opioid use. This is, to our knowledge, the first study to assess analgesia expectancies for BZD use. BZD analgesic expectancies warrant further study as a treatment target in comorbid pain and BZD use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Motivations for Misusing Opioids Among African Americans

BACKGROUND

A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations.

METHODS

This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida.

RESULTS

Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia).

CONCLUSIONS

This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.

Benzodiazepine Use and Dependence in Relation to Chronic Pain Intensity and Pain Catastrophizing

Benzodiazepines (BZDs), a class of sedative-hypnotic medications, generated concern as their popularity grew, with particular alarm regarding elevated rates of BZD use among chronic pain populations. Consistent with negative reinforcement/motivational models of substance use, desire for pain alleviation may motivate BZD use. Yet, little is known about relations between pain and addiction-relevant BZD use processes. This cross-sectional survey study aimed to: a) test associations between pain intensity and clinically relevant BZD use patterns, and b) examine the role of pain catastrophizing in hypothesized pain-BZD relations. Participants included 306 adults with chronic musculoskeletal pain and a current BZD prescription who completed an online survey study (Mage = 38.7, 38.9% female). Results indicated that pain intensity was positively associated with past-month BZD use frequency, BZD dependence severity, and likelihood of endorsing BZD misuse behaviors (ps < .05). Pain catastrophizing was positively associated with BZD dependence/likelihood of BZD misuse, covarying for pain intensity (P < .05). These findings build upon an emerging literature by highlighting positive covariation of pain intensity and pain catastrophizing with addiction-relevant BZD use behaviors. Results underscore the need to further investigate high-risk BZD use among individuals with chronic pain, with and without concurrent opioid use, to inform prevention/intervention efforts. PERSPECTIVE: This article presents findings on cross-sectional associations of pain intensity and pain catastrophizing with clinically relevant benzodiazepine (BZD) use outcomes, including dependence and misuse, among individuals with chronic pain. Findings help elucidate the higher burden of BZD misuse/dependence in chronic pain populations and suggest that pain relief may be a common, yet under recognized, self-reported motivation for taking BZDs.

Tramadol misuse in treatment-seeking adolescents and young adults with problematic substance use - Prediction of treatment retention

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Misuse of tramadol is increasingly highlighted as a problem in adolescents and adults.

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In treatment for substance use in the young, tramadol use increased the risk of treatment drop-out.

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Tramadol misuse, hitherto little examined, requires further clinical research.

Non-medical prescription use of opioids (NMPUO) is a public health concern worldwide. Recently, tramadol misuse is increasing, but the systematic research of misuse of this specific opioid is limited. This study set out to assess the relationship between tramadol use and completion of treatment for substance use among adolescents and adults ≤ 25 years in an outpatient clinical setting. A retrospective cohort study of treatment outcome, expressed as “completion” or “non-completion” of treatment, was conducted in treatment-seeking adolescents with problematic substance use (n = 335). Data was extracted from Ung-DOK interviews, a semi-structured assessment instrument designed for adolescents with substance abuse. The study included all treatment-seeking patients at an out-patient facility in 2014–2017. A total of 26% (n = 88) were tramadol users (life-time prevalence). Twenty percent (n = 66) of all treatments were non-completed. Tramadol users were significantly more likely than non-users to drop out of treatment (35% vs 15%, p < 0.001). In multivariate logistic regression, tramadol use and age 18 and above were factors significantly associated with non-completion. Tramadol use was statistically significantly associated with non-completion of treatment. Further research addressing treatment needs and treatment completion among tramadol users is needed.

Information provision and retrieval by registered salespersons from consumers during over-the-counter drug sales - a questionnaire survey

Background

In Japan, non-pharmacists who are accredited as registered salespersons can sell over-the-counter (OTC) drugs, and they play a very important role in supporting proper OTC drug use by consumers. The purpose of this study was to evaluate information provided to and information collected from consumers, and cooperation with pharmacists during OTC drug sales by registered salespersons, and to clarify their related concerns and behaviors.

Methods

A cross-sectional questionnaire-based survey of 385 registered salespersons working at 56 drugstores throughout Japan was conducted. Based on the questionnaire survey, the frequency of information provision/collection in various categories was determined for the registered salespersons. The relation between concerns of registered salespersons relating to OTC drug sales and the frequency of information provision/collection was examined. The frequency of consultation of registered salespersons with a pharmacist was calculated for registered salespersons with/without in-store pharmacists. The χ-square test or Fisher’s exact test was performed to assess the significance of differences.

Results

Two hundred and seven registered salespersons (53.7%) responded completely. A greater number of OTC drug purchasers per day was associated with a greater frequency of information provision about “side effects” and information collection about “favorite items” (alcohol, tobacco, health foods, etc.) (p < 0.05). One hundred and thirty-nine (67.2%) participants had concerns about “interactions between OTC drugs and prescription drugs”, and these concerns were related to the frequency of information provision/collection (p < 0.05). Regarding the frequency of consultation with a pharmacist, 35 of 46 participants (76.1%) working with pharmacists answered “always” or “usually”, whereas only 19 of 161 participants (11.8%) working without full-time pharmacists answered “always” or “usually”. More than half of the registered salespersons thought that cooperation with a pharmacist was necessary when they were “asked about concomitant use with prescription drugs” or “told that side effects happened.”

Conclusions

The results of this study show that experienced registered salespersons selling OTC drugs are more likely to collect information from consumers and to provide information to consumers. It appears to be important for registered salespersons to cooperate with pharmacists in order to provide and collect appropriate information about concomitant medications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07343-x.

Prescription Tranquilizer/Sedative Misuse Motives Across the US Population

OBJECTIVES

Roughly 6.5 million US residents engaged in prescription tranquilizer/sedative (eg, benzodiazepines, Z-drugs) misuse in 2018, but tranquilizer/sedative misuse motives are understudied, with a need for nationally representative data and examinations of motives by age group. Our aims were to establish tranquilizer/sedative misuse motives and correlates of motives by age cohort, and whether motive-age cohort interactions existed by correlate.

METHODS

Data were from the 2015 to 2018 US National Survey on Drug Use and Health, with 223,520 total respondents (51.5% female); 6580 noted past-year prescription tranquilizer/sedative misuse motives (2.4% overall, 50.3% female). Correlates included substance use (eg, opioid misuse), mental (eg, suicidal ideation) and physical health variables (e.g., inpatient hospitalization). Design-based, weighted cross-tabulations and logistic regression analyses were used, including analyses of age cohort-motive interactions for each correlate.

RESULTS

Prescription tranquilizer/sedative misuse motives varied by age group, with the highest rates of self-treatment only motives (ie, sleep and/or relax) in those 65 and older (82.7%), and the highest rates of any recreational motives in adolescents (12-17 years; 67.5%). Any tranquilizer/sedative misuse was associated with elevated odds of substance use, mental health, and physical health correlates, but recreational misuse was associated with the highest odds. Age-based interactions suggested stronger relationships between tranquilizer/sedative misuse and mental health in adults 50 and older.

CONCLUSIONS

Any tranquilizer/sedative misuse signals a need for substance use and mental health screening, with intervention needs most acute in those with any recreational motives. Older adult tranquilizer/sedative misuse may be more driven by undertreated insomnia and anxiety/psychopathology than in younger groups.

Nonmedical use of prescription drugs: A comparison between intoxication-oriented and other nonmedical users

Aims:

Nonmedical use of prescription drugs (NMUPD) is a major public health concern. The aim of the study was to compare intoxication-oriented users to those who utilised prescription drugs nonmedically for other purposes. The characteristics of the study groups, prescription drugs used, motivations for their use and sources of prescription drugs were also examined.

Methods:

Data were derived from the population-based Drug Survey 2014 which was conducted in Finland. The respondents were divided into intoxication-oriented users (n = 118) and other nonmedical users (n = 74) according to the motivation behind their NMUPD. The reference population (n = 3277) did not report any NMUPD. Pearson’s chi square test was used to compare the distributions. A multinomial logistic regression model was used to estimate the association of sociodemographic background and intoxicant use with NMUPD.

Results:

Low education level and illegal drug use were associated with intoxication-oriented and other nonmedical use of prescription drugs. Intoxication-oriented use was associated also with younger age and current smoking. Sedatives were the most commonly used prescription drugs among intoxication-oriented users, and opioids among other nonmedical users. Experimentation and facilitating social interactions as a motivation for use were emphasised among intoxication-oriented users. Friends and relatives were the most common sources of prescription drugs for nonmedical use, especially among intoxication-oriented users.

Conclusion:

The characteristics, motivations and sources of nonmedically used prescription drugs differed in intoxication-oriented and other nonmedical users. These findings may help to identify those at risk for NMUPD. More attention should be paid to the motivations of NMUPD when new prevention and intervention methods are developed.

Prescription Opioid Misuse Motives in US Older Adults

OBJECTIVES

To evaluate age-based differences in prescription opioid misuse (POM) motives and to evaluate substance use and mental and physical health correlates of POM motive categories in older adults.

DESIGN

Data were from the National Survey on Drug Use and Health (NSDUH), a nationally representative US survey.

SETTING

The NSDUH is a household survey.

SUBJECTS

A total of 5,826 US residents with past-year POM; 415 were 50 years and older (7.1%).

METHODS

Nine POM motives were assessed among those engaged in past-year POM, grouped into three categories: solely physical pain relief, solely non-pain relief, or mixed motives. Prevalence of POM motives were calculated by age group, with logistic models examining age-based differences. Finally, odds of substance use and mental and physical health correlates by motive category were calculated via logistic models in older adults.

RESULTS

POM motivated solely by physical pain relief increased from 35.1% in young adults to 65.4% in older adults; in older adults, 84.7% of POM episodes involved pain relief as a motive. POM for solely non-pain relief or mixed motives was associated with greater odds, vs pain relief only, of past-year benzodiazepine misuse (odds ratio [OR] = 4.43 and 6.15, respectively), any substance use disorder (OR = 5.57 and 5.60, respectively), and suicidal ideation (OR = 4.05 and 3.56, respectively) in older adults.

CONCLUSIONS

. POM motives change over the lifespan, with increasing POM for pain relief with aging. Comprehensive nonopioid pain management is needed for those engaged in POM for pain relief, and substance use and mental health treatment are needed for those with non-pain relief motives.

A Latent Transition Analysis of Self-Reported Reasons for Marijuana Use During Young Adulthood

Individuals' reasons for marijuana use have been linked to their risk for continued use and development of disordered use. Although individuals tend to have multiple reasons for use, co-occurrence of reasons is not always accounted for in analytic approaches. Latent transition analysis (LTA) is ideal for modeling transitions in co-occurring reasons. Using longitudinal panel data from Monitoring the Future, LTA was used to identify profiles of self-reported reasons for marijuana use among young adults, examine transitions between profiles, and determine whether cohort, gender, race/ethnicity, parent education, grade of first marijuana use, and 4-year college attendance predicted transitions between profiles. Data included senior year cohorts from 1976-2009 and were collected at ages 19/20, 21/22, and 23/24 (weighted n = 7,294; 55.9% female; 79.3% White). Five latent classes were identified: Non-Users and individuals with Experimental, Typical, Get High + Relax, and Escape + Coping Reasons. Transitions among Non-Users, Experimental Reasons, and Typical Reasons were common; generally, those with earlier cohort membership, early initiation, college non-attending parents, and college attendance were more likely to make transitions to higher-risk classes. As the legalization of recreational marijuana use continues to expand, change over time in reasons for use should be considered carefully as interventions are developed and implemented.

Sexual Identity and Motivations for Prescription Drug Misuse Among U.S. Adults

Purpose: Although we know that sexual minority populations, particularly bisexual individuals, tend to be at increased risk for substance use, less research has focused on prescription drug misuse (PDM). The current study is the first to assess differences in motivations for PDM by sexual identity and sex. This is important as research has established a link between certain motivations and adverse outcomes. Methods: This study used data from multiple years of the National Survey on Drug Use and Health (2015-2018). Respondents who reported past-year PDM were asked follow-up questions to identify motivations for PDM. We ran several weighted cross-tabulations to estimate the prevalence and 95% confidence intervals for motivations for PDM by sexual identity (i.e., heterosexual, lesbian or gay, and bisexual) for males and females separately. When chi-square tests were significant, post hoc comparisons using design-based multivariable regressions were conducted. Results: Prevalence rates for both PDM and substance use disorder associated with prescription drugs were higher among sexual minority adults than heterosexual adults. With regard to motives, bisexual females were more likely to endorse recreational motives (i.e., to get high) for prescription opioids, tranquilizers, and stimulants than heterosexual females. Gay males were more likely to endorse self-treatment motives (e.g., to relax, to lose weight) than both bisexual and heterosexual males. Conclusion: High prevalence rates and endorsement of recreational motives identify bisexual females as an important at-risk population. It is important for clinicians to consider how prevention, treatment, and intervention strategies focused on PDM may be improved to best target this unique population.

Development and Validation of a Prediction Model of Prescription Tranquilizer Misuse Based on a Nationally Representative United States Sample

BACKGROUND

Prescription tranquilizer misuse is a risky behavior associated with fatal drug poisonings. Although various predictors have been examined, there is no published prediction model for tranquilizer misuse. This study develops and internally validates a tranquilizer misuse prediction model based primarily on drug histories of participants in a national cross-sectional survey. Predictors also include psychiatric, behavioral and demographic variables.

METHODS

We analyzed data from 471,097 individuals aged 14-to-29-years in the United States, as sampled by the National Survey of Drug Use and Health, 2004-2018, an annual cross-sectional survey. We encoded 21 predictors with known or likely onset prior to tranquilizer misuse initiation, (e.g., early onset of cannabis use). With this dataset, we trained a neural network and regularized logistic regression model. While the assessment for tranquilizer misuse changed slightly in 2015, by pooling all years of survey data, predictions are robust to this source of variation.

RESULTS

1.44% of the pooled sample, 2004-2018, recently initiated tranquilizer misuse (unweighted estimate). On held-out test data (n = 43,714), logistic regression and the neural network performed equally well, with an area under the receiver operating characteristic curve (AUC) of ∼0.83 on the primary model, containing 12 variables known to occur before tranquilizer misuse.

CONCLUSION

Built for case prediction rather than case detection, this model restricted predictors to those with known timing prior to initiation of tranquilizer misuse. Yet its performance supersedes commonly accepted criteria for clinical prediction models (AUC > 0.80). Future work should incorporate survey analysis weights into the prediction model to minimize possible bias.

Sex differences in benzodiazepine misuse among adults with substance use disorders

Women are more likely than men to be diagnosed with anxiety disorders and to be prescribed benzodiazepines. People with substance use disorders are at a heightened risk for the misuse of benzodiazepines, yet little is known about sex differences in the prevalence, correlates or patterns of benzodiazepine misuse in this population. The aim of this study was to characterize sex differences in benzodiazepine misuse in a sample of adults receiving substance use disorder treatment (N = 352). Almost half of the sample had been prescribed a benzodiazepine and more than 40% had misused a benzodiazepine. Women were more likely to have a lifetime prescription than men, but were not more likely to report misuse or regular misuse. Consistent with data for other substances, women were more likely to report misusing benzodiazepines to cope and reported greater anxiety sensitivity. The vast majority (97%) of participants reported co-use of benzodiazepines with other substances and 65% of women reporting misusing benzodiazepines via a non-oral route of administration (e.g., intranasal). Although benzodiazepine misuse prevalence was not substantively different between men and women, several sex differences in clinical characteristics and patterns of use were identified. Further research on the nature of sex differences in benzodiazepine misuse is needed to inform targeted treatment for both men and women with substance use disorders.

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion

IMPORTANCE

Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.

OBJECTIVE

To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.

EVIDENCE REVIEW

Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.

FINDINGS

Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.

CONCLUSIONS AND RELEVANCE

These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

Differences in Prescription Stimulant Misuse Motives Across Adolescents and Young Adults in the United States

OBJECTIVE

While prescription stimulant misuse (PSM) is common in adolescents and young adults (AYAs), PSM motives are poorly understood. This study examined a number of PSM motives across the AYA age spectrum using the 2015-2018 National Survey on Drug Use and Health.

METHODS

In all, 86,918 AYAs (aged 14-25 years) were included. Individual PSM motives (eg, to study) and motive categories (ie, cognitive enhancement only, recreational only, weight loss only, and combined motives) were examined by age. Logistic regression models examined links between individual motives or motive categories and educational status, substance use, DSM-IV substance use disorders (SUD), and mental health correlates.

RESULTS

Significant differences were found across AYAs in cognitive enhancement only (14 years = 40.4%; 24 and 25 years = 71.2%; P < .0001) and recreational only (14 years = 25.8%; 24 and 25 years = 9.8%; P < .0001) or combined PSM motives, (14 years = 32.3%; 24 and 25 years = 18.0%; P = .008); college students and graduates had particularly high rates of cognitive enhancement only (college = 78.2%; graduates = 74.7%; non-college = 63.5%). Recreational-only and combined motives were significantly elevated in AYAs with any past-year SUD, especially to get high (78%-136% higher in those with SUD; P ≤ .001). While any PSM was associated with higher odds of SUD and mental health outcomes, including suicidal ideation, odds were highest for recreational or combined motives.

CONCLUSIONS

Cognitive enhancement with PSM occurs more often in young adults compared to adolescents, college students endorse more cognitive enhancement than those not in school, and the presence of any PSM in AYAs is linked to more substance use, suicidal ideation, and other psychopathology. PSM prevention in adolescents as well as screening and intervention among AYA is highly recommended.

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.

Contextual risk among adolescents receiving opioid prescriptions for acute pain in pediatric ambulatory care settings

Many adults with opioid use disorder (OUD) report that their first exposure to opioids was in the course of routine pain treatment in medical care settings. Adolescents receive opioid prescriptions with frequency, but are susceptible to a constellation of unique risks in the context of pain management. This empirical study presents the first cohort of adolescents recruited from ambulatory medical care within 72 h of their receipt of opioids to treat acute pain. The primary aim was to capture a time-sensitive report of the intersection of prescription opioid receipt and contextual risks for opioid misuse related to pain experience, mental health symptoms, and substance use at the adolescent and parental levels. Data were collected from 70 14-19-year-old adolescents and their accompanying parent. Results reflected that 90% of this sample of adolescents reported 2 or more risks and 35% reported 5 or more risks for future opioid misuse. Pain catastrophizing (46%) and alcohol use (40%) and were the most common adolescent-level risk factors; mother history of chronic pain (32%) and parent anxiety (21%) were the most common parent-level risk factors. Past-week parent pain intensity showed the strongest association with adolescent past-week pain intensity; neither was associated with adolescent OUD symptoms. Adolescent pain catastrophizing most reliably predicted OUD symptoms; parent pain interference was also associated. Seventy-one percent of parents reported keeping opioids at home, a relevant risk factor for future misuse. These findings illuminate the intersection between adolescent and parental risks in the context of pediatric opioid prescribing for acute pain management, and provide initial insight into potential points of prevention early in adolescent pain treatment, including avenues by which to inform and enhance prescriber decision-making regarding factors to be weighed in adolescent candidacy for opioid therapy.

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.

Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review

The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.

Prescription opioid misuse motive latent classes: outcomes from a nationally representative US sample

AIMS

Prescription opioid misuse (POM) contributes to a larger opioid crisis in the US and Canada, with over 17 000 US POM-related overdose deaths in 2017. Our aims were to (1) identify specific profiles of respondents based on POM motives using the US National Survey on Drug Use and Health (NSDUH) and (2) compare profile respondents on sociodemographics, substance use and mental and physical health outcomes.

METHODS

Analyses included 2017-18 NSDUH respondents with data on POM motives (n = 4810). POM was defined as prescription opioid use in a way not intended by the prescriber, including use without a prescription, in larger amounts or more frequently. Nine POM motives for the most recent episode were assessed, including 'to relieve physical pain' and 'to get high'. Latent classes, based on POM motives, were estimated. Classes were compared on sociodemographics, substance use and physical and mental health outcomes.

RESULTS

Eight latent classes were identified (in order of prevalence): pain relief only, relax-pain relief, sleep-pain relief, multi-motive, high, experimenter, emotional coping and dependent/hooked. Compared to the pain relief only group, the high and multi-motive classes had higher odds of all substance use outcomes, with the dependent/hooked class having higher odds on all but one outcome. Six of the eight classes had higher odds of past-year mental health treatment and suicidal ideation than the pain relief only class.

CONCLUSIONS

Screening for pain, pain conditions, problematic substance use and psychopathology are recommended in those with any POM. While those in the dependent/hooked, multi-motive and emotional coping classes are most likely to have prescription opioid use disorder (OUD), screening for OUD symptoms in all individuals with POM is also warranted.

The Role of Past and Current Medical Use on Nonmedical Use of Prescription Drugs among College Students: Exploring Same-Drug and Cross-Drug Class Associations

Background: Understanding the role that medical use of prescription drugs plays in nonmedical use of prescription drugs can inform prevention efforts. In order to understand fully the potential risk that medical use of prescription drugs conveys for nonmedical use of prescription drugs, the current study explored (a) the simultaneous associations between the medical use of several classes of prescription drugs with current nonmedical use of the same and other prescription drug classes, and (b) whether the associations depended upon past or current medical use. Methods: Data came from a cross-sectional survey of 1686 college students, which assessed past and current medical use and current nonmedical use of stimulants, sedatives/anxiolytics, and opioid analgesics. Results: Logistic regression analyses revealed that both past and current medical use of sedatives/anxiolytics and opioid analgesics predicted the current nonmedical use of the same drug class, whereas past medical use of stimulants predicted the current nonmedical use of stimulants. In addition, current medical use of stimulants predicted current nonmedical use of sedatives/anxiolytics and past medical use of sedatives/anxiolytics predicted current nonmedical use of opioid analgesics. Conclusions: This study provides a broader examination than past research of simultaneous same-drug class and cross-drug class associations between medical and nonmedical prescription drug use, as well as the role of past and current medical use in these associations. Overall, the results suggest that efforts to prevent nonmedical use of a prescription drug class should move beyond targeting only those who have or who are using the same drug class medically.

The epidemiology of benzodiazepine misuse: A systematic review

BACKGROUND

Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research.

METHODS

PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse.

RESULTS

The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment.

CONCLUSIONS

Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.

Motives for prescription stimulant use by patterns of non-medical use

Background

Understanding motivations behind non-medical use of prescription stimulants (NMUPS) is important to prevent such use.

Methods

Adult participants from St. Louis, MO, who endorsed NMUPS on 5 or more days in the past 12 months (n=60) were asked about their motivations for use. Associations between motives for use and patterns of non-medical use in the past 12 months were assessed using multivariable logistic regression, controlling for demographic factors and non-medical use of other prescription drugs.

Results

On average, 5.5 different motives for stimulant use were endorsed. Compared to those who only used someone else's stimulants, adults who only used stimulants other than prescribed were less likely to endorse use "to get high" (aOR=0.48, 95%CI 0.26-0.90) and more likely to endorse use "to function" (aOR=1.97, 95%CI 1.04-3.75); adults who were engaged in both patterns of NMUPS were more likely to endorse use "to function" (aOR=4.12, 95%CI 1.56-10.88) and "to modify the effects of other drugs" (aOR=2.29, 95%CI 1.13-4.61).

Conclusion

Although using stimulants for performance enhancement is common, most people who used diverted stimulants reported using stimulants to get high. Prevention and harm reduction strategies should consider these differences.

The relationship between past 12-month suicidality and reasons for prescription opioid misuse

BACKGROUND

Understanding reasons for prescription opioid misuse can help elucidate suicide prevention efforts. The goal of the current study is to assess associations of reasons for prescription opioid misuse subtypes and suicide-related variables. We also assessed whether prescription opioid misuse differentiates ideators from those who attempt suicide.

METHODS

Using data from the 2015-2017 National Survey of Drug Use and Health (N = 45,074), prescription opioid misuse subtypes were grouped as follows: (a) Pain only, (b) Other reasons, and (c) Mixed reasons (i.e., pain and at least one other reason). Logistic regressions examined associations of misuse subtypes and past 12-month suicide-related variables (ideation, planning, attempts) relative to non-misusers. Logistic regression analyses were also conducted among the subset reporting ideation to assess whether prescription opioid misuse differentiated ideators with no attempt from ideators with an attempt.

RESULTS

In adjusted models, the Pain only and the Other reasons subtypes were associated with ideation and planning, but not attempts. The Mixed reasons subtype had higher odds of suicide ideation and planning compared to those not misusing prescription opioids and the Pain only misuse subtype. The Mixed reasons subtype had higher odds of a suicide attempt only when compared to those not misusing prescription opioids. Prescription opioid misuse was also associated with suicide attempts among the subset of ideators.

CONCLUSIONS

Findings indicate that people misuse prescription opioids for various reasons, and misuse subtypes are associated with past 12-month suicidality. Addressing pain and other reasons for misuse together through use of evidence-based treatments may help mitigate suicide risk.

Illicit Use of Prescription Stimulants: Gender Differences in Perceptions of Risk

Background: Little research exists on gender differences regarding the relationship between illicit use of prescription stimulants (IUPS) and perceptions of risk of illicit use. Risk perception is a common target for both prevention and intervention programs. Objectives: To measure gender differences in prevalence rates of illicit use and perceptions of legal, health, and social risks of illicit use. Method: Data from undergraduate students at a large, southeastern university (N = 1,714) were examined for gender differences in prevalence of illicit use and related risk perceptions. Results: More men engaged in illicit use than women (26.2% vs. 18.7%). Overall, men perceived lower legal, health, and social risks related to illicit use. Further, illicit users also perceived lower legal, health, and social risks. Nonusing men perceived lower legal and health risks than nonusing women, but similar levels of social risks. Within the subgroup of illicit users, men perceived lower health risks than women, but similar levels of legal and social risk. Conclusions/Importance: There were significant gender differences in IUPS and risk perception, with particular importance of lack of social risk perceived for all groups and lower health risk perception for men who had engaged in IUPS. It is unclear if the lower risk perceptions are present prior to or after illicit use begins and whether risk perceptions affect the development, maintenance, or termination of illicit use behaviors. Future research is needed to clarify these relationships and to evaluate whether increasing risk perceptions is a viable target for prevention or intervention efforts.

Alcohol use disorder and motives for prescription opioid misuse: A latent class analysis

Introduction: Among those who misuse prescription opioids, alcohol use disorder (AUD) is associated with progression to opioid use disorder, risk of overdose, and poor treatment outcomes. However, little is known about co-occurring AUD and prescription opioid misuse. Motives, or reasons, for substance use are important factors in substance use initiation and maintenance; characterizing common motives can help inform treatment targets. The aims of the present study were to (1) identify patterns of motives for prescription opioid misuse, and (2) examine the association between AUD and motives. Methods: Data were extracted from the 2015 National Survey on Drug Use and Health. Analyses included adult respondents with past-year prescription opioid misuse (N = 2,627), of which 24.2% had a co-occurring AUD. Latent class analysis was utilized to identify patterns of motives for prescription opioid misuse. AUD was included as a predictor of class membership. Results: We identified three classes: (1) pain relief (56.1% of the sample), (2) recreational (e.g., to get high; 29.3%), and (3) mixed motives (e.g., coping, pain relief, recreational; 14.6%). AUD was associated with greater odds of membership in the recreational (OR = 2.05, 95% CI = 1.36, 3.10, p = .001) and mixed motives (OR = 2.11, 95% CI = 1.21, 3.67, p = .008) classes, as compared to the pain relief class. Results: Pain relief was the most commonly endorsed motive for opioid misuse among those with and without AUD. These results underscore the need to improve pain management among those who misuse prescription opioids. Those with co-occurring AUD might also benefit from interventions targeting negative affect and/or positive outcome expectancies.

Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex

INTRODUCTION

Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.

METHOD

Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.

RESULTS

BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.

CONCLUSIONS

This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents

Despite being a significant public health concern, the role of opioid prescriptions in potentiating risk of opioid misuse in the context of pediatric pain has been under-investigated. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. A multi-level model of mechanisms through which opioid prescriptions may impact pain and other negative outcomes in youth, including risk for opioid misuse and related problems, is proposed with particular attention paid to the role that psychologists can play in informing policies and developing preventative interventions in healthcare settings.

Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States

OBJECTIVE

The authors sought to simultaneously examine the prevalence and correlates of prescription stimulant use, misuse, use disorders, and motivations for misuse in the U.S. adult population.

METHOD

This was a nationally representative household population study of adults age 18 or older from the 2015 and 2016 National Surveys on Drug Use and Health (N=102,000). Measurements included prescription stimulant use, use without misuse, misuse without use disorders, and misuse with use disorders, as well as sociodemographic characteristics, health conditions, and mental health factors.

RESULTS

Among U.S. adults, 6.6% (annual average) used prescription stimulants overall; 4.5% used without misuse, 1.9% misused without use disorders, and 0.2% had use disorders. Adults with past-year prescription stimulant use disorders did not differ from those with misuse without use disorders in any of the examined sociodemographic characteristics and in many of the examined substance use problems. The most commonly reported motivations for misuse were to help be alert or concentrate (56.3%). The most likely source of misused prescription stimulants was by obtaining them free from friends or relatives (56.9%). More frequent prescription stimulant misuse and use disorder were associated with an increased likelihood of obtaining medications from physicians or from drug dealers or strangers and less likelihood of obtaining them from friends or relatives.

CONCLUSIONS

Approximately 16.0 million U.S. adults used prescription stimulants in the preceding year (annual average), 5.0 million misused prescription stimulants, and 0.4 million had use disorders. Cognitive enhancement was the most commonly reported reason for misusing prescription stimulants. Patients who are using their medication for cognitive enhancement or diverting their medication to others present a high risk.

Nonmedical Use of Prescription Stimulants Among US High School Students to Help Study: Results From a National Survey

OBJECTIVE

Mixed findings exist regarding extent and efficacy of nonmedical use of prescription stimulants (NMUPS) for study enhancement (SE). This national study of US high school seniors examined NMUPS for SE and addressed risk/benefit questions: To what extent are students reporting NMUPS specifically for SE, and do these individuals demonstrate fewer problem behaviors and superior academic performance?

METHOD

Total of 15 098 US students surveyed (2009-2015) and divided into 4 subgroups: (1) no past-year NMUPS (nonusers), (2) past-year NMUPS to help study (NMUPS-SE only), (3) past-year NMUPS for study/nonstudy motives (NMUPS-SE+ other), and (4) past-year NMUPS for nonstudy motives (NMUPS-nonSE only). Student characteristics (eg, grade point average [GPA]) and substance-related problems (eg, binge drinking) compared between subgroups.

RESULTS

Among students who reported past-year NMUPS (n = 781), 7.4% reported NMUPS-SE only, 40.9% NMUPS-SE+ other, and 51.7% NMUPS-nonSE only. Odds of binge drinking, cigarette smoking, marijuana, and opioid nonmedical use significantly higher among all NMUPS subgroups. GPAs significantly lower among subgroups reporting NMUPS nonstudy motives; did not differ between NMUPS-SE only and nonusers.

CONCLUSIONS

7% of US high school seniors engaged in NMUPS for SE only (0.4% total population). Findings indicate greater substance-related problems without superior academic performance among NMUPS-SE subgroups.

Past-year nonmedical use of prescription drugs among women on probation and parole: A cross-sectional study

BACKGROUND

Prescription drug-related overdose deaths have increased dramatically in recent years. Women in the justice system experience high rates of drug use, victimization, trauma symptoms, and other health problems and would appear to be at high risk for nonmedical use of prescription drugs (NMUPD). This study will be among the first to describe prevalence and correlates of NMUPD among this population.

METHODS

This cross-sectional study collected data from 406 victimized women on probation and parole between 2010 and 2012. In a multiple logistic regression model, we differentiated women who reported past-year NMUPD from those who did not using demographic, health, other drug use, substance use treatment, and trauma symptom severity variables.

RESULTS

Past-year NMUPD was reported by 26.8% (n = 109) of the overall sample. Women reporting NMUPD were significantly younger and more likely to be white. Past-year use of alcohol (adjusted odds ratio [AOR]: 3.3; 95% confidence interval [CI]: 1.8-6.1), marijuana (AOR: 3.6; 95% CI: 1.8-7.0), methamphetamines (AOR: 6.1; 95% CI: 1.7-21.3), and heroin (AOR: 8.4; 95% CI: 2.0-35.2) were significantly associated with NMUPD. Additionally, each unit increase in the measure assessing bodily pain was associated with a 40% increase (AOR: 1.4; 95% CI: 1.1-1.7) in the odds of NMUPD. Finally, meeting diagnostic criteria for posttraumatic stress disorder almost doubled (AOR: 1.9; 95% CI: 1.1-3.4) the odds of reporting past-year NMUPD.

CONCLUSIONS

Victimized women on probation and parole report high rates of NMUPD, and this behavior intersects with other complex social, behavioral, psychological, and physical needs. The authors recommend increased access to trauma-informed correctional care among women in the justice system.

Reasons for Vaping Among U.S. 12th Graders

INTRODUCTION

Vaping has recently increased in popularity among adolescents. Little is known about heterogeneity of vapers, particularly in terms of why they vape. Identifying major subgroups of adolescent vapers by reasons for vaping is important to understand adolescent vaping behavior and to identify those most at risk for other substance use.

METHODS

Monitoring Future data from 2015 and 2016 were used in a latent class analysis to identify subgroups of 12th graders based on their endorsement of 10 potential reasons for vaping. Multinomial regression with a latent class outcome was used to predict class membership.

RESULTS

Three distinct classes of vapers were identified: adolescents who were (1) Vaping to Experiment (29.4%), (2) Vaping to Replace Cigarettes (7.3%), and (3) Vaping for Taste + Entertainment (63.4%). Vaping only flavors was associated with lower odds of membership and cigarette use was associated with higher odds of membership in the Vaping to Replace Cigarettes subgroup, and marijuana was associated with lower odds of membership in the Vaping to Experiment subgroup, compared with the Vaping for Taste + Entertainment subgroup.

CONCLUSIONS

This study identified multiple subgroups of vapers based on reasons for vaping. Whereas a small subgroup vaped for reasons related to cigarette use, most adolescent vapers reported vaping for reasons unrelated to cigarette use. There were considerable differences in primary reasons for vaping and risk for traditional cigarette and other substance use, suggesting different intervention strategies may be needed for different subgroups of vapers.

Nonmedical Use of Prescription Medications Among Medical Students in Greece: Prevalence of and Motivation for Use

BACKGROUND

Non-medical use of prescription medications has risen to unprecedented levels over the past decade worldwide; however, studies assessing misuse across medical students are sparse.

OBJECTIVES

The purpose of this study was to1) estimate the lifetime and the past-year prevalence of non-medical use of prescription medications among medical students in Greece 2) identify the motivation for use.

METHODS

591 medical students completed an anonymous, self-administered, web-based survey assessing lifetime and past-year prevalence of non-medical use of four classes of prescription drugs (opioid painkillers, tranquillizers, sleeping and stimulant medications). According to the motivation to use the responders were classified into three subtypes (selftreatment, recreational, and mixed).

RESULTS

The prevalence of lifetime use was 10.7% for at least one of the four prescription drug classes and 9% of the respondents reported lifetime misuse of multiple categories of prescription drugs. The past-year prevalence was approximately 7.7% for at least one of the four prescription drug classes, while the majority misused the drugs "1-2 times per year". Senior students used tranquilizers more than junior students. Self-treatment and mixed subtypes of tranquillizers misuse was more prevalent among women than men while the self-treatment subtype was the most prevalent subtype in all the four drug classes.

CONCLUSIONS

This is the first study investigating non-medical use of prescription medications among Greek medical students and indicates a high prevalence of misuse of some categories of prescription drugs, mostly for self-treatment purposes.

Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use

BACKGROUND

While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.

METHOD

In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.

RESULTS

The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.

CONCLUSION

Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

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.

"I love having benzos after my coke shot": The use of psychotropic medication among cocaine users in downtown Montreal

BACKGROUND

Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal.

METHOD

Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner.

RESULTS

Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine).

CONCLUSION

PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.

Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users

INTRODUCTION

While marijuana has been legal for medical purposes in California since 1996, little is known about the health histories of young adult medical marijuana patients who are a significant proportion of medical marijuana patients. We examined whether young adult medical marijuana patients reported health conditions and motivations for use that were consistent with medical use of marijuana in California.

METHODS

Young adults (N = 366) aged 18 to 26 years were sampled in Los Angeles in 2014-2015 and segmented into medical marijuana 'patients' (n = 210), marijuana users with a current recommendation, and non-patient users or 'non-patients' (n = 156), marijuana users who never had a medical marijuana recommendation. Differences between patients and non-patients regarding self-reported health histories and past/current motivations for marijuana use were expressed as unadjusted risk ratios.

RESULTS

Compared with non-patients, patients were significantly more likely to report a range of lifetime health problems, such as psychological, physical pain and gastrointestinal. In the past 90 days, patients were significantly more likely to report motivations for marijuana use than non-patients concerning sleep, anxiety, physical pain and focusing. Psychological and pain problems were the most common health conditions reported to receive a medical marijuana recommendation. Patients were significantly less likely than non-patients to report any privacy concerns about obtaining a medical marijuana recommendation.

CONCLUSIONS

Patients were significantly more likely to report a range of health conditions and motivations associated with medical use than non-patients. A great majority of patients reported obtaining a medical marijuana recommendation for health problems in accordance with the California law. [Lankenau SE, Ataiants J,Mohanty S, Schrager S, Iverson E, Wong CF.Health conditions and motivations for marijuana use among young adultmedical marijuana patients and non-patient marijuana users. Drug Alcohol Rev 2017;00:000-000].

Motives for Prescription Stimulant Misuse in a College Sample: Characteristics of Users, Perception of Risk, and Consequences of Use

BACKGROUND

Prescription stimulant misuse is increasingly prevalent in college populations, with some misuse estimates over 40%. Stimulant use is associated with a variety of health and psychological problems. Motives for use may provide insight into problematic trajectories.

OBJECTIVES

The purpose of the current study was to evaluate characteristics of users and motives for prescription stimulant misuse in a large southeastern university.

METHOD

College students reported on prescription stimulant use, motives for use, consequences associated with use, perceptions of risk, and social norms. We specifically elicited participation from prescription stimulant misusers. Of the 199 participants, 86 reported misusing prescription stimulants in the past 60 days. We assessed motives for use, rates of substance use, risk perception, normative beliefs, and consequences associated with use. We evaluated differences between misusers and non-misusers, differentiate motives subscales, and identify relationships between motives subscales, rates of use, and consequences.

RESULTS

Misusers used more alcohol and other drugs, held different normative beliefs regarding stimulants, and had lower risk perceptions than non-misusers. We evaluated seven motives subscales among misusers: coping, social, enhancement, expansion, conformity, academic performance, and weight loss. Enhancement, social, weight loss, and expansion scales were correlated with negative consequences, while social motives were correlated with use. Results from regression analyses revealed positive associations between weight and expansion with negative consequences, and a negative association between conformity and consequences. Conclusions/Importance:Motives for prescription stimulant use and user characteristics may provide insight into prevention and treatment. Continued work is needed to refine item content and replicate findings.

Understanding the demand side of the prescription opioid epidemic: Does the initial source of opioids matter?

BACKGROUND

These studies were carried out to examine whether the onset and progression of an opioid substance use disorder (SUD) differed in those who first used opioids to get "high" compared to those who received a prescription from a doctor to relieve pain (Non-Rx vs. Rx groups, respectively).

METHODS

A subset of patients (N=214) from an ongoing larger study of patients entering one of 125 drug treatment programs for opioid use disorder across the country agreed to give up their anonymity and participate in structured and open-ended online interviews examining drug abuse patterns.

RESULTS

With the exception that the Non-Rx group began their opioid abuse at a younger age than the Rx group and more quickly evolved from initial exposure to regular opioid abuse, there were relatively few differences in the characteristics, patterns and trajectories of opioid abuse. The vast majority of patients in both groups, most of whom had serious, antecedent psychiatric disorders, indicated that they used opioids to self-medicate psychological problems (67-73%) and/or stated that opioids provided a means to "escape" from the stresses of everyday life (79-85%). As the SUD progressed, for many individuals any "positive" attributes of opioids waned and avoidance of withdrawal became the overriding concern, often serving as the impetus for treatment.

CONCLUSIONS

Our results suggest that self-treatment of co-morbid psychiatric disturbances is a powerful motivating force to initiate and sustain abuse of opioids and that the initial source of drugs-a prescription or experimentation-is largely irrelevant in the progression to a SUD.

Unhealthy Weight Management Practices and Non-medical Use of Prescription Drugs

INTRODUCTION

Non-medical use of prescription drugs (NMUPD) has reached epidemic proportions in the U.S. With approximately one in five high school students engaging in NMUPD, it is important to understand behavioral correlates.

METHODS

Data were combined from the 2011 and 2013 cycles of the Youth Risk Behavior Survey, a nationally representative, cross-sectional survey. After restricting the analytic sample to students who reported a weight loss goal of either staying the same weight or losing weight, logistic regression models were used to estimate adjusted prevalence ratios and 95% CIs for associations between unhealthy weight management practices (UWMPs) and lifetime NMUPD. Individual UWMPs-fasting; taking diet pills, powders, or liquids without a doctor's advice; and vomiting or taking laxatives-and total number of UWMPs were examined. Data were analyzed in 2016.

RESULTS

UWMPs were more prevalent among female students (21.1% vs 10.7% for fasting; 7.5% vs 5.2% for taking diet pills, powders, or liquids; and 7.6% vs 3.2% for vomiting or taking laxatives). Significant associations between individual UWMPs and NMUPD and between the number of UWMPs and NMUPD were observed.

DISCUSSION

UWMPs were associated with NMUPD. Health educators in the school setting, as well as other health professionals who provide services to an adolescent population, can focus on healthy weight management strategies, and other substance-specific messages.

CONCLUSIONS

The association between UWMPs and NMUPD may reflect a constellation of problem behaviors exhibited among some adolescents.

Diversion of prescription stimulants among college students: An initial investigation of injunctive norms

Nonmedical use of prescription stimulants (NMUPS) is an increasing problem among the college student population. Despite recent increases in stimulant prescriptions, little research has examined diversion of prescription stimulants among college students. The purpose of the current exploratory study was to compare normative beliefs about the frequency and motives of NMUPS among a college student sample. Participants were 121 college students who reported having a current prescription for a prescription stimulant. Participants completed online surveys and reported occasions of diversion behavior along with ratings of perceived approval for NMUPS and associated motives. Participants with a history of diversion were more likely to rate their close friends as more approving of more frequent NMUPS, and more approving of various motives for NMUPS. Perceived approval of NMUPS and NMUPS motives among parents and typical university students was similar across diversion groups, with parents and university students being rated as more approving of NMUPS for educational purposes. These findings extend the use of social norms theory to a new behavior while adding to our understanding how those who divert their medication differ from those who do not. Future studies should seek to establish a causal relationship between perceived approval for NMUPS and diversion behaviors. These findings also suggest that future research should focus on the feasibility and impact of social norms intervention for NMUPS and medication diversion.

The prevalences of and association between nonmedical prescription opioid use and poor sleep among Chinese high school students

The purpose of this study was to investigate the prevalences of and association between nonmedical prescription opioid use (NMPOU) and sleep quality among Chinese high school students. A cross-sectional study was conducted in Chongqing high school students in 2012, and questionnaires from 18,686 students were completed and eligible for this study. Demographic and NMPOU information was collected using a self-administered questionnaire. The Chinese Pittsburgh Sleep Quality index (CPSQI) was used to assess the occurrence of poor sleep. Among the total sample, 18.0% were classified as poor sleepers (27.4% of the subjects with past-month NMPOU), and the prevalences of lifetime, past-year and past-month NMPOU were 14.6, 4.6 and 2.8% across the entire sample, respectively. The most commonly used medicine was licorice tablets with morphine (9.1, 2.5 and 1.5% for lifetime, past-year and past-month, respectively), followed by cough syrup with codeine, Percocet, diphenoxylate and tramadol. After adjustment for potential confounders, the association between past-month NMPOU and poor sleep remained significant (AOR = 1.47, 95% CI 1.17 to 1.85). Programs aimed at decreasing NMPOU should also pay attention to sleep quality among adolescents.

Modeling motivations for non-medical use of prescription drugs

INTRODUCTION

Non-medical use of prescription drugs (NMUPD) is a growing problem among college-aged individuals. Motivations for use of a substance have been shown to predict consumption behavior across a variety of substances, but research on motivations for engaging in NMUPD is limited. We hypothesize that Confirmatory Factor Analysis (CFA) would support a two-factor latent structure for motivations (self-treatment and recreational) for NMUPD across three classes of drugs (stimulants, tranquilizers and sedatives, and pain relievers).

METHODS

Data were collected from 1016 undergraduates attending a large southeastern university via an online survey. Motivations for use were subjected to a CFA for those participants who reported past-year use of each drug class (tranquilizer and sedative use n=138, pain reliever use n=189, and stimulant use n=258).

RESULTS

Model fit varied across drug class. A two-factor model emerged for both pain relievers and stimulants, and each factor was positively correlated with one another and with frequency of use for both drug classes. A two-factor model was not a good fit for tranquilizers and sedatives.

CONCLUSIONS

Motives for NMUPD are a relatively understudied construct. Although our initial results suggest that a proposed framework consisting of self-treatment and recreational motives might have some utility in explaining the use of stimulants and pain relievers, more research is needed to characterize motives for tranquilizers and sedatives. Additional research is also needed to develop assessment measures that capture the full range of motives for all three classes of NMUPD.

Health anxiety and the non-medical use of prescription drugs in young adults: A cross-sectional study

INTRODUCTION

Studies have demonstrated a relation between health anxiety (hypochondriasis) and substance use, but this minimal body of literature has focused on alcohol or illicit drugs. The use of medications without a physician's prescription (i.e., non-medical use of prescription drugs, NMUPD) is increasingly prevalent among young adults. Health anxiety, a tendency to worry excessively about health, is a factor that could contribute to NMUPD, but this has not been examined. The purpose of the current study was to examine the relations among health anxiety, NMUPD, and other psychological variables related to substance use.

METHODS

In the present study, young adult college students (N = 758), ages 18-25, completed an anonymous online survey assessing demographics, health anxiety, NMUPD, and other psychological characteristics, including depression and general anxiety.

RESULTS

Participants who reported NMUPD had higher scores in health anxiety, as well as more frequent healthcare appointments, and were more likely to report having a chronic health condition. Given that multiple factors influence a decision to engage in NMUPD, a multivariable logistic regression analysis was performed. Results suggested that hopelessness, sensation-seeking, and health anxiety were risk factors for NMUPD, and that health anxiety predicted NMUPD over and above these other variables.

CONCLUSIONS

Medical professionals and mental health service providers should be aware of the increased risk of NMUPD for patients with health anxiety. Future research on NMUPD should more closely examine the role of health anxiety.

Non-medical use of prescription pain relievers among high school students in China: a multilevel analysis

OBJECTIVES

Given the differences between general high school (GHS) and vocational high school (VHS) students, this study aimed to investigate the lifetime prevalence of non-medical use of prescription pain relievers (NMUPPR) among high school students as well as the associations between NMUPPR and individual-level factors and school category.

METHODS

A cross-sectional study was conducted in GHS and VHS students in 2012 in Chongqing, and 11 906 students' questionnaires were completed and qualified for the survey. Self-reported NMUPPR and information regarding individual-level determinants and school category were collected. A multilevel multivariate logistic regression model was fitted to explore independent predictors of NMUPPR.

RESULTS

The total lifetime prevalence of NMUPPR was 11.3%, and NMUPPR was more prevalent among VHS students (15.8%) compared with GHS students (9.8%). Overall, the results indicated that VHS students were more likely to be involved in NMUPPR (adjusted OR (AOR)=1.64, 95% CI 1.42 to 1.89). Regarding the individual-level predictors of NMUPPR, below-average family economic status was negatively correlated with NMUPPR (AOR=0.77, 95% CI 0.60 to 0.98), and students with more pocket money were more likely to be engaged in NMUPPR. Students who had difficult family relationships, had poor relationships with teachers, had parents or friends who engaged in non-medical prescription drug use, and considered or attempted suicide were more likely to be engaged in NMUPPR.

CONCLUSIONS

NMUPPR among high school students is a multidetermined phenomenon. The current findings indicate that VHS students are an important subgroup of adolescents and highlight the need for additional research as well as targeted prevention and intervention programmes for NMUPPR.

Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse

OBJECTIVE

This study examined relations between adolescents' family structures, social ties, and drug-related attitudes, and their misuse of prescription opioids and stimulants. Different relationships were anticipated for the substances based on prior research highlighting varying motivations for their use.

METHOD

Based on an earlier model of adolescent substance misuse, two path analytic models were tested using data from 12 to 17 year olds in the 2012 U.S. National Survey on Drug Use and Health (NSDUH: N=17,399).

RESULTS

Female respondents reported higher levels of parental warmth, as did youth from wealthier families. Greater parental monitoring was reported by adolescents from wealthier and intact families. Parental monitoring and warmth predicted adolescents' social ties and individual differences associated with drug use, and both variables predicted prescription opioid and stimulant misuse. Contrary to previous research, for adolescents aged 12 to 14, high levels of parental monitoring, while positively associated with attitudes and social ties, also predicted higher rates of prescription stimulant misuse when combined with low levels of parental warmth. Results were cross-validated with data from the 2011 NSDUH.

CONCLUSIONS

Analyses highlighted the importance of understanding and differentiating the underlying factors associated with adolescent prescription stimulant and opioid misuse, and the role of parental behaviors in prevention.