Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in Quebec

The nexus between gender, parental supervision, and opioid misuse among justice-involved adolescents

Justice-involved adolescents (JIA) are at higher risk for opioid misuse (OM) and opioid-related overdose than nonoffending adolescents. Untreated OM can lead to severe consequences (e.g., trauma), which may be harsher for female JIA. Therefore, examining risk and protective factors, such as parental supervision, is essential to identify factors that may impact OM. The current study used a statewide, cross-sectional dataset including 79,960 JIA from the Florida Department of Juvenile Justice. Stratified logistic regression analyses were conducted. Results indicated that JIA who experienced sporadic or inadequate supervision had 2.14 and 3.54 higher odds, respectively, of misusing opioids compared to JIA who experienced consistent supervision. Female JIA who experienced sporadic or inadequate supervision had 2.23 and 3.70 higher odds, respectively, of misusing opioids. Results suggest parental supervision is an important protective factor that should be considered in developing prevention and treatment efforts that serve JIA who misuse opioids, especially females.

Changing patterns of hospitalization for sedative misuse among youth aged 10-24 years in Quebec, Canada

Purpose

To assess trends in hospitalization for sedative misuse among youth.

Methods

Using a serial cross-sectional design, we computed hospitalization rates for sedative-related suicide attempts, sedative use disorders, and other sedative poisonings within individuals aged 5-24 years in Quebec, Canada. We computed sedative-related hospitalization rates in 2006-2011, 2012-2017, and 2018-2023, and examined differences according to age, sex, polysubstance use, mental health comorbidity, and social vulnerability using rate ratios (RR) and 95 % confidence intervals (CI) comparing the last time period relative to the first.

Results

Sedative-related hospitalization rates more than doubled during the study. Suicide attempts using sedatives increased from 50.5 per 100,000 youth in 2006-2011, to 82.2 in 2012-2017 and 114.4 in 2018-2023 (RR 2.26, 95 % CI 1.63-3.15), while sedative use disorders increased from 13.1 to 21.8 and 60.5 per 100,000 in these same time periods (RR 4.62, 95 % CI 2.54-8.40). Rates increased for 10-24 year-olds and in both sexes, particularly among youth with polysubstance use, anxiety and attention disorders, and social vulnerability.

Discussion

Sedative misuse requiring hospitalization appears to be a growing issue among youth.

Within-Person Predictors of Same-Day Alcohol and Nonmedical Prescription Drug Use Among Youth Presenting to an Urban Emergency Department

OBJECTIVE

Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets.

METHOD

At an urban emergency department, research assistants recruited youth ages 14-24 reporting past-6-month substance use (n = 599; 58.8% male). Participants self-administered validated measures of alcohol consumption, cannabis use severity (quantity and consequences), mental health symptoms, and social influences at baseline and at four biannual follow-ups. In addition, participants completed Timeline Followback calendars that assessed same-day use of alcohol and prescription drugs. We used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency.

RESULTS

Between 6.0% (baseline) and 8.6% (6-month follow-up) of youth reported same-day alcohol use and NMPDU across follow-ups. Within-person increases in alcohol consumption, cannabis use severity, and depression and anxiety symptoms all corresponded to greater same-day alcohol and NMPDU frequency, with consistent findings across genders. Increased positive peer behaviors corresponded to decreased same-day use frequency among males but not females. Decreased parental support and increased delinquent peer exposures corresponded to greater same-day use frequency among females but not males.

CONCLUSIONS

Substance use and mental health symptom escalation are robust predictors of greater same-day use frequency, whereas the roles of social factors appear gender-specific. Interrupting worsening trajectories of substance use and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same-day use frequency.

Self-Esteem and Non-Medical Use of Prescription Drugs among College Students: Coping as a Mediator

Objectives: Non-medical use of prescription drugs (NMUPD) has become a threat to public health. In the United States, NMUPD is especially common in young adults (aged 18-25). Self-esteem is a robust psychosocial factor of substance use. The substance use literature also documents that self-esteem is associated with alcohol use through other cognitive factors, such as coping. Given the important role of coping in substance use intervention, it is important to understand how coping alters mechanisms underlying the effects of self-esteem on NMUPD. However, little research has explored mediational mechanisms among self-esteem, coping, and NMUPD. The current study sought to examine a hypothesized mediation model among self-esteem, coping, and NMUPD in college students. Methods: Data were collected online from 1052 undergraduates (aged 18 to 25; 723 females) in a large public university in Virginia. Participants reported their past-three-month NMUPD (i.e. opioids, sedatives, anxiolytics, and stimulants), self-esteem, and coping (13 domains; e.g. active coping and self-blame). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the factorial structure of coping. Structural equation modeling (SEM) was employed for examining the hypothesized mediation model. Results: EFA and CFA identified a two-factor structure of coping (i.e. adaptive coping and maladaptive coping). SEM suggested that adaptive coping together with maladaptive coping completely mediated the relationship between self-esteem and NMUPD. The goodness-of-fit indicators suggest a good model fit (RMSEA = .04; CFI = .95; TLI = .93; WRMR = 1.11). Conclusion: Self-esteem appears to be a protective factor for NMUPD in college students, and its relationship with NMUPD is mediated by two types of coping. Future interventions targetting NMUPD among college students should attend to self-esteem and coping.

The mediating effects of depressive symptoms on the association of childhood maltreatment with non-medical use of prescription drugs

BACKGROUND

Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents.

METHODS

A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%).

RESULTS

In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001).

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.

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

Purpose of review

This paper reviews the most recent epidemiological evidence on adolescent NMPD use. Particular attention is given to prevention, assessment and diagnosis of disorder, and treatment.

Recent findings

While international in scope, global evidence is only available for NMPD use, morbidity and mortality estimates. Prevention strategies, assessment and treatment are U.S.-centric. The literature on prevention strategies lacks high-quality evidence. Assessment, diagnosis and treatment of NMPD use disorder have more robust evidence bases. Despite this, screening for NMPD (and other drug) use disorders is infrequent and insensitive, leading to incomplete treatment provision. Treatments are shown to be safe and effective, but disparities in provision prevent wide-scale amelioration of the adolescent NMPD use problem.

Summary

Mental health care professionals and primary care physicians with adolescent patient populations should become involved in preventative strategies mentioned in this review. Additionally, higher screening rates will lead to less downstream problems related to NMPD use.

Associations between childhood maltreatment and non-medical use of prescription drugs among Chinese adolescents

AIMS

To test, among Chinese adolescents: (1) whether childhood maltreatment is associated with non-medical use of prescription drugs (NMUPD) and (2) whether there are interaction effects of childhood maltreatment and depressive symptoms on NMUPD.

DESIGN

A secondary analysis of the cross-sectional data collected from 7th- and 12th-graders who were sampled using a multi-stage, stratified-cluster, random-sampling method in the 2015 School-based Chinese Adolescents Health Survey (SCAHS).

SETTING

Surveys conducted in high schools in six cities of China in 2015.

PARTICIPANTS

There were 24 457 students who were invited to participate and 23 039 students' questionnaires were completed and qualified for our survey.

MEASUREMENTS

The outcomes comprised self-report of NMUPD (prior 30 days); a history of childhood maltreatment was our main predictor. Other covariates included depressive symptoms, smoking, drinking and demographics. Data were analysed using multi-level regression modelling.

FINDINGS

Our final multivariable logistic regression models demonstrated that after adjusting for other variables, physical abuse was associated positively with non-medical use of opioids [adjusted odds ratio (AOR) = 1.13, 95% confidence interval (CI) = 1.10-1.22], sedatives (AOR = 1.11, 95% CI = 1.10-1.21) and any prescription drugs (AOR = 1.13, 95% CI = 1.09-1.20); emotional abuse, sexual abuse and emotional neglect were also associated with an increased risk of opioids, sedatives and any prescription drugs misuse; students who reported that they had experienced childhood physical neglect were more likely to be involved in the non-medical use of sedatives (AOR = 1.08, 95% CI = 1.04-1.12) and any prescription drugs (AOR = 1.06, 95% CI = 1.03-1.10). Additionally, there was no evidence of interaction effects on NMUPD between depressive symptoms and each of physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect, respectively.

CONCLUSIONS

Maltreatment while a child is associated with an increased risk of non-medical use of prescription drugs (NMUPD) among Chinese adolescents. The interactions of maltreatment while a child and depressive symptoms do not appear to be associated significantly with NMUPD among Chinese adolescents.

The mediating effects of depressive symptoms and sleep quality on the relationship between the non-medical use of prescription drugs and suicidal behaviors among Chinese adolescents

BACKGROUND

The nature of the relationship between the non-medical use of prescription drugs (NMUPD) and suicide has not been clearly elucidated. Some studies have suggested that the relationship between substance use and suicidal ideation may be spurious and could be explained by other variables.

METHODS

A school-based cross-sectional study was performed in Guangzhou. A total of 5853 students completed questionnaires and were included in the study. NMUPD, alcohol use, illicit drug use, depressive symptoms, sleep quality, and suicidal behaviors were assessed. The mediating effects of depressive symptoms and sleep quality on the relationship between NMUPD and suicidal behaviors were examined using a structural equation model.

RESULTS

In the simple model without mediation, a positive relationship between NMUPD and suicidal behaviors in adolescents was found, which was independent of effects from the use of other substances. Both depressive symptoms and sleep quality were significant mediators of this relationship.

CONCLUSION

Public health and educational professionals should survey depressive symptoms and sleep quality and provide interventions when managing suicidal behaviors among adolescents engaging in NMUPD.