Nonmedical Use Of Prescription Medication Research Articles

“Here in Ghana hard work don’t deserve money”: The uncertainty and precarity of youth who use tramadol

There has been a global rise in problematic non-medical use of prescription medication. In West Africa, recent media reports have highlighted increases in the use of tramadol especially among youth. In Ghana, current framings of this issue have described the (ab)use of tramadol as symptomatic of moral laxity among youth. Several academic and media publications portray tramadol use as a form of deviance by youth while ignoring structural drivers of abuse. Through a Ghanaian case study, this research briefly explored media framings of tramadol abuse vis à vis the lived experiences of youth who currently use tramadol. Through a discourse analysis of 295 media articles and 15 interviews (11 with youth who use tramadol and 4 with health system stakeholders), this study drew on the theoretical perspective of structural violence and key theoretical literature on precarity, uncertainty and anxiety in Africa to describe the contexts that fuel tramadol use among youth. The evidence reveals that while government responses to tramadol use have focused mainly on arrests and victim blaming, poor conditions of work, weakened social and health systems due to neoliberal transformations and anxiety and uncertainty also explain tramadol use. A policy reorientation towards establishment of rehabilitation facilities, improving the living conditions of vulnerable youth and improved working conditions should be considered in responding to problematic use of tramadol among youth as these social factors rather than moral deviance resonate with the lived experiences of youth who use tramadol.

'Keeping a lid on it': Exploring 'problematisations' of prescribed medication in prisons in the UK.

The non-medical use of prescription medication and risk of diversion have become policy and practice concerns within prison settings in the UK. These issues have been highlighted by the Advisory Council on the Misuse of Drugs, Her Majesty's Inspectorate of Prisons and Her Majesty's Prison and Probation Service (2019) prison drugs strategy. In 2019, new prescribing guidance was issued by the Royal College of General Practitioners for clinicians working within prison settings. Informed by Bacchi's (2009) What's the problem represented to be? framework, the ways in which the 'problem' of prescribed medication in prisons have been represented is interrogated through an analysis of the prescribing guidance framework for clinicians working in prisons. Restrictive prescribing practices are recommended as a solution to the 'problem' of diversion and misuse of prescribed medication. Prescribers are advised to consider de-prescribing, non-pharmacological treatments and alternative prescriptions with less diversionary potential. They are represented as responsible for the 'problems' that prescribed medication bring to prisons. The guidance is underpinned by the assumption that prescribers lack experience, knowledge and skills in prison settings. People serving prison sentences are assumed to be 'untrustworthy' and their symptoms treated with suspicion. This representation of the 'problem' has a number of effects including the possibility of increasing drug-related harm, damaging the patient-doctor relationship and disengagement from healthcare services. The representation of prescribed medication as problems of diversion and prescribing practices inhibits alternative representations of the problem which would inform different policy directions including improvements to regime and healthcare provision and would include a range of practitioners in prison settings to address the 'problem' more holistically.

Prevalence and factors associated with non-medical prescription stimulant use to promote wakefulness in young adults

Objective: This study examined the prevalence and factors associated with non-medical use of prescription stimulants to promote wakefulness. Participants: We surveyed 3,160 university students aged 18–35 between June 2016 and May 2017. Method: Participants reported whether they used prescription stimulants non-medically to stay awake and completed measures of anxiety and depressive symptoms, sleep quality, insomnia, daytime sleepiness, and attitudes toward non-medical prescription drug use. Univariate and multivariate regression models were used. Results: Prevalence of non-medical prescription stimulant use to promote wakefulness was 3.1%. The following factors remained significant in the multivariate model: alcohol, tobacco, and nicotine vapor use, attitude toward non-medical use of prescription medication, poor sleep quality, and daytime sleepiness. Conclusion: Poor sleep, substance use and more liberal attitudes to non-medical prescription drug use were associated with the misuse of stimulants to promote wakefulness. Prevention/intervention programs should promote sleep hygiene and highlight the risks of using prescription drugs non-medically.

If kids ruled the world, how would they stop non-medical use of prescription drugs?

We examined ideas about how youth would mitigate non-medical use of prescription medications among their peers. The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) interviewed 11,048 youth10-18 years of age between 2008 and 2011 from entertainment venues of 10 US urban, suburban, and rural areas. Using a mixed-methods approach, participants completed a survey culminating in open ended questions asking: 1) How should kids your age be told about prescription drugs and their effects?; 2) If you ran the world, how would you stop kids from taking other people's prescription medicines?; 3)Why do people use prescription stimulants without a prescription? Responses from a random sample of 900 children were analyzed using qualitative thematic analyses. The random sample of 900 youth (52% female, 40% white, with a mean age was 15.1 years) believed they should be educated about prescription drugs and their negative effects at schools, at home by parents, through the media, and health professionals. Youth would stop kids from using other people's prescription drugs through more stringent laws that restricted use, and education about negative consequences of use. Peer pressure was the most common reason youth gave for using other's pills, though some reported using for curiosity. This analysis shows the importance of considering youth's opinions on non-medical use of prescription medications, which are often overlooked. Studies should disseminate this data from youth to stop the illicit use of prescription drugs among teens and youth.

Gun access, ownership, gun-related experiences, and substance use in young adults: a latent class analysis

ABSTRACT Background Substance use is found to associate with gun violence. However, mixed findings have been reported for gun access/ownership. To date, studies have examined gun access/ownership and gun-related experiences (e.g., carrying) separately despite the fact that gun-related experiences often occur among gun owners. Objectives This study identifies groups of young adults based on their gun access/ownership and gun-related experiences (i.e., gun carrying, threatened someone with a gun, been threatened with a gun) and assesses whether these groups differ on their use of alcohol, cigarettes, e-cigarettes, marijuana, hard drugs, and nonmedical use of prescription medication. Methods This study uses cross-sectional data from Wave 8 of the study Dating it Safe. Participants were 663 young adults (Mean age = 22 years; 62% female). Latent class analysis (LCA) was performed. Results LCA identified three classes: (1) Minimal Gun Access/Experience (65.0%), (2) Gun Access without Experience (33.4%), (3) Gun Access with Experience (1.6%). Individuals in the Gun Access with Experience class reported more frequent few past month alcohol (17 days vs. 7 and 8 days, p < .001), episodic heavy drinking (13 days vs. 2 and 3 days, p < .001) and cigarette use (21 days vs. 10 and 10 days, p < .001) compared to these in the Minimal Gun Access/Experience and Gun Access without Experience classes, respectively. Conclusions Individuals who have access to/own guns with and without gun-related experiences face different risks of substance use. Findings highlight the need to examine gun access/ownership based on actual gun experiences and further emphasize the importance of addressing substance abuse for gun violence prevention.

Associations Between Adverse Childhood Experiences, Student-Teacher Relationships, and Non-Medical Use of Prescription Medications Among Adolescents

Abstract Objective Few studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association. Design Data were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n = 104,332) was comprised of 8th, 9th, and 11th graders. Results Approximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs. Conclusion Our findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives.

Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents

ObjectiveFew studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association. DesignData were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n=104,332) was comprised of 8th, 9th, and 11th graders. ResultsApproximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs. ConclusionOur findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives.

Depression Moderates the Relationship Between Pain and the Nonmedical Use of Opioid Medication Among Adult Outpatients.

The nonmedical use of prescription medication among US adults is a growing public health problem. Healthcare providers should proactively address this problem in outpatient encounters. We sought to understand the interactive effects among prescription drugs, pain, and psychiatric symptoms among adult outpatients to build an empirical foundation for comprehensive screening. We screened 625 adult neurosurgery and orthopedic patients at a suburban satellite clinic of an urban academic medical center. A convenience sample was screened for psychiatric and substance use disorder symptoms using the American Psychiatric Association's recommended screening protocol. We tested whether psychiatric symptoms moderated the relationship between pain level and nonmedical use of prescription medicine. Patients reported average levels of depression, anxiety, and pain symptoms, within 1 standard deviation of the screeners' normative data. However, patients reported highly elevated levels of nonmedical use of opioids and benzodiazapines compared with national data. Controlling for age, sex, and race, pain level predicted nonprescription use of opioid and benzodiazapine medications. Patients with high levels of depression and pain were more likely to engage in the unprescribed use of opioids. Likewise, patients with reduced levels of depression and pain were protected against the unprescribed use of opioids. These findings highlight the importance of examining unprescribed medication use even with patients at moderate levels of psychiatric symptoms and pain.

279 Perceptions of Sharing Prescribed Controlled Substances Among an Emergency Department Population

Non-medical use of prescription medication is a growing epidemic that has been associated with many health concerns. The most common medications used non-medically are opioids and tranquilizers. The source of most prescription medications used non-medically is not from drug dealers or physicians, but from friends and family members of the individual that abuses the medication. Opioids and sedatives are commonly prescribed from the emergency department and the rate of these prescriptions are increasing. In this study, we assess the perceptions of sharing prescribed opioids or sedatives in the emergency department population. This was a prospective observational study that was conducted in the waiting room of a tertiary care level 1 trauma center. Individuals were approached while in the waiting room and chosen randomly based on their seat in the waiting room. A random list of numbers was generated daily. A survey assessing the individual’s perception of sharing controlled substances were distributed utilizing electronic tablets. The study was conducted over a 3-week period. Descriptive statistics were used to analyze the data. There were 263 individuals approached with 217 individuals completing the survey yielding a response rate of 83%. Overall 7% reported sharing prescribed controlled substances with family, 3% reported sharing with friends and 62% reported that they would save their medications for later use. Seventeen percent of individuals thought that it was acceptable to share their prescribed controlled substances and were significantly more likely to share these medications including opioids, prescribed medications for insomnia, and prescribed muscle relaxers with friends or family. Only 25% of responders reported properly disposing of their additional prescribed controlled substances. There was no significant difference in age or sex. In our study 1 of 6 of the ED population sampled reported that they perceived nothing wrong with sharing their prescribed controlled medications with friends or family, and only 25% of the ED population reported correctly disposing of their leftover prescribed controlled substances. Increased efforts to raise awareness of the dangers of sharing prescribed controlled substances and appropriate disposal of controlled substances should be pursued.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

"It Was Me on a Good Day": Exploring the Smart Drug Use Phenomenon in England.

The non-medical use of prescription medication for the pursuit of increasing cognitive and intellectual capacities (defined neuroenhancement) has received growing attention from the scientific community and policymakers alike. To date, limited qualitative data exist exploring the nature of the phenomenon, especially as a potentially emerging trend among university students in England. Existing American literature suggests that students believe that neuroenhancement helps the individual to maximize his/her time, consenting a suitable balance between work and leisure. Students’ motivation to experiment with neuroenhancement appears to be more in line with a need to regulate emotions surrounding study/work settings than to actually improve cognitive abilities beyond normal levels. This study aimed to qualitatively explore representations, motivations, beliefs, and consumption styles of a cohort of university student users residing in England. Through snowball sampling, 13 informants were contacted and interviewed regarding their experience with neuroenhancers. Narrations were analyzed and interpreted using qualitative analysis software and Grounded Theory methodology. Participants belonged to a broad variety of university courses and were predominantly habitual consumers of modafinil. Neuroenhancers were acquired either through friends or via the Internet. Motivations regarded the need to “catch up” and be on par with high achieving students. The entire cohort had previously experimented with other psychotropic substances. Synthetic compounds in particular were believed to be “gateway” drugs to using neuroenhancers. Experimentation with neuroenhancement can be seen as a self-governing strategy aimed at achieving continued focused productivity. Participants acknowledged sustainable benefits in neuroenhancement as it optimized work performance. The majority of the cohort also contemplated the possibility of using these drugs in the future once they entered the workforce. Neuroenhancing drug users expressed “situated morality,” differentiating between using these substances for assessments (exams) or during revisions, finding only the former as an immoral conduct. In the present scenario, it appears that neuroenhancement is practiced by small numbers of students. Nonetheless, the instrumental views of psychotropic substances held by many young adults and the globalization of these practices make the normalization of neuroenhancement a plausible possibility of the future.

Longitudinal trajectories of non-medical use of prescription medication among middle and high school students

ABSTRACTThe non-medical use of prescription medications has been identified as a major public health problem among youth, although few longitudinal studies have examined non-medical use of prescription medications in the context of other drug use. Previous cross-sectional studies have shown gender and race differences in non-medical use of prescription medications. It was hypothesized that (1) non-medical use of prescription medications increases with age, and (2) these increases will be stronger in magnitude among female and Caucasian adolescents. Changes in non-medical use of prescription medications across 4 years were examined and compared with changes in other drug use (e.g., alcohol and marijuana). Middle and high school students enrolled in 5 schools in southeastern Michigan completed web-based surveys at 4 annual time points. The cumulative sample size was 5,217. The sample ranged from 12 to 18 years, 61% were Caucasian, 34% were African American, and 50% were female. Using a series of repeated measures latent class analyses, the trajectories of non-medical use of prescription medications were examined, demonstrating a 2-class solution: (1) the no/low non-medical use of prescription medications group had low probabilities of any non-medical use of prescription medications across all grades, and (2) the any non-medical use of prescription medications group showed a roughly linear increase in the probability of non-medical use of prescription medications over time. The probability of any non-medical use of prescription medications increased during the transition from middle school to high school. Results from this longitudinal study yielded several noteworthy findings: Participants who were classified in the any/high non-medical use of prescription medications group showed a discontinuous pattern of non-medical use of prescription medications over time, indicating that non-medical use of prescription medications is a relatively sporadic behavior that does not persist over time. However, among the “any/high non-medical use of prescription medications” group the pattern of change over time varied by race/ethnicity, with Caucasians showing a clear increase in the probability of non-medical use of prescription medications over time compared to non-Caucasians. This study fills gaps in knowledge by examining non-medical use of prescription medications over time and provides important information about the course of non-medical use of prescription medications among adolescents.

Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in Quebec.

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

Religiosity in the non-medical use of prescription medication in college students

Background: The non-medical use of prescription drugs (NMUPD) is a hazardous health behavior popular among young adults and college students. Past research has documented prevalence rates and risk factors associated with NMUPD, while little research has addressed protective factors. Objective: The present study examined the associations of religiosity and NMUPD in a sample of college students. Methods: Young adult (ages 18–25) college students (n = 767) completed an anonymous online survey assessing demographic variables, NMUPD, personality factors, perceptions of risk, mental health, and religiosity. Results: Results showed that greater religiosity scores were consistently associated with lower odds of engaging in NMUPD in the past 3 months. These associations were partially mediated by the personality characteristics of conscientiousness and openness to experience as well as perceived risk of NMUPD. The effect of religiosity on NMUPD was moderated by Greek (i.e. fraternity or sorority) membership, such that those in a Greek organization showed no relation between religiosity and NMUPD, while religiosity served as a protective factor for NMUPD among those who did not have Greek membership. Conclusion: These results extend past research demonstrating that religiosity is protective against substance abuse/misuse. Greek status appears to negate the protective influence of religiosity on NMUPD.

Exploration of claims-based utilization measures for detecting potential nonmedical use of prescription drugs.

Nonmedical use of prescription medication is a significant and growing public health concern in the United States. Drug utilization measures that can reliably quantify the extent of nonmedical use of a given medication or medication class would greatly facilitate efforts to identify, monitor, and constrain nonmedical prescription drug use. Measures making use of prescription claims data would be especially valuable given the ready availability of these data among health care plans and payers. To explore the extent to which claims-based utilization measures can provide information that aids in identifying and quantifying nonmedical drug use. Prescription claims from a large employer-based administrative claims database (MarketScan) were used to evaluate drug utilization during the first year after an index prescription for 6 classes of drugs with a known abuse potential and 3 classes without. Traditional population-level measures of adherence (i.e., medication possession ratio [MPR] and proportion of days covered [PDC]) and a novel measure of overlapping days supply (MPR/PDC ratio) were calculated for all medications. Measures of asymmetrical use within a population were evaluated with the Lorenz curve, representing the total drug supply used by the heaviest 1%, 5%, and 50% of all users. All of the measures across compounds were compared with Spearman nonparametric rank correlations, and the Friedman's test was performed to determine whether the rankings were consistent in pairwise analysis. The ability of each measure to discriminate between abusable and nonabusable compounds was evaluated using the c-statistic. The study cohort included 6,291,810 patients, mean age 52 years, 57.9% female. The mean MPR and mean PDC for drugs with known abuse potential were both lower than for drugs without known abuse potential. The MPR/PDC ratio (MPR:PDC) ranged from 1.02-1.09. Highest values for the Lorenz-1 curve were seen for acetaminophen with codeine, acetaminophen with oxycodone, oxycodone, and acetaminophen with hydrocodone. The individual MPR and PDC were strongly correlated to each other (r = 0.99; P less than 0.001 for both), moderately correlated with the MPR:PDC (r = 0.62 and 0.57, respectively) and moderately inversely correlated with Lorenz 1 (r = -0.83 and -0.86, respectively, P less than 0.001 for both). The MPR:PDC was inversely correlated with the Lorenz-1 (r = -0.39; P = 0.02). After rank ordering individual drugs by each measure from highest to lowest value, the MPR:PDC resulted in consistent distributions with the individual MPR (P = 0.0097) and PDC (P = 0.0018), but not the Lorenz-1 (P = 0.0835), nor Lorenz-50 (P = 0.1343). The MPR, PDC, Lorenz-1, and Lorenz-50 were able to discriminate between the drugs with known abuse potential and those without (c-statistic 0.979 to 1), while the MPR:PDC was not (c-statistic 0.592). When comparing classes of drugs with a known abuse potential with classes of drugs not prone to such use, using an array of drug utilization measures, significantly different patterns emerge, although the ability of these measures to serve as reliable indicators of the extent of nonmedical prescribing may be limited. There is a need for valid and reliable algorithms to detect the extent of nonmedical use at a population level to help target public health interventions aimed at constraining illicit use. Further work is warranted on the development of novel measures that make use of individual patient-level use patterns.

Non-medical use of prescription medications among middle school students: a qualitative analysis

Non-medical use of prescription medication (NMUPM) has surpassed all other drugs abused by adolescents with the exception of marijuana. One third of adolescents aged 12–17 have reported using a prescription medication for non-medical purposes in their lives. Twenty-five middle school students participated in in-depth interviews about their experience with NMUPM. Interviews were recorded, transcribed and downloaded to Nvivo 10 for analysis. Researchers identified 11 common themes among participants. Middle school students did not recognize prescription medications as potentially dangerous when used non-medically compared to using street drugs. Obtaining prescription medications for non-medical purposes was perceived as relatively easy and parents, friends’ parents and friends were major sources for obtaining them. NMUPM occurred at school even with teachers present and at parties and private homes with and without parents at home. Some students described using prescription medications as a means to satisfy desires for sensation and to deal with life problems. Practitioners can use these results to inform healthcare professionals, pharmaceutical companies, parents and adolescents of the prevalence and serious risks involved with NMUPM.

Cognitive Test Anxiety and Cognitive Enhancement: The Influence of Students’ Worries on Their Use of Performance-Enhancing Drugs

This online panel study (nt1 = 5,882; nt2 = 3,486 (randomly selected)) used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010. Rare events logistic regression revealed that increased cognitive test anxiety increased the prevalence of medication use over various time windows. Negative binomial regression models showed that the higher the cognitive test anxiety, the higher the use frequencies were during the previous six months. The models controlled for expected side effects, risk attitudes, self-attributed competencies, prior medication use, sex, and age. We also discuss the study's implications.

Added Stakeholders, Added Value(s) to the Cognitive Enhancement Debate: Are Academic Discourse and Professional Policies Sidestepping Values of Stakeholders?

Background: The debate on the nonmedical use of prescription medication for the enhancement of cognitive function (e.g., attention, memory, concentration, vigilance), accompanied by heated public discussions in the media, has spurred the interest of scholars and the public. Methods: In this article, we present qualitative data from a focus-group study with university students, parents, and health care providers. We identified ethical, social, and legal issues related to the nonmedical use of methylphenidate for cognitive enhancement (CE) and closely examined the positions taken on these issues and their supporting arguments. Results: The ethical, social, and legal issues we identified (e.g., authenticity, cheating) were similar to those identified in a previous discourse analysis of the bioethics literature but indicate the existence of moderately and highly contentious issues as well as factors and values underlying these issues. The model we generated from these findings shows how interplay between values (e.g., effort and honesty) and external factors (e.g., regulation and access) may lie at the root of contentious ethical issues in CE. Conclusions: Our discussion points to an unsuspected complexity in understanding the values of stakeholders and an unclear relationship to academic discourse and professional societies. We propose deliberative or other democratic processes as a way to recognize and incorporate the complexity of the CE debate.

Adolescent Sexual Assault and the Medical and Nonmedical Use of Prescription Medication

Previous research has documented an association between sexual victimization and prescription medication use among adults. The purpose of this study was to determine whether such a relationship was present for adolescent girls when considering sexual victimization by a peer and the use of four drug classes for medical and nonmedical reasons. The study was based on a secondary analysis of a cross-sectional Web-based, self-administered survey of female students from a middle and high school (n = 490). As predicted, sexual victimization increased the likelihood of non-medical prescription medication use of opioid analgesics and sedative medication, although these relationships varied based on the severity of sexual assault. Findings are discussed in light the importance of increasing awareness among health professionals, researchers, and the wider community of the increased risk for prescription medication abuse among adolescent girls who have a history of sexual violence.

Nonmedical Use of Prescription Medications: An Emerging Risk Behavior Among Rural Adolescents

Little is known about prescription medication abuse by rural youth. We surveyed 849 rural high school students and found that 34% reported lifetime nonmedical use of prescription medication higher than the 12% reported nationally. Boys and marijuana users had higher odds of nonmedical use of prescription medication than did girls or marijuana nonusers (odds ratio 1.9 and 3.8, respectively).