Nonprescription Opioid Use Prevalent Among Older Teens
Study Reveals Reasons for Use Multiple, Complex
More than 1 in 10 high-school seniors has used a prescription opioid without a doctor's authorization, and 45% of those who used these drugs in the past year did so to relieve physical pain, new research shows.
The study showed that students who use opioids to relieve pain were less likely than users with other motives to take these drugs nonorally or to have other substance-abuse behaviors.
The existence of multiple motives for taking prescription opioids — for example, to get high, relax, go to sleep, or relieve pain — may explain why traditional substance-abuse prevention programs are not effective in reducing nonmedical use, according to the study's lead author, Sean Esteban McCabe, PhD, from the University of Michigan Substance Abuse Research Center in Ann Arbor.
"It's time that we recognized the complexity of behaviors associated with the nonmedical use of prescription opioids in order to identify individuals in need of an evaluation for pain management and/or those who need more comprehensive assessment and may require substance-abuse treatment," Dr. McCabe told Medscape Psychiatry.
The study is published in the August issue of Archives of Pediatrics and Adolescent Medicine.
The researchers used the National Survey on Drug Use and Health, Monitoring the Future, an annual survey of a national representative sample of high-school seniors in about 135 public and private schools in the United States.
The study sample included 12,441 students who were surveyed between 2002 and 2006. The sample was 53% female, 62% white, and most were about 18 years old.
Students were asked how often they had ever used prescription opioids — including Vicodin, OxyContin, Percodan, Percocet, Demerol, Dilaudid, morphine, opium, and codeine — without a doctor's prescription, and how often they had used these drugs in the preceding year. They were also asked about their reasons for taking the drugs, the route of administration, their use of other drugs, binge drinking, and cigarette smoking.
About 12.3% of the respondents reported lifetime nonmedical use of prescription opioids, and 8.0% reported such use in the preceding year.
Teens Use Opiates to "Relax"
The leading motive for nonmedical opioid use was "to relax or relieve tension" (56.4%). This was followed by the desire "to feel good or get high" (53.5%), "to experiment to see what it's like" (52.4%), "to relieve physical pain" (44.8%), and "to have a good time with friends" (29.5%).
For the most part, motives of males and females were similar, except that girls were more apt to report using the drugs "to get to sleep" and "because of anger and frustration."
About 6.1% of students reported pain relief as their sole motive, 38.7% reported pain relief along with other motives, and 55.2% reported nonpain-relief motives only.
Students motivated only by pain relief were less likely to take nonoral prescription opioids. For instance, 2.2% of these users took the drugs intranasally, whereas 32.8% of those who reported pain relief plus other motives and 35.3% of those who reported nonpain-relief motives administered the drugs intranasally.
More than 70% of teens who used the drugs nonmedically for pain relief were likely to have once been prescribed these drugs.
Risk for abuse of nicotine, alcohol, and other substances appeared to be higher among students who used opioids for reasons other than pain relief. For example, 2.2% of the pain-relief-only group used cocaine in the preceding year, compared with 39.5% in the group with nonpain-relief motives.
Adolescents who obtain opioids without a prescription don't receive important information such as dosage, contraindications, or possible drug interactions, said Dr. McCabe.
"Furthermore," he said, "prescription opioids carry the risk of causing both physical dependence and withdrawal symptoms upon discontinuation, which should be discussed with any individual using these medications."
Determining motives for taking opioids nonmedically can help target interventions, said Dr. McCabe. He would like to see healthcare professionals strategically placed in hospital emergency departments to serve as "a point of contact" to screen and provide brief interventions to reduce prescription opioid abuse.
After marijuana, nonmedical prescription opioids represent the most prevalent form of illicit drug use among adolescents and young adults, said Dr. McCabe.
Asked to comment on the study findings by Medscape Psychiatry, Catherine Martin, MD, vice chair for research, child and adolescent psychiatry at the University of Kentucky College of Medicine, said the study helps clinicians better understand the phenomenon of opiate use among high-school seniors.
Dr. Martin said the finding that adolescents who took opiates for pain relief only had not received opiates through a physician "challenges a commonly raised issue of treating pain in adolescents leading to increased drug-abuse risk."
In addition to underlining the need for further investigation into whether physical pain among adolescents is undertreated, the study reinforces the need for further research into adolescents with stress levels that need attention and into the early identification and treatment of the well-described group of polysubstance users who also use opiates, she said.
The researchers have disclosed no relevant financial relationships.
Nonprescription Opioid Use Prevalent Among Older Teens
by: Pauline Anderson
Medscape Medical News, August 6, 2009