Nonmedical Use of Controlled Medications by Adolescents and Young Adults

Nonmedical Use of Controlled Medications by Adolescents and Young Adults

Nonmedical prescription drug use (NMPDU) refers to using controlled prescription medications for purposes other than initially prescribed. Among adolescents and young adults (AYAs), NMPDU remains a prevalent issue, including medications such as stimulants, sedatives, and opioids. Defined as either using someone else’s prescription, altering the intended dosage or frequency, or using the substance for its euphoric effects, this behaviour poses a growing public health challenge.

Data highlights that AYAs under the age of 25 are particularly vulnerable to drug misuse. Their developmental stage, which predisposes them to risky decision-making, amplifies this tendency. Recent analysis shows that while rates of nonmedical opioid use have decreased among 12 to 17-year-olds from 3.9% in 2015 to 2.3% in 2019, morbidity from misuse remains significant, with 672 prescription opioid overdose deaths reported among 15-24-year-olds in 2019.

Patterns of Nonmedical Use Among Adolescents

Types of Medications Misused

NMPDU among adolescents primarily involves three categories of controlled medications:

  • Opioids such as hydrocodone, oxycodone, and tramadol
  • Stimulants including amphetamines and methylphenidate
  • Sedatives like benzodiazepines

Rates of misuse vary based on drug class. For instance, stimulants have remained stable in usage, with approximately 2% of adolescents aged 12 to 17 reporting misuse between 2015 and 2019. However, benzodiazepines saw a sharp rise in overdoses between 2000 and 2015.

Regional and Demographic Trends

The risk of nonmedical use differs significantly across racial groups. While the overall rate of misuse in 2019 was 2.3%, the prevalence was highest among American Indian and Alaska Native adolescents at 2.9%. By contrast, the rate was much lower among Asian teens (0.3%). Similarly, LGBTQ+ adolescents also face a greater risk compared to their heterosexual peers, with 26% of lesbian, gay, or bisexual (LGB) students reporting lifetime misuse compared to 16% among heterosexual students.

Internationally, patterns of misuse follow regional distinctions. According to a global analysis from PMC, North America often reports the highest misuse rates, with 5.4% of Canadian high school students engaging in NMPDU. Europe reports an average rate of 5.6%, and Middle Eastern countries such as Lebanon have recorded figures as high as 10% among adolescents.

Risk Factors for Misuse

Individual and Environmental Influences

A variety of factors contribute to the risk of nonmedical use. Individual drivers include the presence of untreated medical or psychological conditions, such as anxiety, depression, or ADHD. Similarly, early initiation into substance use is strongly correlated with progression to broader substance use disorders. Family dynamics also play a critical role, with lax parental supervision and the availability of leftover prescriptions in the home environment serving as key risk contributors.

Peer Influence

Peers excessively influence adolescent behaviour. AYAs whose close friends engage in drug misuse are significantly more likely to experiment with prescription drugs.

Sources of Misused Medications

Adolescents primarily obtain prescription drugs through family and friends. A study from the AAP report reveals that 73.7% of adolescents with prescriptions had unsupervised access to their medication, facilitating nonmedical use. Other channels include peer exchange and, to a lesser degree, online illicit suppliers.

Consequences of Nonmedical Prescriptions

Acute and Long-Term Impacts

Adverse outcomes of NMPDU are wide-ranging. Acute risks include overdose, particularly from opioid or benzodiazepine misuse. Notably, 14% of overdose deaths among 15-24-year-olds involved prescription opioids. Additionally, misuse of sedatives is linked to severe withdrawal symptoms, which may occasionally prove fatal.

Educational performance also suffers in those engaging in regular misuse of stimulants or sedatives. Weight loss, appetite changes, and nutritional deficiencies may similarly emerge due to misuse’s physiological and psychological toll.

Social Costs

Misuse during adolescence is highly correlated with future substance use disorders. Studies also show links between nonmedical use and risky behaviours, including unsafe sexual practices or operating vehicles under the influence.

Prevention Strategies

Targeted Interventions

Efforts to mitigate NMPDU focus on family-centred and clinical interventions. AAP emphasises the importance of limiting prescriptions to necessary dosages while educating families on proper storage practices. Community drug return programmes have also shown promise, with initiatives recovering large quantities of unused prescription drugs.

Early Detection and Education

Screening tools such as the Brief Screener for Tobacco, Alcohol, and Other Drugs have been developed to identify early-stage misuse. Such strategies, coupled with reinforcing healthy behaviours through brief interventions, aim to curtail progression to addiction.

Insights from PMC

Complementing the AAP findings, PMC’s global review highlights broader epidemiological trends and challenges in addressing NMPDU worldwide. One key insight notes the universal vulnerability of adolescents, especially those experiencing social tensions or inequities, such as LGBTQ+ youth and those from rural backgrounds. Preventive strategies such as the Iowa Strengthening Families Program demonstrate the success of cohesive family-skills training in reducing misuse.

SourceAAP Pediatrics
PMC.

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