Nonmedical Prescription Drug Research Articles

Nonmedical prescription drug use among Hispanic youths: An emerging problem

Nonmedical prescription drug (NMPD) use is a significant public health issue among Hispanic youths. Limited information on risk and protective factors for NMPD use among Hispanic youths is known. The present study examined use rates and identified factors that increase and decrease odds for use. In so doing, prevention and intervention efforts can be enhanced. A total of 946 Hispanic youths in seventh through twelfth grade participated in this study. Participants completed the PRIDE questionnaire assessing substance abuse involvement. Overall, study findings indicated that 16.4% of youths used NMPDs in their lifetime. Involvement in risky behavior increased odds for use whereas having high levels of parent protective factors and teacher/school protective factors decreased the odds for use. Peer use of alcohol, tobacco, and marijuana also increased the odds of NMPD use. Findings indicate NMPD use is problematic for Hispanic youths. Professionals working with Hispanic youths may benefit from study findings as risk and protective factors are identified that may prevent NMPD use.

The Association Between Ethnic Identity and Non-Medical Prescription Drug Use Among A Sample of College Students: Does a Sense of Ethnic Belonging Matter?

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

Examining the Relationship Between Strain and the Use of Nonmedical Prescription Drugs Among College Students

The study of nonmedical prescription drug use (NMPDU) on college campuses is of importance, as college students tend to engage in NMPDU more often than their same-age peers not attending college. Typical correlates of NMPDU include need for alertness, perception of peer use, desire to get high, and use of other drugs including alcohol and marijuana. Few studies have explored the relationship between strain, depression, and NMPDU among college students. Using general strain theory as the theoretical framework, the current study aims to add to the literature on NMPDU by exploring the role that strain and depression play in the prevalence of nonmedical prescription stimulant, tranquilizer/sedative, and pain reliever use at a midsized university. Results support the relationship proposed by strain theorists for both nonmedical use of prescription pain relievers and tranquilizers/sedatives, but not stimulants. Policy implications and future areas of research are discussed.

Assessing service and treatment needs of young people who use illicit and non-medical prescription drugs living in Northern Ontario, Canada

Background: The use of illicit and prescription drugs for non-medical purposes among youth and young adults living in Northern Ontario communities is a major public health concern. This problem is amplified in that there is insufficient knowledge on the types of services and treatment centers available for and utilized by young people with substance use issues in Northern Ontario. This needs assessment study aims to examine the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Methods/Design: A mixed-methods study design will be used to assess the service and treatment needs of youth and young adults (aged 14-25) who have used one or more illicit drug (excluding cannabis) and/or psychoactive prescription drug for non-medical purposes for at least 3 months and on at least 10 days in the last month. Participants will be recruited from approximately ten Northern, remote and rural communities across Northern Ontario using a mobile research lab. Eligible study candidates from each community will be asked to partake in a focus group and questionnaire exploring service and treatment utilization and needs. We will additionally collect basic socio-demographic information as well as examine patterns of problematic drug use. Interviews with service providers and community organizers will also be conducted in each community. Discussion: Findings from our study will highlight the availability, accessibility and utilization of existing services; identify the gaps and barriers in current service provision; and provide insight into the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Assessing the needs of young people who use drugs will allow service providers, community organizers and health policymakers to improve addiction-related services and treatment centers in Northern Ontario.

Correlates of Non-Medical Prescription Drug Misuse Among a Treatment-Seeking Population: A Comparison with Illicit Drug Users.

Prescription drugs (PD) undoubtedly help people with various physical or psychiatric ailments. Nevertheless, they are often diverted and misused (use without prescription or for purposes/in ways not intended by the prescriber). This study compared the sociodemographic and clinical correlates of those who misused PDs, used illegal drugs and co-ingested both, to identify those who were at a high risk of misusing these drugs. Retrospective analysis of the treatment outcome monitoring (TOM) data for the period of 2013–2017 identified 1369 subjects for the study; 295 patients presented with PD use disorder (PDUD alone), 811 with illegal drug use disorder (IDUD alone), and 263 had both PDUD and IDUD. The study sample included treatment seeking population (Singaporeans and permanent residents). TOM data included data collected through direct interviews (addiction severity, quality of life) and from the clinical case notes (diagnosis, co-morbidities, socio demographic information, etc.). The most commonly misused prescription and illegal drugs were benzodiazepines (63.1%) and heroin (63.4%), respectively. Those who co-ingested both PD and illegal drugs (PDUD+IDUD) had a significantly higher addiction severity score, lower quality of life and higher psychiatric co-morbidities than that of IDUD alone at baseline. When compared to Chinese patients, Malay and Indian patients had lower odds (p < 0.05) of PDUD alone and PDUD+IDUD than Chinese patients; divorcees had higher odds of PDUD+IDUD than those who were married. Those with primary and secondary qualifications had higher odds (2.1 and 2.9 times, respectively) of PDUD+IDUD than those with tertiary qualification and those in managerial or professional roles had higher odds of PDUD alone than those who were unemployed. Gender, ethnicity, marital status, education and occupational classes were associated with PDUD and IDUD. These characteristics can be helpful to identify those who are at the risk of PDUD and incorporate strict prescription monitoring to their care.

Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically.

Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use. Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana. Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16). Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

Adolescent Suicide Cases: Toxicology Reports and Prescription Drugs

Abstract The use of nonmedical prescription drugs in adolescent suicide is a critical issue. This study examined the toxicology of drugs found in a sample of 134 medical examiner records. The majority of adolescents died at home of asphyxia, had a trauma history, psychiatric illness, and a history of child abuse. Thirty-seven types of prescription drugs were found on autopsy; most were not prescribed. Findings from this study suggest that prescription drug misuse has a potent impact on adolescent risk factors. Identifying neurobiological and contextual factors associated with suicidality is critical for prevention efforts by health providers.

Pre-Incarceration Rates of Nonmedical Use of Prescription Drugs among Black Men from Urban Counties.

There are inconsistent findings regarding the rates of nonmedical prescription drug use (NMPDU) among Black Americans. The majority of previous studies used pharmaceutical names of drugs and relied on national data that excludes incarcerated populations, in which Black men are overrepresented. Therefore, the current study aimed to describe pre-incarceration rates of NMPDU among Black men in prison using culturally relevant alternative drug names. We recruited 208 incarcerated (adult age 18 or older) Black men nearing community reentry to urban counties from four state prisons in Kentucky. Results indicated the majority of participants engaged in lifetime NMPDU. The most commonly endorsed class of prescription drug was, "Other Sedatives, Hypnotics, and Tranquilizers" and the most commonly endorsed specific prescription drugs were "Syrup," Lortab/Hydrocodone, and Xanax. There were significant age differences in the number of days that drugs were used in the year prior to incarceration. The current study contributes to the dearth of literature on NMPDU among Black Americans. These findings have implications for disease transmission, overdose risk, and culturally relevant data collection methods and interventions aimed at reducing NMPDU among Black men.

Substance use and population life expectancy in the USA: Interactions with health inequalities and implications for policy.

Life expectancy at birth for the USA has not increased in recent years. This commentary assesses the impact of substance use on this phenomenon. Although crude mortality rates of the most important causes of death (such as cardiovascular diseases or cancer) have declined between 2010 and 2014, crude mortality rates of drug- and alcohol-induced causes of death have increased. Alcohol use, non-medical prescription drug use (especially prescription opioid use) and illicit drug use have likely played a crucial role in life expectancy trends of the past years. Importantly, the current mortality crisis due to substances is disproportionately borne in lower socio-economic strata. As such, policies should reduce this impact.

The new mothers’ little helpers: medicalization, victimization, and criminalization of motherhood via prescription drugs

ABSTRACTIn order to understand the relationship between nonmedical prescription drug use, gender, and crime, interviews were conducted with 40 incarcerated women who self-identified as nonmedical Rx users. Of the women we interviewed, 70% were prescribed Rx drugs from their doctors to aid in recovery from cesarean section childbirth deliveries, treat postpartum depression, or for mental or physical health problems associated with childhood abuse and victimization. These women subsequently discovered that these pills also helped them cope with the stresses of caretaking and keeping the family together, particularly when experiencing intimate partner violence and prolonged poverty. Women were motivated to use Rx drugs in order to be a “good” mother, as defined by medical and cultural discourse; however, despite positive intentions, prolonged nonmedical use often hindered the realization of these ideals and ultimately resulted in their criminalization, incarceration, and separation from their children.

Nonmedical Prescription Drug Use among Adolescents: Global Epidemiological Evidence for Prevention, Assessment, Diagnosis, and Treatment.

This paper reviews the most recent epidemiological evidence on adolescent NMPD use. Particular attention is given to prevention, assessment and diagnosis of disorder, and treatment. While international in scope, global evidence is only available for NMPD use, morbidity and mortality estimates. Prevention strategies, assessment and treatment are U.S.-centric. The literature on prevention strategies lacks high-quality evidence. Assessment, diagnosis and treatment of NMPD use disorder have more robust evidence bases. Despite this, screening for NMPD (and other drug) use disorders is infrequent and insensitive, leading to incomplete treatment provision. Treatments are shown to be safe and effective, but disparities in provision prevent wide-scale amelioration of the adolescent NMPD use problem. Mental health care professionals and primary care physicians with adolescent patient populations should become involved in preventative strategies mentioned in this review. Additionally, higher screening rates will lead to less downstream problems related to NMPD use.

Prescription opioid use in the rural Appalachia: A community-based study

The purpose of this study is to describe the sample characteristics and methods for a study of rural medical and nonmedical prescription opioid users with a history of OxyContin use. Snowball sampling was used to recruit 221 rural Appalachian residents. Participants included those under medical supervision for pain (n = 101) as well as those self-reporting nonmedical use of prescription opioids (n = 120). Participants were given an intervieuwer-administered questionnaire. Data relating to demographics, illicit and nonmedical prescription drug use, medical, legal, family, and psychiatric status, as well as pain history were collected. The primary outcomes of interest were differences in past 30 day prescription drug use between pain patients and nonmedical opioid users. A significantly greater proportion of those treated for pain reported using oxycodone and hydrocodone prescribed by a physician in the prior 30 days (p < 0.001); however, more than third of pain participants also reported nonmedical use of OxyContin, methadone, hydrocodone, benzodiazepines, and marijuana in the prior 30 days. A large proportion of rural opioid users who reported being treated for pain also reported nonmedical use ofprescription drugs. Similarly, among the nonmedical users, half of those reported experiencing pain that interfered with their daily life. These results suggest that many rural prescription drug users are being either incorrectly or perhaps inadequately treated for chronic nonmalignant pain. Therefore, developing educational materials and training for rural physicians about pain treatment (including drug seeking behavior) is proposed.

Heroin Use and Drug Injection among Youth Also Misusing Prescription Drugs.

We identified the prevalence of nonmedical prescription drug use and its relationship to heroin and injection drug use in 4 nationally representative samples of adolescents. We used the most recent data (2009-2015) from the Youth Risk Behavior Surveillance System (Ntotal= 61,132). Prevalence rates and 95% confidence intervals for prescription drug misuse, heroin use, and injection drug use were calculated across time points, sex, and race/ethnicity subgroups. Using odds ratios, we determined the likelihood of youth reporting nonmedical prescription drug use also reporting heroin and drug injection. In 2015, one in 6 adolescents reported recent prescription drug misuse. High rates of nonmedical prescription drug use persisted or increased among Hispanic boys, black boys, and "other" youth, while declining among white youth. Youth who used prescription drugs nonmedically at least once were 17.5 times more likely to have used heroin (CI: 13.7, 22.4) and 14.6 times more likely to have injected drugs (CI: 11.2, 19.2) in their lifetime. Public health programming focused on reducing prescription drug misuse also may reduce youth engagement in heroin and/or injection drug use. Preventive efforts to support communities of color in reducing rates of prescription drug misuse are crucial.

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

Recent data suggest that both nonmedical prescription drug and MDMA (ecstasy/molly) use have risen among African Americans. However, studies investigating these two forms of drug use among African Americans are rare. As a result, very little is known about African-American MDMA users and their nonmedical use of prescription medications. The primary goal of this study, therefore, was to describe patterns of nonmedical prescription drug use among African Americans who use MDMA. We also assessed alcohol and illicit drug use among the sample. Surveys (n=100) and in-depth interviews (n=15) were conducted with African-American young adults in Southwest Florida between August 2014 and November 2015. Survey results show that a significant proportion of the sample used MDMA in conjunction with prescription medications (benzodiazepines=59%; opioids=35%; stimulants=13%). Qualitative findings suggest that benzodiazepine medications were used to alleviate MDMA comedown symptoms, opioids were used to achieve a different quality high, and stimulants were used to provide added energy throughout the night. These results suggest that treatment practitioners and harm reduction professionals should pay particular attention to informing users of the potential hazards of combining MDMA with prescription medications. Although additional research is clearly needed, these findings are an important first step towards understanding both nonmedical prescription drug and MDMA use among African Americans, and could be used to tailor treatment and risk reduction interventions to this population.

Religiosity as a Substance Use Protective Factor Among Female College Students.

Research exists about religiosity as a substance use protective factor. However, there is little attention of this issue regarding Israeli female college students. Undergraduate religious and secular students were studied. Religious students reported lower last month tobacco, alcohol, cannabis and non-medical prescription drug use. Secular females who smoked, missed class because of party habits and reported easy access to cannabis had a higher probability of binge drinking. This study contributes to knowledge about religiosity and college student substance use, and it provides useful information for their mental health and well-being.

Gender differences in pathways from physical and sexual abuse to early substance use

Early substance use (i.e., before age 14) is a known risk factor for substance use disorder, but scarce research has examined gender differences in pathways to early substance use. This study applies a developmental traumatology perspective to examine the relations between child physical and sexual abuse and early substance use among youths investigated by child protective services (CPS), a population with high risk for substance use disorder. Drawing from the first National Survey of Child and Adolescent Well-Being (NSCAW), a sample of 11–13year olds (n=467 girls, n=329 boys) was examined. Multiple group path analysis assessed gender differences in the relations between physical and sexual abuse severity and early substance use and indirect effects via internalizing problems, externalizing problems, and posttraumatic stress. Focal measures included the child-reported Parent-Child Conflict Tactics Scale (physical abuse severity), the Trauma Symptom Checklist for Children (posttraumatic stress), the Youth Self-Report (internalizing and externalizing problems), and the NSCAW's caseworker-alleged abuse (sexual abuse severity) and child substance abuse modules (any current alcohol, marijuana, hard drug, inhalant, or nonmedical prescription drug use). Significant indirect effects of physical abuse severity to early substance use were found through externalizing behavior problems in girls only (β=0.068; 95% CI=0.029, 0.130; p=0.004), with a significantly stronger relation between externalizing problems and early substance use in girls. Results suggest gender differences in the sequelae of trauma as they relate to early onset substance use and the need to integrate mental health and substance use services.

Associations Between Early Onset of E-cigarette Use and Cigarette Smoking and Other Substance Use Among US Adolescents: A National Study.

This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents. Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study. A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05). Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted. To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.

Nonmedical Prescription Drug Use Among Adults in Their Late Twenties: The Importance of Social Bonding Trajectories

Although weak social bonds are found to be associated with addictive behaviors in cross-sectional studies, few studies have explored the longitudinal impacts of social bonds on nonmedical prescription drug use (NPDU). This study adopted a developmental perspective on social bonds and tested how their different trajectories are associated with NPDU among adults. With panel surveys from the National Longitudinal Study of Adolescent to Adult Health from 1994 to 2008, this study employed group-based latent trajectory modeling to obtain the different trajectories of social bonds including religious, civic, familial, educational, and marital, and then used them as predictors of NPDU while controlling for potential confounders and the baseline NPDU. The findings show that constant and high-level social bonds significantly reduce the risk of NPDU, except for educational bond. However, for religious, civic, and educational bonds, the “low initial” trajectories are not significantly different from the “high-decrease” trajectories, implying that strong early-life social bonds do not prevent NPDU if such bonds register a recent decline. Weak social bonds constitute significant risk of NPDU for adults in their late twenties, and recent social bonds override the contribution of early-life bonds in most cases. Policy makers may consider strategies to sustain the active and meaningful participation in conventional institutions, and not solely rely on programs that facilitate early-life social integration.

Nonmedical Prescription Drug Use by College Students for Recreational and Instrumental Purposes: Assessing the Differences

Nonmedical prescription drug use (NMPDU) is a serious issue on college campuses. We examine the factors affecting instrumental and recreational NMPDU within the same sample, and test the efficacy of learning and strain theories in predicting NMPDU for both instrumental and recreational use. This cross-sectional study utilizes survey data gathered from a convenient but representative sample ( n = 2,466) of students attending a large public university in the Southwestern United States. There is support for learning theory, but not for strain theory, in predicting both recreational and instrumental use. Logistic regression analyses also show that while marijuana smokers, illicit street drug users, and those possessing less of an academic ethic are more likely to partake in NMPDU for both recreational and instrumental purposes, the predictors for recreational and instrumental NMPDU differ in interesting ways with regard to race, gender, binge drinking, living arrangement, and Greek organization membership.

Medicalized addiction, self-medication, or nonmedical prescription drug use? How trust figures into incarcerated women's conceptualization of illicit prescription drug use

Trust is crucial to optimal care. When trust is compromised, patients, doctors, and others involved in the provision of health care may not act in patients' best interests, particularly when dealing with prescription (Rx) drugs. Patients must trust that doctors are giving them the proper treatment, including access to Rx drugs only when medically necessary. They must also trust themselves to use these drugs properly. Likewise, doctors must trust the patient's ability to use medications appropriately. Given the recent rise in illicit Rx drug use in the U.S., we seek to understand how women articulate levels of trust in doctors and themselves and if different combinations of trust and distrust impact how they acquire, use, and articulate their experiences with Rx drugs. To this end, we identified and interviewed 40 women incarcerated in the U.S., who were deeply entrenched in illicit Rx drug use prior to prison. Based upon this research, we argue that illicit Rx drug use may be tied to different combinations of trust and distrust in individual doctors (interpersonal trust), the field of medicine (institutional trust), and the users themselves (self trust). How these women acquire Rx drugs: through doctors, friends, family, or the street market are influenced by combinations of interpersonal, institutional, and self trust.