Clinical Characteristics of Patients With Overdose Engaging in Nonmedical Use of Prescription Drugs: A Single-Center Study in Japan.

Nonmedical prescription drug use among African Americans who use MDMA (ecstasy/molly): Implications for risk reduction

Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City

Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991–1992 and 2001–2002

Objective/Background: Poor sleep and nonmedical use (NMU) of prescription drugs (NMUPD) are both common among college students. Since lack of sleep adversely influences academic performance, this study examined the association between NMUPD and subjective sleep quality among college students. Participants: Students who completed the American College Health Association–National College Health Assessment data (Fall 2010, Spring 2011; N = 135,874). Methods: Associations were examined between NMUPD in four classes over the past 12 months (antidepressant, painkillers, sedatives, and stimulants), and five aspects of sleep quality (Enough Sleep, Early Awakening, Daytime Sleepiness, Difficulty Falling Asleep, and Problem With Daytime Sleepiness) in the past seven days. Results: Any NMUPD (at least one class), NMU of stimulants specifically, and NMU of painkillers specifically were associated with getting fewer days of Enough Sleep (OR: 0.86, 0.93, and 0.84 respectively), more days of Early Awakening (OR: 1.28, 1.10, and 1.28 respectively), Daytime Sleepiness (OR: 1.23, 1.13, and 1.16 respectively), and Difficulty Falling Asleep (OR:1.32, 1.10, and 1.27 respectively; p < .0001, each). NMU of sedatives was significantly associated with having Problem With Daytime Sleepiness (OR: 1.10), more days of Early Awakening (OR: 1.12), and Difficulty Falling Asleep (OR: 1.17; p < .0001). Conclusions: NMUPD is associated with poor sleep among college students. Therefore, behavioral medicine screening and treatment of this vulnerable population should consider sleep health, NMUPD, and the potential that these problems may be comorbid.

Maier and colleagues' study of purported ‘pharmacological neuroenhancement’ (2015) is difficult to contextualize with prior studies. In the absence of evidence supporting stimulant medications’ cognitive benefits in individuals without diagnosable conditions, researchers should employ conservative terminology such as ‘non-medical drug use’ to avoid perpetuating unsubstantiated beliefs about such benefits, and adopt standardized measures. Maier et al. 1 present the results of a survey of Swiss employees and students that focused on the non-medical use of tranquilizers, antidepressants, attention deficit hyperactivity disorder (ADHD) medications, beta-blockers, modafinil and anti-dementia drugs for self-reported ‘pharmacological neuroenhancement’. Only 411 participants of the 10 171 had used any of these drugs for this purpose in their life-time. Non-medical use was elevated among students, individuals with a mental disorder (including ADHD, depression and anxiety) and individuals reporting poorer health and higher stress levels. This commentary discusses the possible reasons for differences in prevalence estimates across various settings and calls for judiciousness in the way researchers describe non-medical use. The authors place their findings in the context of other surveys conducted in other countries. Comparisons of prevalence estimates are difficult because of the variety of sampling methods used, the survey questions utilized, varying response rates and the characteristics of the individuals surveyed. Population-based estimates from the United States of non-medical use of prescription stimulants are lower than what has been reported in studies of college students from a single campus 2. Even among studies of US college students, these estimates can vary widely 3. Variations in availability and access to treatment, as well as regional differences in prescribing practices of various pharmacological formulations, can also influence prevalence estimates because some formulations are more often used non-medically than others (i.e. immediate versus extended release) 4. In addition to environmental-level conditions, such as availability, non-medical use of prescription drugs, such as the use of any other substance, is driven by a number of individual-level factors (e.g. risk-taking propensity, the balance between one's perception of risk and perception of benefit). An enticing label such as ‘pharmacological neuroenhancement’ as a substitute for a more traditional one such as ‘non-medical drug use’ can amplify public perceptions that non-medical use of these drugs is associated with improvements in cognitive functioning for individuals without a diagnosable condition. For example, while the therapeutic benefit of stimulant medications is established for ADHD patients 5, considerable debate exists regarding extra benefits for individuals without ADHD, especially with regard to executive function 6-8. Even if such effects could be demonstrated for task performance in placebo-controlled laboratory conditions, most agree that there is no evidence that non-medical prescription stimulant users achieve improvements that translate into real-world academic success 6, 9. In fact, nearly every study examining grade point average (GPA) as an outcome of non-medical prescription stimulant use has demonstrated quite the opposite—that non-medical use of prescription stimulants is associated with lower GPAs 3, 10-12. Our group has developed models based on longitudinal data from college students to understand more clearly the precursors of academic decline among non-medical prescription stimulant users. In short, we have found that escalations in excessive drinking and marijuana use appear to precede skipping class and decreases in GPA which, in turn, are associated with the non-medical use of prescription stimulants 10. The significant overlap between all forms of non-medical prescription drug use and other forms of drug use is a robust finding in the literature 3, 4, 13-15, and also observed in Maier's study 1. When prescription drugs are used purportedly for neurocognitive enhancement, it must be considered that the person who is using might be experiencing deficits in cognitive function due to other forms of drug use, and perhaps struggling with an untreated mental health condition. These are underlying problems that deserve our focused attention. Certainly, the motives behind non-medical drug use are interesting phenomena for researchers to understand and explain; but non-medical use of prescription drugs in the current historical context should not be equated with pharmacological neuroenhancement, regardless of purported motives. Perhaps other drugs will be developed in the future that will boost cognitive performance for individuals without a diagnosable condition 16. At a population level, we should continue to develop and use standardized methods for inquiry regarding non-medical prescription drug use. At a clinical level, non-medical use of prescription drugs should be viewed as a possible ‘red flag’ and signal a need for a more comprehensive assessment and possible intervention. None. This commentary was supported by the National Institute on Drug Abuse (NIDA, R01DA014845).

To present national data on the prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders for sedatives, tranquilizers, opioids, and amphetamines. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face nationally representative survey of 43,093 adults conducted during 2001 and 2002. Lifetime prevalences of nonmedical use of sedatives, tranquilizers, opioids, and amphetamines were 4.1%, 3.4%, 4.7%, and 4.7%, respectively. Corresponding rates of abuse and/or dependence on these substances were 1.1%, 1.0%, 1.4%, and 2.0%. The odds of nonmedical prescription drug use and drug use disorders were generally greater among men, Native Americans, young and middle-aged, those who were widowed/ separated/divorced or never married, and those residing in the West. Abuse/dependence liability was greatest for amphetamines, and nonmedical prescription drug use disorders were highly comorbid with other Axis I and II disorders. The majority of individuals with non-medical prescription drug use disorders never received treatment. Nonmedical prescription drug use and disorders are pervasive in the U.S. population and highly comorbid with other psychiatric disorders. Native Americans had significantly greater rates of nonmedical prescription drug use and drug use disorders, highlighting the need for culturally-sensitive prevention and intervention programs. Unprecedented comorbidity between nonmedical prescription drug use disorders and between nonmedical prescription drug use disorders and illicit drug use disorders suggests that the typical individual abusing or dependent on these drugs obtained them illegally, rather than through a physician. Amphetamines had the greatest abuse/dependence liability, and recent increases in the potency of illegally manufactured amphetamines may portend an epidemic in the youngest NESARC cohort.

Research suggests that non-medical prescription drug (NMPD) use is becoming increasingly prevalent, particularly among adolescents. A critical step towards developing effective intervention efforts requires identifying adolescents who are at risk for NMPD use. An extensive literature suggests that both adolescents and adults with elevated anxiety sensitivity (AS) are at greater risk for problematic substance use, and a small body of work has identified similar links with NMPD use specifically among adults. However, most of this literature combines all prescription drugs into a single category, and no work has evaluated the relation between AS and NMPD use among adolescents. The current study endeavors to further this area of research by examining the relation between AS (overall and subscales) and NMPD use among adolescents. The project evaluated 276 adolescents (age 9-19 years) enrolled in a residential treatment program on level of AS, including sub-dimensions (i.e., cognitive, physical, and social), and NMPD use across three categories of drugs: analgesic (e.g., Vicodin®), anxiolytic (e.g., Xanax®), and stimulant (e.g., Adderall®). A series of logistic regression models indicated that overall AS predicted nonmedical analgesic use, but not anxiolytic/sedative or stimulant use. A closer investigation of the AS subscales demonstrated that only the AS social subscale significantly predicted nonmedical analgesic and anxiolytic/sedative use. These results suggest that AS is related to NMPD use among adolescents, highlighting the need for future work to disaggregate the assessment of NMPD use into specific drug classes and explore the subscale dimensions of AS.

Background: National data demonstrate significant differences in non-medical prescription drug (NMPD) use, with Whites seeming to be more likely to use compared to non-Whites. College students also appear to be at an increased risk for NMPD use. Objectives: This study examines NMPD use using a component of social identity theory. We propose that a stronger sense of ethnic identity may reduce the likelihood of NMPD use among college students due to ethnic identity’s ties to self-esteem and self-efficacy. We also propose that the protective power of ethnic identity may vary according to one’s race. Methods: Data for this study were collected from a survey of undergraduate students at a Midwestern university (N = 530). Poisson regression analyses were used to test the relationship between ethnic identity and NMPD use. Of our sample, 135 participants (25.5%) indicated NMPD use over the past year. This percentage is high compared to findings from national college data. Results: Results indicate that a stronger sense of ethnic identity reduced the frequency of NMPD use among young adults. The findings also reveal that the relationship between ethnic identity and NMPD use is moderated by race. Ethnic identity was found to be a protective factor for non-White participants only. Conclusions: This study suggests that ethnic belonging may act as a protective factor against NMPD use among non-White young adults. These findings build upon our understanding of the relationship between ethnic identity and substance use. We conclude with a discussion of directions for future research and intervention programs

The latent structure and predictors of non-medical prescription drug use and prescription drug use disorders: A National Study

Behavioral Intervention for Nonmedical Use of Prescription Drugs Among Adolescents and Young Adults: A Narrative Review

This article presents data from four groups of rural Key Informants—Community leaders, educators, health care providers and justice/law enforcement officials—to understand the nonmedical use and misuse of prescription drugs. Seventy key informants were purposively selected from two counties in Appalachian Kentucky. Key informants indicated that the nonmedical use of prescription drugs is complex and has historical roots. Two pathways, or entry points, into the nonmedical use and misuse of prescription drugs were identified: physical pain and recreational use. Data show trends with regard to drug use patterns, drug use education, involvement with the criminal justice system and the role of economics in the prescription drug use problem. Key Informants underscored a common theme that the rural prescription drug problem was fueled by a cultural acceptance of drug misuse. Recommendations are presented for services and research.

Background: Non-medical prescription drug use is an increasing problem among university students. Purpose: The present study investigated university students' involvement in non-medical prescription drug (NMPD) use and associations between use and other risky behaviors. Methods: A sample of 363 university students completed a four page survey assessing involvement in NMPD use and risky behaviors. Results: Results indicated that approximately one in three university students have used prescription drugs without a doctor's prescription. Pain medication (22.4%) was the number one misused prescription drug followed by stimulants (17.5%). Almost half of university students reported using NMPDs with alcohol. Logistic regression analyses revealed being male and being a junior or senior increased the odds of involvement in NMPD use. Additional analyses revealed engaging in NMPD use was associated with increased odds for cigarette use, marijuana use, and suicidal ideation. Discussion: Health professionals should educate students about the dangers of NMPD use and attempt to identify students at high risk. Translation to Health Education Practice: Prevention programs should be developed to target university students who may be at risk for misuse.

Male-to-female transgender women (TGW) experience high rates of substance use and HIV. A recent substance use trend is the use of prescription medication without a doctor's consent. No research to date has examined the associations between this non-medical use of prescription drugs and HIV risk behaviour in TGW. In the present study, TGW recruited from community venues (N = 104) in the Mid-Atlantic region of the United States completed surveys assessing demographic information, non-medical use of prescription drugs, other substance use, injection practices and sexual risk behaviour. Twenty-four per cent of the sample reported lifetime non-medical use of prescription drugs across the following categories: analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%) and sedatives (8.7%). Participants reporting non-medical use of prescription drugs were more likely to report other substance use, needle use to inject drugs, injecting silicone and sharing needles. In multivariable analyses, non-medical use of prescription drugs was associated with unprotected sex, sex after engaging in substance use, and commercial sex work, after controlling for demographic factors. Self-esteem and social support from family served as protective factors for non-medical use of prescription drugs. HIV-prevention programmes focused on TGW in the United States may wish to expand their assessment of substance use to include the use of prescription medications without a physician's consent.

In this study, we examine the explanation of the nonmedical use of prescription drugs. We test the comparative utility of two theories of drug use (i.e., social learning theory and self-control theory) on the nonmedical use of prescription drug use. Our contribution to social learning theory is the use of an understudied part of the theory—nonsocial reinforcement. We expect the two theories to explain the nonmedical use of prescription drugs. Using data from the 2006 Monitoring the Future Survey (MTF), we showed both theories have a link with the nonmedical use of prescription drugs. A consistent theme was that social learning theory had a consistent link with the nonmedical use of prescription drugs. However, self-control and nonsocial reinforcement have inconsistent links with the nonmedical use of prescription drugs. We discuss the policy implications of these findings.

To compare the prevalence of nonmedical prescription drug use among adolescents residing in urban, suburban, and rural areas of the United States and to determine factors independently associated with rural nonmedical prescription drug use among adolescents aged 12 to 17 years. Cross-sectional, population-based survey. Noninstitutionalized residents in the United States. Participants included adolescents aged 12 to 17 years (N = 17 872), most of whom were residing in urban areas (53.2%), male (51%), and white (59%). Living in rural compared with urban area. Nonmedical use of prescription drugs (pain relievers, tranquilizers, sedatives, and stimulants). Data were from the 2008 National Survey on Drug Use and Health. Rural adolescents were 26% more likely than urban adolescents to have used prescription drugs nonmedically (adjusted odds ratio, 1.26; 95% confidence interval, 1.01-1.57) even after adjustment for race, health, and other drug and alcohol use. When examining the rural adolescents in particular, factors positively associated with nonmedical use of prescription drugs included decreased health status, major depressive episode(s), and other drug (marijuana, cocaine, hallucinogens, and inhalants) and alcohol use. Protective factors for nonmedical prescription drug use among rural adolescents included school enrollment and living in a 2-parent household. Rural adolescents were significantly more likely than urban adolescents to report nonmedical prescription drug use. However, these results suggest there are multiple potential points of intervention to prevent initiation or progression of use among rural adolescents including preventing school dropout, increased parental involvement, and increased access to health, mental health, and substance abuse treatment.