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McCabe SE, Veliz PT, Boyd CJ, Schepis TS, McCabe VV, Schulenberg JE. A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife. Drug Alcohol Depend 2019; 194:377-385. [PMID: 30481692 PMCID: PMC6355143 DOI: 10.1016/j.drugalcdep.2018.10.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This longitudinal study assesses characteristics associated with adolescents' nonmedical use of prescription opioids (NMUPO) including: frequency, co-ingestion, motives, specific opioid type; sequence of initiation of medical use of prescription opioids and NMUPO in relationship to subsequent substance use disorder (SUD) symptoms. METHODS Twenty-one independent national cohorts of U.S. high school seniors (n = 8,373) were surveyed and followed 17 years from adolescence to age 35. RESULTS The majority of adolescents who engaged in NMUPO reported occasional/frequent NMUPO, non-pain relief motives for NMUPO, simultaneous co-ingestion involving NMUPO and other drugs, opioid analgesics with high misuse potential, and multiple types of opioid analgesics. Adolescents who reported NMUPO for pain relief, NMUPO involving opioid analgesics with high misuse potential, or multiple prescription opioids had significantly greater odds of SUD symptoms at age 35, relative to those who had no history of NMUPO during adolescence. In addition, medical use of prescription opioids after initiating NMUPO (or NMUPO only) during adolescence was associated with significantly greater odds of subsequent SUD symptoms at age 35 relative to those who reported the medical use of prescription opioids only or had no medical use or NMUPO during adolescence. CONCLUSIONS This is the first U.S. national prospective study to examine the relationships between adolescents' NMUPO characteristics and later SUD symptoms in early midlife. Several characteristics (frequency, co-ingestion, motives, opioid type, and medical/NMUPO initiation history) were identified that could be used to screen and detect high-risk youth for indicated interventions to reduce prescription opioid misuse and SUDs.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Philip T. Veliz
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA
| | - Carol J. Boyd
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, TX 78666, USA
| | - Vita V. McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,St. Joseph Mercy Ann Arbor, St. Joseph Mercy Health System, Ypsilanti, MI 48197, USA
| | - John E. Schulenberg
- Developmental Psychology, Department of Psychology, University of Michigan, Ann Arbor, MI 48106, USA,Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA
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Trends in the Misuse of Tranquilizers, Sedatives, and Sleeping Pills by Adolescents in Spain, 2004-2014. J Adolesc Health 2018; 63:709-716. [PMID: 30064889 DOI: 10.1016/j.jadohealth.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Misuse of prescription medication has increased during the last 20 years among adolescents and young adults. We aimed to report the prevalence and factors associated with misuse of tranquilizers, sedatives, and sleeping pills (TSSp) in high-school students in Spain. We also analyzed misuse of these drugs during the decade 2004-2014. METHODS Nationwide, epidemiological, cross-sectional study on the misuse of TSSp by the Spanish school population. We used individualized secondary data retrieved from the 2004 and 2014 Spanish State Survey on Drug Use in Secondary Education. A total of 179,114 surveys respondents aged 14-18 years. Estimates and trends of previous 30 days misuse of TSSp. RESULTS The prevalence of TSSp misuse among school population aged 14-18-years increased significantly from 2004 (2.40%) to 2014 (2.96%). The values for consumption were always greater in adolescent girls than boys throughout the study (3.51% vs. 2.18%). The variables associated with a greater probability of TSSp misuse were consumption of alcohol, tobacco, and marijuana. Students who reported consumption of an illicit drug other than marijuana during the previous year are 4.91 times more likely to misuse TSSp (adjusted odds ratio = 4.91; 95% confidence interval, 4.15-5.81). CONCLUSIONS We found that misuse of TSSp by adolescents in Spain has significantly increased from 2004 to 2014. Misuse of TSSp was more likely in adolescent girls than Spanish boys. Alcohol, tobacco, and marijuana consumption are factors associated with the use of TSSp.
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Carrà G, Bartoli F, Galanter M, Crocamo C. Untreated depression and non-medical use of prescription pain relievers: findings from the National Survey on Drug Use and Health 2008-2014. Postgrad Med 2018; 131:52-59. [PMID: 30415596 DOI: 10.1080/00325481.2019.1546533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders. METHODS We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit. RESULTS Among respondents, about 9% (youths) and 7% (adults) reported past year MDE and about 6% (youths), and 4% (adults) NMUPPRs. About 1.2% (youths) and 0.7% (adults) reported both MDE and NMUPPRs. Those with past year MDE were more likely to report NMUPPRs (RR, 95%CI: 2.60, 2.42-2.80, and 2.64, 2.47-2.82, for youths and adults). Considering the any treatment/MDE interaction on NMUPPRs, MDE risk ratio for subjects who received some treatment (youths: adjusted risk ratio (ARR) = 1.15; adults: ARR = 1.25) was about 70-80% as compared with their untreated counterpart (youths: ARR = 1.57; adults: ARR = 1.54). The likelihood of reporting NMUPPRs amongst respondents who did not receive any treatment was higher for those with past year MDE (main effect: youths ARR = 1.57, p < 0.001; adults ARR = 1.54, p < 0.001). CONCLUSION Unrecognized and untreated depressive disorders should be considered for prevention, treatment, and policy implications in order to tackle NMUPPRs epidemic.
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Affiliation(s)
- Giuseppe Carrà
- a Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.,b Division of Psychiatry , University College London , London , UK
| | - Francesco Bartoli
- a Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
| | - Marc Galanter
- c Department of Psychiatry , NYU School of Medicine , New York , NY , USA
| | - Cristina Crocamo
- a Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy
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Van Winkle PJ, Ghobadi A, Chen Q, Menchine M, Sharp AL. Association of age and opioid use for adolescents and young adults in community emergency departments. Am J Emerg Med 2018; 37:1397-1403. [PMID: 30343960 DOI: 10.1016/j.ajem.2018.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Adolescents and young adults are at high risk for opioid misuse and abuse. The emergency department (ED) plays a key role in treatment of acute and chronic pain and is a primary place that this patient population is exposed to prescription opioids. We evaluate the effect of patient age on use of opioids for adolescents and young adults in community EDs. METHODS Retrospective cohort study of adolescent and young adult encounters in 14 community EDs from 2013 to 2014. We evaluate the percent of ED encounters with parenteral and/or oral opioids administered, morphine milligram equivalents per ED patient encounter, and percent of patient encounters discharged with an opioid prescription. Age was the main exposure. The association between outcomes and age was examined using bivariate and multivariate logistic regression adjusting for measurable confounders. RESULTS There were 259,632 adolescent and young adult encounters in our sample, average age 17.6 years, with 15.8% given opioids. Increasing patient age was associated with a significant increase in the percent of encounters with opioids given (AOR, 1.11; 95% CI 1.10-1.11), morphine milligram equivalents administered (β 0.38; 95% CI 0.33-0.43 for parenteral and β 0.26; 95% CI 0.23-0.28 for oral), and percent of patients receiving outpatient prescriptions (AOR, 1.14; 95% CI 1.13-1.14). Significant variability also existed between medical centers (AOR, 2.02; 95% CI 1.86-2.20). CONCLUSION For adolescent and young adult patients in the ED, there is a significant association between opioid prescribing and increasing age. This describes an opportunity to reduce opioid use in older adolescents and young adults.
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Affiliation(s)
- Patrick J Van Winkle
- Kaiser Permanente, Orange County, 3440 La Palma Ave, Anaheim, CA 92806, United States of America.
| | - Ali Ghobadi
- Kaiser Permanente, Orange County, 3440 La Palma Ave, Anaheim, CA 92806, United States of America.
| | - Qiaoling Chen
- Southern California Permanente Medical Group, 100 South Los Robles Ave, Pasadena, CA 91101, United States of America.
| | - Michael Menchine
- University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States of America
| | - Adam L Sharp
- Kaiser Permanente, Los Angeles, 4867 Sunset Blvd, Los Angeles, CA 90027, United States of America.
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Major Depression and Sedative-Hypnotic Use Disorder: a Review. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nock NL, Minnes S, Alberts JL. Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders. Birth Defects Res 2018; 109:1711-1729. [PMID: 29251846 DOI: 10.1002/bdr2.1182] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022]
Abstract
Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.
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Affiliation(s)
- Nora L Nock
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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School racial composition and lifetime non-medical use of prescription painkillers: Evidence from the national longitudinal study of adolescent to adult health. Health Place 2018; 53:103-109. [PMID: 30092414 DOI: 10.1016/j.healthplace.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/13/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the possible effects of middle and high school racial composition on later reporting of lifetime non-medical use of prescription painkillers (NMUPP) in young adulthood, and to explore whether there is evidence of variability by individual race/ethnicity in such effects. METHODS Using data from Wave 1 (1994/5) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we categorized the sample's 52 middle schools and 80 high schools as majority (>50%) non-Hispanic white, majority non-Hispanic black, or neither. We used two-level hierarchical modeling to explore associations between individual- and school-level race at Wave 1 and lifetime prescription painkiller misuse reported at Wave 4. We included a cross-level interaction between individual race and school racial composition to assess variability in school-level associations by race. RESULTS Overall crude prevalence of lifetime NMUPP in majority white schools (17.9%) was over three times that of prevalence in majority black schools (4.8%), and also higher than prevalence in schools neither predominantly black nor predominantly white (12.4%). Lifetime misuse among blacks in majority white schools was more prevalent (5.2%) than among blacks in black schools (2.8%), as was misuse among whites in white schools (19.3%) compared to their white peers in black schools (15.7%). Two-level random intercept Poisson regression results suggest that attendance in a majority black secondary school lowered a participant's risk of lifetime NMUPP (compared to attending a majority white school: RR=0.66, p = 0.03). Compared to blacks in black schools, blacks in white schools had twice the risk of prescription painkiller misuse (p = 0.004) over a decade later, and whites in white schools had 5.5 times the risk (p = 0.01). The risk ratio comparing whites in black schools to whites in white schools was not significant (RR: 1.30; p = 0.37). CONCLUSIONS We found evidence of an effect of school racial composition on the risk of misusing prescription painkillers over a decade later, over and above individual race, with higher risk of misuse reported among participants who had attended white schools. Black participants who had attended predominantly white schools were, on average, twice as likely to report lifetime misuse of prescription painkillers compared to blacks who had attended black schools.
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Voepel-Lewis T, Zikmund-Fisher BJ, Boyd CJ, Veliz PT, McCabe SE, Weber M, Tait AR. Effect of a Scenario-tailored Opioid Messaging Program on Parents' Risk Perceptions and Opioid Decision-making. Clin J Pain 2018; 34:497-504. [PMID: 29135696 PMCID: PMC5934298 DOI: 10.1097/ajp.0000000000000570] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Poor parental understanding of prescription opioid risks is associated with potentially dangerous decisions that can contribute to adverse drug events (ADE) in children and adolescents. This study examined whether an interactive Scenario-tailored Opioid Messaging Program (STOMP) would (1) enhance opioid risk perceptions and (2) improve the safety of parents' decision-making. MATERIALS AND METHODS In total, 546 parents were randomized to receive the STOMP versus control information and 516 completed the program. A baseline survey assessed parents' opioid risk knowledge, perceptions, and preferences for pain relief versus risk avoidance (Pain Relief Preference). Parents then made hypothetical decisions to give or withhold a prescribed opioid for high-risk (excessive sedation) and low-risk (no ADE) scenarios. The STOMP provided immediate feedback with specific risk and guidance information; the control condition provided general information. We reassessed knowledge, perceptions, and decision-making up to 3 days thereafter. RESULTS Following the intervention, the STOMP group became more risk avoidant (Pain Relief Preference, mean difference -1.27 [95% confidence interval, -0.8 to -1.75]; P<0.001) and gained higher perceptions of the critical risk, excessive sedation (+0.56 [0.27 to 0.85]; P<0.001). STOMP parents were less likely than controls to give a prescribed opioid in the high-risk situation (odds ratio, -0.14 [-0.24 to -0.05]; P=0.006) but similarly likely to give an opioid for the no ADE situation (P=0.192). DISCUSSION The STOMP intervention enhanced risk perceptions, shifted preferences toward opioid risk avoidance, and led to better decisions regarding when to give or withhold an opioid for pain management. Scenario-tailored feedback may be an effective method to improve pain management while minimizing opioid risks.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan, Ann Arbor MI 48109-4245
| | - Brian J. Zikmund-Fisher
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor MI 48109-4245
| | - Carol J. Boyd
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor MI 48109-4245
| | - Philip T. Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor MI 48109-4245
| | - Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor MI 48109-4245
| | - Monica Weber
- Department of Anesthesiology, University of Michigan, Ann Arbor MI 48109-4245
| | - Alan R. Tait
- Anesthesiology, University of Michigan, Ann Arbor MI 48109-4245
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Moses TE, Lundahl LH, Greenwald MK. Factors associated with sedative use and misuse among heroin users. Drug Alcohol Depend 2018; 185:10-16. [PMID: 29413433 PMCID: PMC5889740 DOI: 10.1016/j.drugalcdep.2017.11.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Rates of both opioid and sedative use and misuse are rising. Comorbid opioid and sedative use is associated with especially severe consequences (e.g., overdose and poor health outcomes). Heroin users report multiple motivations for sedative use, including self-medication. We aimed to understand differences in lifetime substance use characteristics between heroin users with different sedative use histories. METHODS Substance use data were collected from 385 non-treatment seeking heroin users. Subjects were divided into four lifetime sedative-use groups: no use, medical use only, non-medical use only, and mixed medical and non-medical use. We examined patterns of use of various substances of abuse (tobacco, alcohol, marijuana, cocaine, heroin, and sedatives) and individual characteristics associated with each. RESULTS Non-medical sedative use (alone or in addition to medical use) was associated with more negative consequences from using all substances. Medical sedative use alone was not related to increased overdose or emergency room visits associated with heroin use. Non-medical sedative use was associated with increases in 15 of the 21 measured heroin consequences and only one of those - health problems - was also associated with medical sedative use. CONCLUSIONS Concomitant non-medical sedative use and heroin use is associated with significantly greater negative outcomes than those experienced by heroin users who report use of sedatives only as prescribed. Understanding these differences offers insight into risks related to using both substances and may help treatment providers create targeted harm reduction interventions for this population.
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Affiliation(s)
- Tabitha E.H. Moses
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine
| | - Leslie H. Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine
| | - Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University, Detroit, MI 48201, USA
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Beyene KA, Aspden TJ, Sheridan JL. A qualitative exploration of healthcare providers’ perspectives on patients’ non-recreational, prescription medicines sharing behaviours. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kebede A. Beyene
- School of Pharmacy; Faculty of Medical and Health Sciences; the University of Auckland; Auckland New Zealand
| | - Trudi J. Aspden
- School of Pharmacy; Faculty of Medical and Health Sciences; the University of Auckland; Auckland New Zealand
| | - Janie L. Sheridan
- School of Pharmacy; Faculty of Medical and Health Sciences; the University of Auckland; Auckland New Zealand
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61
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Li DH, Turner BC, Mustanski B, Phillips GL. Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates. Addict Behav 2018; 77:143-151. [PMID: 29017108 PMCID: PMC5701833 DOI: 10.1016/j.addbeh.2017.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/14/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. METHOD Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. RESULTS Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males. CONCLUSION These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States.
| | - Blair C Turner
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Gregory L Phillips
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL 60611, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
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Nonmedical prescription opioids and pathways of drug involvement in the US: Generational differences. Drug Alcohol Depend 2018; 182:103-111. [PMID: 29220668 PMCID: PMC5870126 DOI: 10.1016/j.drugalcdep.2017.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study sought to specify (1) the position of nonmedical prescription opioids (NMPO) in drug initiation sequences among Millennials (1979-96), Generation X (1964-79), and Baby Boomers (1949-64) and (2) gender and racial/ethnic differences in sequences among Millennials. METHODS Data are from the 2013-2014 National Surveys on Drug Use and Health (n = 73,026). We identified statistically significant drug initiation sequences involving alcohol/cigarettes, marijuana, NMPO, cocaine, and heroin using a novel method distinguishing significant sequences from patterns expected only due to correlations induced by common liability among drugs. RESULTS Alcohol/cigarettes followed by marijuana was the most common sequence. NMPO or cocaine use after marijuana, and heroin use after NMPO or cocaine, differed by generation. Among successively younger generations, NMPO after marijuana and heroin after NMPO increased. Millennials were more likely to initiate NMPO than cocaine after marijuana; Generation X and Baby Boomers were less likely (odds ratios = 1.4;0.3;0.2). Millennials were more likely than Generation X and Baby Boomers to use heroin after NMPO (hazards ratios = 7.1;3.4;2.5). In each generation, heroin users were far more likely to start heroin after both NMPO and cocaine than either alone. Sequences were similar by gender. Fewer paths were significant among African-Americans. CONCLUSIONS NMPOs play a more prominent role in drug initiation sequences among Millennials than prior generations. Among Millennials, NMPO use is more likely than cocaine to follow marijuana use. In all generations, transition to heroin from NMPO significantly occurs only when both NMPO and cocaine have been used. Delineation of drug sequences suggests optimal points in development for prevention and treatment efforts.
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Rougemont-Bücking A, Grazioli VS, Marmet S, Daeppen JB, Lemoine M, Gmel G, Studer J. Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors. Eur J Psychotraumatol 2018; 9:1468706. [PMID: 29760868 PMCID: PMC5944370 DOI: 10.1080/20008198.2018.1468706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/03/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Non-medical use of prescription drugs (NMUPD) is an increasing phenomenon associated with physical and psychological consequences. This study investigated the effects of distinct forms of stress on NMUPD. Methods: Data from 5308 young adult men from the Swiss cohort study on substance use risk factors (C-SURF) were analysed regarding NMUPD of sleeping pills, tranquilizers, opioid analgesics, psychostimulants, and antidepressants. Various forms of stress (discrete, potentially traumatic events, recent and long-lasting social-environmental stressors) during the period preceding the NMUPD assessment were measured. Backward log-binomial regression was performed and risk ratios (RR) were calculated. Results: NMUPD was significantly associated with the cumulative number of potentially traumatic events (e.g. for opioid analgesics, RR = 1.92, p < .001), with problems within the family (e.g. for sleeping pills, RR = 2.45, p < .001), and the peer group (e.g. for tranquilizer use, RR = 2.34, p < .01). Factors describing family functioning in childhood showed very few significant associations. Sexual assault by acquaintances was associated only with use of sleeping pills (RR = 2.91, p p <.01); physical assault by acquaintances was not associated with NMUPD. Physical (e.g. for psychostimulants, RR = 2.01, p < .001) or sexual assaults (e.g. for antidepressants, RR = 4.64, p < .001) perpetrated outside the family context did show associations with several drug categories. Conclusion: NMUPD appears to be more consistently associated with discrete and potentially traumatic events and with recent social-environmental stressors than with long-lasting stressors due to family functioning during childhood and youth. Physical and sexual assaults perpetrated by strangers showed more associations with NMUPD than those perpetrated by a family member.
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Affiliation(s)
- Ansgar Rougemont-Bücking
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.,Chair of Psychiatry and Psychotherapy, University of Fribourg, Department of Neurosciences and Movement Science (NMS), Psychiatry and Psychotherapy, Fribourg, Switzerland
| | - Véronique S Grazioli
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Simon Marmet
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Mélissa Lemoine
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland.,Addiction Suisse, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Canada.,Frenchay Campus, University of the West of England, Bristol, UK
| | - Joseph Studer
- Alcohol Treatment Center, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
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64
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Rajan S, Ruggles KV, Guarino H, Mateu-Gelabert P. Heroin Use and Drug Injection among Youth Also Misusing Prescription Drugs. Am J Health Behav 2018; 42:144-155. [PMID: 29320347 DOI: 10.5993/ajhb.42.1.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Kelly V. Ruggles
- Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Honoria Guarino
- National Development and Research Institutes, Incorporated, New York, NY, USA
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65
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Peteet BJ. Psychosocial risks of prescription drug misuse among U.S. racial/ethnic minorities: A systematic review. J Ethn Subst Abuse 2017; 18:476-508. [PMID: 29173117 DOI: 10.1080/15332640.2017.1381662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prescription drug misuse (PDM) is the leading cause of accidental death in the U.S. One in five Americans report at least one lifetime incident of PDM. PDM has been studied extensively, yet there is limited inclusion of racial/ethnic minorities due to purportedly lower rates of PDM. However, health disparate groups often face more detrimental consequences of substance abuse including behavioral, social, and medical/mental health (e.g., injury, HIV/AIDS, incarceration, educational attainment, and comorbidity). Failing to characterize risk factors for and consequences of PDM in racial/ethnic minorities may mask the disproportionate negative impact of this epidemic. This systematic review of three research indexes revealed 28 peer-reviewed studies published on PDM in racial/ethnic minority adults. Results indicated a high prevalence of PDM among veterans, bisexual and gay young adults, and substance abusers compared to the general population. Demographic correlates of PDM included younger age, male gender, less educated, unmarried, and those with health/emotional issues. Rates of PDM in demographically vulnerable populations suggest that broadening inclusiveness in PDM research, interventions, and clinical practice is imperative.
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66
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Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study. Pain 2017; 157:2173-2178. [PMID: 27227693 DOI: 10.1097/j.pain.0000000000000624] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to examine the association of context of prescription opioid exposure (ie, medical or nonmedical) in adolescence with the subsequent risk of nonmedical use of prescription opioids (NMUPO) and substance use disorder (SUD) symptoms at age 35. Multiple cohorts of nationally representative probability samples of U.S. high school seniors (n = 4072) were surveyed through self-administered questionnaires and followed longitudinally from adolescence (modal age 18, graduating classes 1976-1996) to age 35 (1993-2013). Main outcome measures were past-year NMUPO and SUD symptoms. The medical and NMUPO during adolescence was significantly associated with NMUPO at age 35. Relative to no prescription opioid exposure, medical use of prescription opioids without any history of NMUPO during adolescence was not associated with SUD symptoms at age 35. In contrast, compared with no prescription opioid exposure during adolescence, the adjusted odds ratios (AORs) associated with SUD symptoms at age 35 were greater among those with a history of both medical use of prescription opioids and NMUPO during adolescence, AOR = 1.49 (95% CI = 1.13-1.97); and among those who reported NMUPO only, AOR = 2.61 (95% CI = 1.88-3.61). The findings indicate medical use of prescription opioids without any history of NMUPO in adolescence is not associated with SUD symptoms at age 35, whereas any NMUPO in adolescence predicts SUD symptoms at age 35. Screening instruments and preventive intervention programs to reduce NMUPO and SUDs must account for the context associated with prescription opioid exposure during adolescence.
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67
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Chen WJ, Wu SC, Tsay WI, Chen YT, Hsiao PC, Yu YH, Ting TT, Chen CY, Tu YK, Huang JH, Yang HJ, Li CY, Strong C, Yen CF, Yen CF, Hsu J. Differences in prevalence, socio-behavioral correlates, and psychosocial distress between club drug and hard drug use in Taiwan: Results from the 2014 National Survey of Substance Use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:99-107. [DOI: 10.1016/j.drugpo.2017.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/08/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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68
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Ford JA, Sacra SA, Yohros A. Neighborhood characteristics and prescription drug misuse among adolescents: The importance of social disorganization and social capital. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:47-53. [DOI: 10.1016/j.drugpo.2017.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/05/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
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69
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Forster M, Gower AL, Borowsky IW, McMorris BJ. Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents. Addict Behav 2017; 68:30-34. [PMID: 28088740 DOI: 10.1016/j.addbeh.2017.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/05/2016] [Accepted: 01/04/2017] [Indexed: 01/22/2023]
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.
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70
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Trends in the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents in 22 European countries. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/nsad-2014-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims Tranquillisers and sedatives are valuable medicines with high misuse potential, increasingly used by adolescents without a doctor's prescription. We examined the changing association between lifetime non-prescribed use of tranquillisers or sedatives and their prescribed use in European adolescents in 2003-2011. Design Cross-sectional data from 199,231 16-year-old students were collected through anonymous questionnaires administered in schools in 22 European countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2003, 2007 and 2011. Results Logistic regression analyses showed a modest increase in lifetime non-prescribed use of tranquillisers or sedatives (adjusted OR [AOR] = 1.08, 95% CI: 1.06-1.11, p < 0.001) and a decrease in prescribed use (AOR = 0.89, 95% CI: 0.87-0.91, p < 0.001) between 2003 and 2011. Adjusting for gender and survey year, any versus no prescribed use increased the odds tenfold for non-prescribed use (AOR = 10.15, 99% CI: 9.60-10.74, p < 0.001). Adjusting also for changes in cannabis use did not affect the strength of the association. Interactions of factors with survey year showed that between 2003 and 2011, there was an increase of 38% in the odds that tranquilliser or sedative misusers had not used these drugs also with a doctor's prescription (AOR = 1.38, 99% CI: 1.28-1.50, p < 0.001). Conclusion The waning strength of the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents may suggest changes both in the patterns of use and the channels of diversion and access to this class of medication in Europe.
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71
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Abstract
Drug-related overdoses are now the leading injury-related death in the USA, and many of these deaths are associated with illicit opioids and prescription opiate pain medication. This study uses multiple sources of data to examine accidental opioid overdoses across 6 years, 2010 through 2015, in Marion County, IN, an urban jurisdiction in the USA. The primary sources of data are toxicology reports from the county coroner, which reveal that during this period, the most commonly detected opioid substance was heroin. During the study period, 918 deaths involved an opiod, and there were significant increases in accidental overdose deaths involving both heroin and fentanyl. In order to disentangle the nature and source of opioid overdose deaths, we also examine data from Indiana's prescription drug monitoring program and the law enforcement forensic services agency. Results suggest that there have been decreases in the number of opiate prescriptions dispensed and increases in law enforcement detection of both heroin and fentanyl. Consistent with recent literature, we suggest that increased regulation of prescription opiates reduced the likelihood of overdoses from these substances, but might have also had an iatrogenic effect of increasing deaths from heroin and fentanyl. We discuss several policy implications and recommendations for Indiana.
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Affiliation(s)
- Bradley Ray
- School of Public & Environmental Affairs, Indiana University – Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Kenna Quinet
- School of Public & Environmental Affairs, Indiana University – Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Timothy Dickinson
- School of Public & Environmental Affairs, Indiana University – Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Dennis P. Watson
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA
| | - Alfarena Ballew
- Marion County (Indiana) Coroner’s Office, Indianapolis, IN USA
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72
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McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976-2015. Pediatrics 2017; 139:peds.2016-2387. [PMID: 28320868 PMCID: PMC5369669 DOI: 10.1542/peds.2016-2387] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015. METHODS The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids. RESULTS Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use. CONCLUSIONS Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, .,Substance Abuse Research Center
| | - Brady T. West
- Survey Research Center, Institute for Social Research
| | - Phil Veliz
- Institute for Research on Women and Gender
| | - Vita V. McCabe
- Department of Surgery, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan
| | | | - Carol J. Boyd
- Institute for Research on Women and Gender,,School of Nursing, and,Addiction Research Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; and
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73
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McCabe SE, Veliz P, Wilens TE, Schulenberg JE. Adolescents' Prescription Stimulant Use and Adult Functional Outcomes: A National Prospective Study. J Am Acad Child Adolesc Psychiatry 2017; 56:226-233.e4. [PMID: 28219488 PMCID: PMC5462599 DOI: 10.1016/j.jaac.2016.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/30/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the prospective 17-year relationship between the medical and nonmedical use of prescription stimulants during adolescence (age 18 years) and educational attainment and substance use disorder (SUD) symptoms in adulthood (age 35 years). METHOD A survey was self-administered by nationally representative probability samples of US high school seniors from the Monitoring the Future study; 8,362 of these individuals were followed longitudinally from adolescence (age 18, high school senior years 1976-1996) to adulthood (age 35, 1993-2013). RESULTS An estimated 8.1% reported medical use of prescription stimulants, and 16.7% reported nonmedical use of prescription stimulants by age 18 years. Approximately 43% of adolescent medical users of prescription stimulants had also engaged in nonmedical use of prescription stimulants during adolescence. Among past-year adolescent nonmedical users of prescription stimulants, 97.3% had used at least one other substance during the past year. Medical users of prescription stimulants without any history of nonmedical use during adolescence did not differ significantly from population controls (i.e., non-attention-deficit/hyperactivity disorder [ADHD] and non-stimulant-medicated ADHD during adolescence) in educational attainment and SUD symptoms in adulthood. In contrast, adolescent nonmedical users of prescription stimulants (with or without medical use) had lower educational attainment and more SUD symptoms in adulthood, compared to population controls and medical users of prescription stimulants without nonmedical use during adolescence. CONCLUSION Nonmedical use of prescription stimulants is common among adolescents prescribed these medications. The findings indicate youth should be carefully monitored for nonmedical use because this behavior is associated with lower educational attainment and more SUD symptoms in adulthood.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor; Substance Abuse Research Center, University of Michigan.
| | - Philip Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 48109
| | - Timothy E. Wilens
- Pediatric and Adult Psychopharmacology Units, Massachusetts General Hospital, Boston, MA 02114 and School of Medicine, Department of Psychiatry, Harvard University, Boston, MA 02115
| | - John E. Schulenberg
- Institute for Social Research and Department of Psychology, University of Michigan, Ann Arbor, MI, USA 48106-1248
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74
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McCabe SE, Veliz P, Boyd CJ, Schulenberg JE. Medical and nonmedical use of prescription sedatives and anxiolytics: Adolescents' use and substance use disorder symptoms in adulthood. Addict Behav 2017; 65:296-301. [PMID: 27569697 DOI: 10.1016/j.addbeh.2016.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/24/2016] [Accepted: 08/13/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study assessed the longitudinal associations between medical and nonmedical use of prescription sedatives/anxiolytics (NMPSA) during adolescence (age 18) and substance use disorder (SUD) symptoms during adulthood (age 35). METHODS Multiple cohorts of nationally representative samples of U.S. high school seniors (n=8373) were surveyed via self-administered questionnaires and followed longitudinally from adolescence (age 18, 1976-1996) to adulthood (age 35, 1993-2013). RESULTS An estimated 20.1% of adolescents reported lifetime medical or nonmedical use of prescription sedatives/anxiolytics. Among adolescents who reported medical use of prescription sedatives/anxiolytics, 44.9% also reported NMPSA by age 18. Based on multivariate analyses that included age 18 sociodemographic and other substance use controls, medical use of prescription sedatives/anxiolytics without any history of NMPSA during adolescence was not associated with SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use. In contrast, adolescents with a history of both medical and nonmedical use of prescription sedatives/anxiolytics and adolescents who reported only NMPSA had between two to three times greater odds of SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use and those who reported only medical use of prescription sedatives/anxiolytics. CONCLUSIONS One in every five U.S. high school seniors reported ever using prescription sedatives/anxiolytics either medically or nonmedically. This study provides compelling evidence that the medical use of prescription sedatives/anxiolytics (without any NMPSA) during adolescence is not associated with increased risk of SUD symptoms in adulthood while any NMPSA during adolescence serves as a signal for SUDs in adulthood.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan, Institute for Research on Women and Gender, Substance Abuse Research Center, Ann Arbor 48109, MI, USA.
| | - Philip Veliz
- University of Michigan, Institute for Research on Women and Gender, Ann Arbor 48109, MI, USA
| | - Carol J Boyd
- University of Michigan, School of Nursing, Department of Psychiatry, Institute for Research on Women and Gender, Ann Arbor 48109, MI, USA
| | - John E Schulenberg
- University of Michigan, Institute for Social Research, Department of Psychology, Ann Arbor 48106, MI, USA
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75
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Martins SS, Ghandour LA. Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon. World Psychiatry 2017; 16:102-104. [PMID: 28127929 PMCID: PMC5269500 DOI: 10.1002/wps.20350] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public HealthNew YorkNYUSA
| | - Lilian A. Ghandour
- Department of Epidemiology and Population HealthAmerican University of BeirutBeirutLebanon
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76
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Gau JM, Brooke EJ. An Assessment of the Impact of a Multipronged Approach to Reducing Problematic Pain Clinics in Florida. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616681273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research evaluates recent changes to Florida law and policy to reduce problematic pain clinics (pill mills) and criminal diversion of prescription opioids. These changes entailed a multipronged effort linking regulatory and criminal-law approaches. Quantitative data from the Florida Department of Health and qualitative data from in-depth interviews with law-enforcement officers assigned to pill-mill taskforces reveal steep declines in pain clinics and pill mills. Respondents credit some regulatory enhancements for the reduction, although they describe some interagency cooperation problems and emphasize that despite success, many troublesome establishments continue to operate. The results suggest that Florida’s effort to reduce opioid diversion by tightening regulatory restrictions and law-enforcement scrutiny illustrates a multiagency approach to a problem spanning public health and criminal justice. This could be an example for other states seeking to combat problems that cannot be effectively addressed using regulatory or criminal law alone.
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77
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McCabe SE, Kloska DD, Veliz P, Jager J, Schulenberg JE. Developmental course of non-medical use of prescription drugs from adolescence to adulthood in the United States: national longitudinal data. Addiction 2016; 111:2166-2176. [PMID: 27338559 PMCID: PMC5183528 DOI: 10.1111/add.13504] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/04/2016] [Accepted: 06/16/2016] [Indexed: 11/30/2022]
Abstract
AIMS To identify the developmental course of non-medical use of four separate prescription drug classes (opioids, sedatives, stimulants and tranquilizers) by examining the general functional growth and related covariates during the transition from adolescence to adulthood in the United States. DESIGN Nationally representative probability samples of high school seniors were followed longitudinally across five waves (waves 1, 2, 3, 4 and 5: modal ages 18, 19/20, 21/22, 23/24 and 25/26 years, respectively). SETTING Data were collected via self-administered questionnaires to high school seniors and young adults in the United States. PARTICIPANTS The sample consisted of nearly 72 000 individuals in 30 cohorts (high school senior years of 1977-2006) who participated in at least one wave. MEASUREMENTS Self-reports of annual non-medical use of prescription opioids, sedatives, stimulants, and tranquilizers. FINDINGS The annual non-medical use of prescription opioids, sedatives, stimulants and tranquilizers was highest at wave 1 over the five waves. There was a consistent descending path (linear and quadratic slopes, P < 0.001) in annual non-medical use from baseline across all four prescription drug classes (e.g. opioids linear slope = -0.043 and opioids quadratic slope = 0.034, P < 0.001). While the annual non-medical use of stimulants declined over time (linear slope = 0.063, P < 0.01; quadratic slope = -0.133, P < 0.001), the same decrease was not observed for the annual non-medical use of prescription opioids, sedatives or tranquilizers when controlling for socio-demographic and substance use behaviors at baseline. The covariates associated with the general functional growth differed across the four prescription drug classes. CONCLUSIONS The non-medical use of prescription opioids, sedatives, stimulants and tranquilizers appears to peak during late adolescence, suggesting preventive intervention efforts should be initiated in early adolescence. The developmental course of non-medical use is not the same among all four classes of prescription drugs, suggesting that each drug class warrants individual research.
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Affiliation(s)
- Sean Esteban McCabe
- University of Michigan, Substance Abuse Research Center and Institute for Research on Women and Gender, Ann Arbor, MI, USA 48109
| | - Deborah D. Kloska
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA 48106
| | - Philip Veliz
- University of Michigan, Institute for Research on Women and Gender, Ann Arbor, MI, USA 48109
| | - Justin Jager
- Arizona State University, T. Denny Sanford School of Social and Family Dynamics, 951 S. Cady Hall, SS 144, Tempe, AZ 85287
| | - John E. Schulenberg
- University of Michigan, Institute for Social Research and Department of Psychology, Ann Arbor, MI, USA 48106
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78
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Ayres CG, Pontes NM, Pontes MCF. Understanding the Nonmedical Use of Prescription Medications in the U.S. High School Adolescents. J Sch Nurs 2016; 33:269-276. [PMID: 27837175 DOI: 10.1177/1059840516677322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The purpose of the study was to examine relationships between sleep insufficiency, depressive symptoms, demographic factors, and the nonmedical use of prescription medications (NMUPMs) in the U.S. high school students. Data from the 2013 Youth Risk Behavioral Surveillance System were used ( n = 13,570) and analyzed using IBM SPSS 23™ (complex samples). Significant bivariate relationships were found between the NMUPMs and sleep ( p < .01), feeling sad ( p < .001), grade level ( p < .001), and race/ethnicity ( p < .01). Logistic regression analyses found that all of the independent variables were significant in predicting the likelihood of the NMUPMs. Findings underscore the potential impact of preventing NMUPMs in high school adolescents by improving their sleep behaviors and assessing adolescents for depressive symptoms.
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Affiliation(s)
- Cynthia G Ayres
- 1 Rutgers School of Nursing-Camden, Rutgers University, Camden, NJ, USA
| | - Nancy M Pontes
- 1 Rutgers School of Nursing-Camden, Rutgers University, Camden, NJ, USA
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79
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Jeanne G, Purper-Ouakil D, Rigole H, Franc N. [New patterns of substance use and abuse among French adolescents, a knowledge synthesis]. Encephale 2016; 43:346-353. [PMID: 27720453 DOI: 10.1016/j.encep.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/20/2022]
Abstract
AIM There have been significant changes in adolescent consumption habits over the past fifteen years. New molecules have been synthesized, new devices created and a number of products have increased in popularity; and as a result clinicians sometimes lack information. We chose to focus on this population because of its vulnerability, as adolescents show low sensitivity to long-term outcomes of their actions and may be easily influenced by peers as regards experimentation of new drugs. The most consumed products by adolescents in France are tobacco, alcohol and cannabis with the physiological effects and consumption patterns of these drugs well documented. The purpose of this review is to identify and describe other products that are frequently used by adolescents to get high, to increase performance, for purposes of self-medication or because of peer pressure. We summarized the current scientific evidence regarding drug availability, physical and chemical properties, pharmacodynamics and adverse effects. METHOD A literature review was conducted from 2000 to 2015 based on Pudmed, Google Scholar and governmental websites, using the following keyword alone or in combination: "adolescent", "new", "misuse", "abuse", "toxicity", "pharmacology" "cocaine", "MDMA", "inhalant", "poppers", "magic mushroom", "psilocybin", "designer drug", "legal high", "smart drug", "cathinone", "mephedrone", "cannabinoid", "prescription drug", "codeine", "opioid", "methylphenidate", "cough syrup", "purple drank". RESULTS New products, including synthetic cannabis, cathinone or purple drank seem to be the most dangerous. They are easily accessible and may lead to short-term severe or lethal complications. Other substances do not pose a major short-term health risk by themselves. However, their consumption may be an indication of other unhealthy risk behaviors, such as prescription drug use, which may be related to psychiatric comorbidity. Unfortunately, we do not have enough data to determine the long-term consequences of the use of these substances. Moreover, these products have a strong addictive potential and may be a risk factor for other addictions. For this reason, increased supervision is justified, both for surveillance and reduction of harm. CONCLUSION Taking care of an adolescent with substance abuse can be difficult. Updated information regarding these new substances and the particular danger they pose to adolescent health is needed. Informed clinicians can provide up to date and accurate information to the patient and family, assess potential risk factors and comorbidities, and provide appropriate support. Furthermore, because of the high prevalence of substance abuse in the adolescent population, systematic screening of adolescent consumption habit is useful to avoid or anticipate complications. Often, problematic substance consumption behaviors are signs of more complicated psychological or psychiatric issues. Substance abuse behaviors will often disappear over time but they can also become a major problem as the adolescent moves into adulthood. If problems persist, consultation with an addiction specialist may be warranted.
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Affiliation(s)
- G Jeanne
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - D Purper-Ouakil
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - H Rigole
- Service de médecine interne et addictologie, CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - N Franc
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
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Boyd CJ, Cranford JA, McCabe SE. Longitudinal trajectories of non-medical use of prescription medication among middle and high school students. J Addict Dis 2016; 35:258-265. [PMID: 27167900 PMCID: PMC5086405 DOI: 10.1080/10550887.2016.1186413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The 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.
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Affiliation(s)
- Carol J. Boyd
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
- Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - James A. Cranford
- Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
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81
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Klein TA, Panther S, Woo T, Odom-Maryon T, Daratha K. Childhood Attention-Deficit/Hyperactivity Disorder Prescribing by Prescriber Type and Specialty in Oregon Medicaid. J Child Adolesc Psychopharmacol 2016; 26:548-54. [PMID: 27135134 DOI: 10.1089/cap.2015.0255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study compares nurse practitioner (NP) and physician (MD/DO) prescribing patterns for treatment of children with an attention-deficit/hyperactivity disorder (ADHD)-related diagnosis covered by Oregon Medicaid from 2012 to 2013. METHODS This study is a limited data set review of Oregon pharmacy claims for youth aged 3-18 at time of prescription fill, who were continuously enrolled for at least 10 months of the index year. Claims with selected ICD-9 codes (n = 197,364) were further defined by 30-day prescriptions and prescription drug events (PDE) linked to each prescriber type of interest. Descriptive statistical analysis of variables included prescriber type (NP vs. physician) and specialty (generalist vs. specialist), child age, and controlled versus noncontrolled drug type. RESULTS A total of 82,754 complete 30-day prescriptions for 10,753 children from 1785 unique prescribers (78 NP specialists; 303 NP generalists; 162 physician specialists; and 1242 physician generalist prescribers) and 16,669 PDE were analyzed. Physicians prescribed more than 81% of all ADHD medications, and physician generalists prescribed nearly 60% of all prescriptions. Sixty-four percent of 30-day supply prescriptions (n = 52,678) were controlled substances. Generalists, both NPs and physician prescribers, prescribed controlled medications more often than specialists. Physician specialists consistently prescribed controlled substances for all age groups, while NP specialists prescribed more controlled substances as child age increased. Rates of controlled medications prescribed generally increased, as children got older, regardless of provider type. CONCLUSION NPs overall prescribe in a similar pattern to physicians when given the authority to prescribe controlled substances for ADHD. Comparisons between prescriber types for controlled substance prescribing by age should be explored further to identify possible variance from national guidelines.
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Affiliation(s)
- Tracy A Klein
- 1 College of Nursing, Washington State University , Vancouver and Spokane, Washington
| | - Shannon Panther
- 2 College of Pharmacy, Washington State University , Spokane, Washington
| | - Teri Woo
- 3 Pacific Lutheran University , Tacoma, Washington
| | - Tamara Odom-Maryon
- 1 College of Nursing, Washington State University , Vancouver and Spokane, Washington
| | - Kenn Daratha
- 1 College of Nursing, Washington State University , Vancouver and Spokane, Washington
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Conn BM, Marks AK. An Ecological Approach to Understanding Adolescent Prescription Drug Misuse. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558415589369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nonmedical use of prescription drugs (NMUPD) among U.S. adolescents is a burgeoning public health problem. Previous studies have observed differences in rates of NMUPD among ethnic/racial groups. However, less is known on the social and cultural processes and mechanisms, which may influence adolescents’ prescription drug beliefs and practices. We conducted semi-structured interviews with 20 diverse 13- to 17-year-olds in an adolescent psychiatric inpatient unit to elicit in-depth, context-sensitive information about social factors relevant to NMUPD. Data analysis was completed using grounded theory and interpreted with a social ecological approach. Results highlighted the myriad of important contextual influences on adolescent NMUPD. Responses reflected factors within microsystem, exosystem, and macrosystem contexts as well as important intrapersonal factors. Furthermore, adolescents who identified as an ethnic minority also described cultural values (e.g., religion) and culturally based beliefs (e.g., mental health stigma), which influenced their prescription drug beliefs. Narratives revealed the interplay between intrapersonal factors and socialization agents, such as parents, peers, and the media, influencing prescription drug behavior. Our findings present ecologically framed insights as a first step in understanding this health risk behavior among U.S. adolescents. Implications as well as important next steps for future research and interdisciplinary prevention and intervention program development are discussed.
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Peiper NC, Ridenour TA, Hochwalt B, Coyne-Beasley T. Overview on Prevalence and Recent Trends in Adolescent Substance Use and Abuse. Child Adolesc Psychiatr Clin N Am 2016; 25:349-65. [PMID: 27338960 DOI: 10.1016/j.chc.2016.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Substance use and consequent disorders have burdened US health care, criminal justice, and society at large for centuries. Pathological substance use almost invariably begins before 25 years of age, demonstrating how critical adolescence is within the etiology, prevention, and treatment of substance use disorder. This article provides a high-level overview of the prevalence of substance use disorders to provide a context within which the remaining issue provides in-depth descriptions of the evidence on specific topics. Described herein are trends in substance use, substance use disorder, and demographic comparisons.
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Affiliation(s)
- Nicholas C Peiper
- RTI International, Behavioral and Urban Health Program, Research Triangle Park, NC 27709-2194, USA
| | - Ty A Ridenour
- RTI International, Behavioral and Urban Health Program, Research Triangle Park, NC 27709-2194, USA
| | - Bridget Hochwalt
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina, CB # 7225, 231 MacNider, Chapel Hill, NC 27599, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina, CB # 7225, 231 MacNider, Chapel Hill, NC 27599, USA.
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Stewart TD, Reed MB. Lifetime nonmedical use of prescription medications and socioeconomic status among young adults in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 41:458-64. [PMID: 26337203 DOI: 10.3109/00952990.2015.1060242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite decreases in the use of illicit drugs in the United States, prescription medications have become a major category of substances used by young adults. OBJECTIVE This study examines the relationship between the socioeconomic status (SES) of young adult respondents (ages 24-32) and their history of nonmedical use of prescription medications (NUPM). METHOD A secondary analysis was conducted with nationally representative data gathered from several waves (n = 15 701) of the National Longitudinal Study of Adolescent Health (Add Health). Four categories of NUPM were examined: (i) sedatives; (ii) tranquilizers; (iii) stimulants; and (iv) pain killers. SES was defined by several measures in the Add Health survey. Given the complex sampling plan of the Add Health, all analyses were weighted appropriately. RESULTS Results indicated higher levels of personal SES, such as having health insurance or not experiencing a financial hardship in the past year, decreased the likelihood of reporting lifetime NUPM. In contrast higher levels of parent SES (e.g. parental education) were associated with an increased likelihood of reporting lifetime use of NUPM tranquilizers and stimulants. CONCLUSIONS The results of this study suggest parental SES may have a stronger influence over NUPM than personal levels of SES, particularly for the categories of tranquilizers and stimulants. Furthermore, these findings indicate more research is needed on this subject to better understand the NUPM epidemic in order to effectively develop comprehensive clinical, public health, and policy-related intervention and prevention approaches.
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Affiliation(s)
- Thomas Darryl Stewart
- a Center for Alcohol and Drug Research, San Diego State University School of Social Work , San Diego , CA , USA
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McCabe SE, Veliz P, Boyd CJ. Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts. Drug Alcohol Depend 2016; 163:55-63. [PMID: 27129621 PMCID: PMC4921894 DOI: 10.1016/j.drugalcdep.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents. METHODS A Web-based survey was self-administered by Detroit-area secondary school students (N=4755) between the 2009-10 and 2012-13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories. RESULTS During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n=322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n=124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation. CONCLUSIONS More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA; Substance Abuse Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Phil Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 204 S. State St., Ann Arbor, MI, USA 48109-1290
| | - Carol J. Boyd
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 204 S. State St., Ann Arbor, MI, USA 48109-1290,School of Nursing, University of Michigan, Ann Arbor, MI,Addiction Research Center, University of Michigan, Ann Arbor, MI
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DeBeck K, Wood E, Dong H, Dobrer S, Hayashi K, Montaner J, Kerr T. Non-medical prescription opioid use predicts injection initiation among street-involved youth. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 34:96-100. [PMID: 27450321 DOI: 10.1016/j.drugpo.2016.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/18/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Room 667, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sabina Dobrer
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Room 667, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Room 667, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Room 667, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Gibbs EL, Kass AE, Eichen DM, Fitzsimmons-Craft EE, Trockel M, Wilfley DE, Taylor CB. Attention-deficit/hyperactivity disorder-specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:300-308. [PMID: 26822019 PMCID: PMC4904716 DOI: 10.1080/07448481.2016.1138477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. PARTICIPANTS Four hundred forty-eight college-age women aged 18-25 at high risk for or with a clinical or subclinical eating disorder. METHODS Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. RESULTS Greater eating disorder pathology, objective binge eating, purging, eating disorder-related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. CONCLUSIONS ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.
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Affiliation(s)
| | - Andrea E. Kass
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- The mHealth Institute, Palo Alto University, Palo Alto, CA, USA
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88
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De La Rosa M, Huang H, Rojas P, Dillon FR, Lopez-Quintero C, Li T, Ravelo GJ. Influence of mother-daughter attachment on substance use: a longitudinal study of a Latina community-based sample. J Stud Alcohol Drugs 2016; 76:307-16. [PMID: 25785806 DOI: 10.15288/jsad.2015.76.307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Advancing our initial, cross-sectional study, which showed that adult Latinas' mother-daughter attachment relates to their substance use, the current, longitudinal study tests whether mother and daughter attachment scores at baseline predict their substance use over time. METHOD We analyzed data from a convenience sample of 133 Latina adult mothers (mean age = 52 years, SD = 10) and 133 Latina adult daughters (mean age = 27, SD = 9) at baseline and at 5-year and 6-year follow-ups after baseline (attrition rate = 16%). Multilevel longitudinal modeling was used to examine the effect of mother-daughter attachment at baseline on their substance use over time. RESULTS Each unit of increase in the attachment score at baseline is associated with a 0.28 drink decrease in monthly alcohol use (p < .05) and a lower likelihood of being a heavy alcohol or other drug user [exp(β) = 0.97, p < .01] compared with average attachment score at baseline (M = 91.52, SD = 18.00). Time and older age at baseline are associated with decreased substance use. Being born outside the United States is associated with decreased risk of heavy alcohol or other drug use. Being a mother is associated with increased substance use. CONCLUSIONS The findings of this longitudinal study on adult Latinas indicate that mother-daughter attachment has long-lasting effects on substance use trajectories among adult Latinas. Future research should focus on (a) investigating social and cultural factors mediating this relationship and (b) greater substance use among Latina mothers compared with daughters.
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Affiliation(s)
- Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Hui Huang
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Patria Rojas
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
| | - Frank R Dillon
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, Division of Counseling Psychology, Department of Educational & Counseling Psychology, School of Education, University at Albany - State University of New York, Albany, New York
| | - Catalina Lopez-Quintero
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
| | - Tan Li
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Gira J Ravelo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
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Relationship Between Gambling Severity and Attitudes in Adolescents: Findings from a Population-Based Study. J Gambl Stud 2016; 31:717-40. [PMID: 25063468 DOI: 10.1007/s10899-014-9481-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study used a nationally representative sample of 14,910 high school adolescents, aged 15-19 years. The large sample size presents a unique opportunity to evaluate firstly the geographical distribution of gambling prevalence, secondly, on a subsample of 5,920 adolescents, we studied the association of "no-problem-gambling", "at-risk gambling" and a relatively rare condition, "problem gambling", with demographic, environmental and behavioral variables. It differs from other studies due to the broad sample, thus enabling the combined analysis of the above variables that typically have only been studied separately. This integrated analysis, involving multiple variables, individual and environmental, allows the control of important covariates. Multivariate analysis showed that at-risk/problem gamblers were more likely to be engaged in behaviors contrary to social rules/law including heavy episodic drinking, tranquillizer/sedatives use as well as to approve gambling and have friends who gamble. It's important to emphasize that risk-perception is not related to gambling. Furthermore, the great geographical variability of at-risk and problem-gambling rates suggest that social aspects have to be considered. Currently universal prevention specifically targeting gambling is lacking, thus an associative model such as social analysis have been implemented in this study, in order to construct the basis for the design of a future prevention program based on scientific results and thus having important implications for implementation within community based activities. Prevention is fundamental: 53.5% of underage individuals have engaged in gambling even though legislation attempts to restrict access.
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90
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Blanch B, Buckley NA, Mellish L, Dawson AH, Haber PS, Pearson SA. Harmonizing post-market surveillance of prescription drug misuse: a systematic review of observational studies using routinely collected data (2000-2013). Drug Saf 2016; 38:553-64. [PMID: 25968812 DOI: 10.1007/s40264-015-0294-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prescription drug misuse is a growing public health concern globally. Routinely collected data provide a valuable tool for quantifying prescription drug misuse. OBJECTIVE To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. METHODS The MEDLINE, EMBASE, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar databases were searched for relevant articles published between 1 January 2000 and 31 July 2013. A total of 10,803 abstracts were screened and 281 full-text manuscripts were retrieved. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria-an aim/method investigating prescription drug misuse in adults and a measure of misuse derived exclusively from prescription/dispensing data. RESULTS Four proxies of prescription drug misuse were commonly used across studies: number of prescribers, number of dispensing pharmacies, early refills and volume of drugs dispensed. Overall, 89 unique measures of misuse were identified across the 52 studies, reflecting the heterogeneity in how measures are constructed: single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported 0.01-93.5 %), variations and factors associated with prescription drug misuse. CONCLUSIONS Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.
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Affiliation(s)
- Bianca Blanch
- Pharmacoepidemiology and Pharmaceutical Policy Research Group, Faculty of Pharmacy, University of Sydney, A15-Pharmacy and Bank Building, Sydney, NSW, 2006, Australia,
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Baumbauer KM, Young EE, Starkweather AR, Guite JW, Russell BS, Manworren RCB. Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations. Med Clin North Am 2016; 100:183-97. [PMID: 26614727 PMCID: PMC4766002 DOI: 10.1016/j.mcna.2015.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the adult population chronic pain can lead to loss of productivity and earning potential, and decreased quality of life. There are distinct groups with increased vulnerability for the emergence of chronic pain. These groups may be defined by developmental status and/or life circumstances. Within the pediatric, geriatric, and drug abuser populations, chronic pain represents a significant health issue. This article focuses on known anatomic, physiologic, and genetic mechanisms underlying chronic pain in these populations, and highlights the need for a multimodal approach from multiple health care professionals for management of chronic pain in those with the most risk.
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Affiliation(s)
- Kyle M Baumbauer
- School of Nursing, The Center for Advancing Management of Pain, University of Connecticut, Storrs, CT 06269-4026, USA; Department of Neuroscience, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA; Institute for Systems Genomics, University of Connecticut Health Center, 400 Farmington Ave, CT 06030, USA
| | - Erin E Young
- School of Nursing, The Center for Advancing Management of Pain, University of Connecticut, Storrs, CT 06269-4026, USA; Institute for Systems Genomics, University of Connecticut Health Center, 400 Farmington Ave, CT 06030, USA; Department of Genetics and Genome Sciences, University of Connecticut Health Center, 400 Farmington Ave, Farmington, CT 06030, USA
| | - Angela R Starkweather
- School of Nursing, The Center for Advancing Management of Pain, University of Connecticut, Storrs, CT 06269-4026, USA
| | - Jessica W Guite
- Department of Pediatrics, University of Connecticut School of Medicine, 236 Farmington Ave, Farmington, CT 06030, USA; Children's Center for Community Research (C3R), 12 Charter Oak Place, Hartford, CT 06106, USA; Pediatric Psychology, Hartford Hospital/The Institute of Living, 100 Retreat, Suite 515, Hartford, CT 06106, USA; Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA
| | - Beth S Russell
- Human Development & Family Studies, University of Connecticut, 368 Mansfield Rd, Storrs, CT 06269-1058, USA
| | - Renee C B Manworren
- School of Nursing, The Center for Advancing Management of Pain, University of Connecticut, Storrs, CT 06269-4026, USA; Department of Pediatrics, University of Connecticut School of Medicine, 236 Farmington Ave, Farmington, CT 06030, USA; Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA.
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92
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Clayton HB, Lowry R, August E, Everett Jones S. Nonmedical Use of Prescription Drugs and Sexual Risk Behaviors. Pediatrics 2016; 137:peds.2015-2480. [PMID: 26668299 PMCID: PMC9923584 DOI: 10.1542/peds.2015-2480] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Substance use is associated with sexual risk behaviors among youth, but little is known about whether nonmedical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors. METHODS Data from the 2011 and 2013 national Youth Risk Behavior Surveys, cross-sectional surveys conducted among nationally representative samples of students in grades 9 to 12 were combined (n = 29,008) to examine the association between ever taking prescription drugs without a doctor's prescription and sexual risk behaviors (ever having sexual intercourse, current sexual activity, lifetime number of sexual partners, condom use, and alcohol or drug use before last sexual intercourse). Using logistic regression models (adjusted for sex, race/ethnicity, grade, ever injection drug use, and use of alcohol, marijuana, heroin, cocaine, methamphetamines, ecstasy, and inhalants), we estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). RESULTS Nonmedical use of prescription drugs (NMUPD) was associated with ever having sexual intercourse (aPR 1.16 [95% CI 1.11-1.22]), being currently sexually active (1.26 [1.20-1.33]), having ≥ 4 lifetime sexual partners (1.45 [1.34-1.57]), drinking alcohol or using drugs before last sexual intercourse (1.32 [1.17-1.48]), and not using a condom at last sexual intercourse (1.14 [1.05-1.23]). As the frequency of NMUPD increased, the association between NMUPD and each of the sexual risk behaviors increased in strength, suggesting a dose-response relationship. CONCLUSIONS NMUPD is associated with sexual behaviors that put high school students at risk for sexually transmitted infections. These findings can be used to inform clinical and school-based interventions developed to reduce drug use and sexually transmitted infections.
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Affiliation(s)
- Heather B. Clayton
- Divisions of Adolescent and School Health, and,Address correspondence to: Heather Breeze Clayton, PhD, MPH, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-75, Atlanta, GA 30329. E-mail:
| | | | - Euna August
- HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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93
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Roy É, Nolin MA, Traoré I, Leclerc P, Vasiliadis HM. Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in Quebec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:556-63. [PMID: 26720824 PMCID: PMC4679164 DOI: 10.1177/070674371506001206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Élise Roy
- Full Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec
| | - Marc-Antoine Nolin
- Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec
| | - Issouf Traoré
- Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec
| | - Pascale Leclerc
- Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec
| | - Helen-Maria Vasiliadis
- Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec
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94
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Tucker JS, Ewing B, Miles JNV, Shih RA, Pedersen ER, D'Amico EJ. Predictors and consequences of prescription drug misuse during middle school. Drug Alcohol Depend 2015; 156:254-260. [PMID: 26455553 PMCID: PMC4640892 DOI: 10.1016/j.drugalcdep.2015.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Non-medical prescription drug use (NMPDU) is a growing public health problem among adolescents. This is the first study to examine the correlates of early NMPDU initiation during middle school, and how early initiation is associated with four domains of functioning in high school (mental health, social, academic, and delinquency). METHODS Students initially in 6th-8th grades from 16 middle schools completed in-school surveys between 2008 and 2011 (Waves 1-5), and a web-based survey in 2013-2014 (Wave 6). We used discrete time survival analysis to assess predictors of initiation from Waves 1 to 5 based on students who provided NMPDU information at any of these waves (n=12,904), and regression analysis to examine high school outcomes associated with initiation based on a sample that was followed into high school, Wave 6 (n=2539). RESULTS Low resistance self-efficacy, family substance use, low parental respect, and offers of other substances from peers were consistently associated with NMPDU initiation throughout middle school. Further, perceiving that more of one's peers engaged in other substance use was associated with initiation at Wave 1 only. By high school, those students who initiated NMPDU during middle school reported lower social functioning, and more suspensions and fighting, compared to students who did not initiate NMPDU during middle school. CONCLUSION NMPDU initiation during middle school is associated with poorer social functioning and greater delinquency in high school. It is important for middle school prevention programs to address NMPDU. Such programs should focus on both family and peer influences, as well as strengthening resistance self-efficacy.
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95
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Mowbray O, Quinn A. Prescription pain reliever misuse prevalence, correlates, and origin of possession throughout the life course. Addict Behav 2015; 50:22-7. [PMID: 26093503 DOI: 10.1016/j.addbeh.2015.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/12/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While a considerable amount of information is available concerning who is most likely to engage in prescription pain reliever misuse, few studies have examined whether the correlates of pain reliever misuse and sources of pain reliever possession are consistent across the life span. METHODS Data from the 2011-2012 National Survey in Drug Use and Health (NSDUH). Multivariate logistic regression examined clinical and social correlates of past-year pain reliever misuse, stratified by age. Additionally, bivariate analyses examined sources of pain reliever possession, and whether these origins differ by age. RESULTS Among respondents, 4.7% reported past-year prescription pain reliever misuse. Prevalence for individuals aged 12 to 17 was 5.9%, 18 to 25 was 10.2%, 26-34 was 7.7%, 35 to 49 was 4.3%, and individuals aged 50 or older was 1.7%. While many social and clinical correlates of pain reliever misuse emerged among younger respondents, these correlates diminished in significance among older adults. Only past-year illicit drug use disorders (marijuana, cocaine, crack cocaine, heroin, and hallucinogen use) was a significant predictor of pain reliever misuse among all age groups. Also, older adults were more likely to report pain reliever possession from multiple medical doctors, whereas younger individuals were more likely to possess pain reliever from friends/relatives or through purchase from a drug dealer/stranger. CONCLUSIONS Increased efforts to better screen for illicit drug use and greater efforts to coordinate patient prescription records among medical care providers may be high priorities in developing interventions to reduce rates of misuse of prescription pain relievers, especially among older adults.
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Affiliation(s)
- Orion Mowbray
- University of Georgia School of Social Work, United States.
| | - Adam Quinn
- University of Georgia School of Social Work, United States
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Koster ES, de Haan L, Bouvy ML, Heerdink ER. Nonmedical Use of Attention-Deficit/Hyperactivity Disorder Medication Among Secondary School Students in The Netherlands. J Child Adolesc Psychopharmacol 2015; 25:649-52. [PMID: 26447641 DOI: 10.1089/cap.2015.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE No studies in Europe have assessed the extent of nonmedical attention-deficit/hyperactivitiy disorder (ADHD) medication use among adolescents, while also, in Europe, prescribing of these medicines has increased. Our objective was to study the prevalence and motives for nonmedical ADHD medication use among secondary school students in the Netherlands. METHODS Adolescent students 10-19 years of age from six secondary schools were invited to complete an online survey on use of ADHD medication, tobacco, alcohol, and drugs. Nonmedical ADHD medication use was defined as self-reported use without a prescription during the previous 12 months. RESULTS Survey data were available for 777 students (15% response rate). The overall proportion of students self-reporting nonmedical ADHD medication use was 1.2% (n = 9), which represented almost 20% of the adolescents who reported ADHD medication use (n = 49). Most adolescents reported self-medication or enhancing study performance as motives for ADHD medication use. CONCLUSIONS The proportion of the study sample reporting nonmedical ADHD medication use in our study is lower compared with that in previous research conducted in the United States and Canada; however, on a population-based level, there might be a considerable proportion of recreational users.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht , the Netherlands
| | - Lydia de Haan
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht , the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht , the Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht UniversityUtrecht , the Netherlands
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97
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Patterns of concurrent substance use among adolescent nonmedical ADHD stimulant users. Addict Behav 2015; 49:1-6. [PMID: 26026384 DOI: 10.1016/j.addbeh.2015.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES There are growing concerns about nonmedical use of ADHD stimulants among adolescents; yet, little is known whether there exist heterogeneous subgroups among adolescents with nonmedical ADHD stimulant use according to their concurrent substance use. METHODS We used latent class analysis (LCA) to examine patterns of past-year problematic substance use (meeting any criteria for abuse or dependence) in a sample of 2203 adolescent participants from the National Surveys on Drug Use and Health 2006-2011 who reported past-year nonmedical use of ADHD stimulants. Multivariable latent regression was used to assess the association of socio-demographic characteristics, mental health and behavioral problems with the latent classes. RESULTS The model fit indices favored a four-class model, including a large class with frequent concurrent use of alcohol and marijuana (Alcohol/marijuana class; 41.2%), a second large class with infrequent use of other substances (Low substance class, 36.3%), a third class characterized by more frequent misuse of prescription drugs as well as other substances (Prescription drug+class; 14.8%), and finally a class characterized by problematic use of multiple substances (Multiple substance class; 7.7%). Compared with individuals in Low substance class, those in the other three classes were all more likely to report mental health problems, deviant behaviors and substance abuse service use. CONCLUSIONS Adolescent nonmedical ADHD stimulants users are a heterogeneous group with distinct classes with regard to concurrent substance use, mental health and behavioral problems. The findings have implications for planning of tailored prevention and treatment programs to curb stimulant use for this age group.
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Boyd CJ, Young A, McCabe SE. Psychological and drug abuse symptoms associated with nonmedical use of opioid analgesics among adolescents. Subst Abus 2015; 35:284-9. [PMID: 24905351 DOI: 10.1080/08897077.2014.928660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Approximately 18% of US adolescents engaged in prescription opioid abuse in 2013. However, this estimate may be misleading because it includes both medical misusers and nonmedical users, and there is evidence that these are 2 groups that differ relative to substance abuse and criminal risk. Thus, this study does not combine medical and nonmedical users; rather, it seeks to better understand the characteristics of nonmedical users. METHODS This was a school-based, cross-sectional study that was conducted during 2009-2010 in southeastern Michigan with a sample of 2627 adolescents using a Web-based survey. Three mutually exclusive groups were created based on responses regarding medical and nonmedical use of opioid analgesics. Group 1 had never used an opioid analgesic, Group 2 used an opioid analgesic only as prescribed, and Group 3 nonmedically used an opioid analgesic. In addition, Group 3 was divided into 2 mutually exclusive subgroups (self-treaters and sensation-seekers) based on reasons for nonmedical use. A series of multinomial logistic regressions were conducted to determine if the groups differed on the presence of pain, psychological symptoms (e.g., affective disorder, conduct disorder, attention-deficit/hyperactivity disorder [ADHD]), and drug abuse. RESULTS Sixty-five percent (65.0%) of the sample was white/Caucasian and 29.5% was African American. The average age was 14.8 years (SD = 1.9). Seventy percent (70.4%; n = 1850) reported no lifetime opioid use, 24.5% (n = 644) were medical users, 3.5% (n = 92) were nonmedical users who used for pain relief only, and 1.6% (n = 41) were classified as nonmedical users for reasons other than for pain relief (e.g., to get high). Both medical users and nonmedical users reported more pain and substance abuse symptoms compared with never users. Those nonmedical users who used opioids for sensation-seeking motivations had greater odds of having psychological symptoms. CONCLUSIONS These data support the need to further consider subgroups of nonmedical users of opioid analgesics.
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Affiliation(s)
- Carol J Boyd
- a School of Nursing , University of Michigan , Ann Arbor , Michigan , USA
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Monnat SM, Rigg KK. Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents. J Rural Health 2015; 32:204-18. [PMID: 26344571 PMCID: PMC4779738 DOI: 10.1111/jrh.12141] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE This study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences. METHODS We used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past-year POM among 32,036 adolescents aged 12-17. RESULTS Among adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past-year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past-year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs. CONCLUSIONS Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents' reliance on emergency departments where opioid prescribing is more likely.
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Affiliation(s)
- Shannon M. Monnat
- Department of Agricultural Economics, Sociology, and Education, Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania
| | - Khary K. Rigg
- Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, Florida
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Guo L, Xu Y, Deng J, He Y, Gao X, Li P, Wu H, Zhou J, Lu C. Non-medical use of prescription pain relievers among high school students in China: a multilevel analysis. BMJ Open 2015; 5:e007569. [PMID: 26169805 PMCID: PMC4513537 DOI: 10.1136/bmjopen-2014-007569] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Xu
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Jianxiong Deng
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Yuan He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xue Gao
- Center for ADR Monitoring of Guangdong, Guangzhou, China
| | - Pengsheng Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hong Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinhua Zhou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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