Prescription Pain Reliever Abuse and Dependence Among Adolescents: A Nationally Representative Study

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Abstract

Objective

We examined the prevalence, patterns, and correlates of adolescents' abuse, subthreshold dependence (“diagnostic orphans”), and dependence on prescription pain relievers (PPRs) such as opioids in a representative national sample (N= 36,992).

Method

Data were from the 2005–2006 National Surveys of Drug Use and Health. DSA-IV criteria for abuse and dependence were examined.

Results

Of all adolescents ages 12 to 17, 7% (n = 2,675) reported nonprescribed PPR use in the past year, and 1% (n = 400) met criteria for past-year PPR abuse or dependence. Among the 2,675 adolescents who reported nonprescribed PPR use, more than one in three reported symptoms of abuse or dependence: 7% abuse, 20% subthreshold dependence, and 9% dependence. Regular PPR use, major depressive episodes, and alcohol use disorders were associated with each diagnostic category. Compared with asymptomatic nonprescribed PPR users, increased odds of abuse were noted among nonstudents (adjusted odds ratio [AOR] 2.6), users of mental health services (AOR 1.8), and those reporting poor or fair health (AOR 2.4); and increased odds of dependence were observed among females (AOR 1.6), those who were involved in selling illicit drugs (AOR 1.7), and users of multiple drugs (AOR 2.9). Subthreshold dependent users resembled dependent users in major depressive episodes (AOR 1.5), alcohol use disorders (AOR 1.8), and use of multiple drugs (AOR 1.7).

Conclusions

Dependence on PPRs can occur without abuse, and subthreshold dependence deserves to be investigated further for consideration in major diagnostic classification systems. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(9): 1020–1029.

Section snippets

Data Source

This study is based on data from the public use file of the 2005 and 2006 NSDUH.2, 19 NSDUH is designed to provide estimates of substance use and related disorders for the U.S. general population. It uses multistage area probability sampling methods to select a representative sample of the U.S. civilian, noninstitutionalized population ages 12 years or older in all 50 states. Participants include household residents; residents of shelters, rooming or boarding houses, halfway houses, college

Demographics

A total of 18,678 and 18,314 adolescents ages 12 to 17 years were identified from the public use data file of 2005 and 2006 NSDUH, respectively. There were no significant yearly variations in the demographics examined (Table 1).

Use, Abuse, and Dependence Among All Adolescents

Of the combined sample (N = 36,992), 7% (n = 2,675) reported nonprescribed PPR use in the past year. As shown in Table 1, use of nonprescribed PPRs was associated with sex, age group, race/ethnicity, and student status (X2 test, p < .010). A comparatively high prevalence

Discussion

Among this representative national sample of adolescents ages 12 to 17 years, about 7% reported PPR use without a prescription in the previous 12 months, and approximately 1% met criteria for past-year PPR abuse or dependence. Among the subset of past-year nonprescribed users, we found that 16% of users met criteria for abuse (7%) or dependence (9%), and an additional 20% exhibited subthreshold dependence. Individuals in the latter group have typically not been recognized (diagnostic orphans).

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    This work was supported by research grants from the U.S. National Institute on Drug Abuse of the National Institutes of Health to Li-Tzy Wu (DA019901 and DA019623). The Substance Abuse and Mental Health Data Archive and the Interuniversity Consortium for Political and Social Research provided the public use data files for NSDUH, which was sponsored by SAMHSA's Office of Applied Studies. The opinions expressed in this article are solely those of the authors and not of any sponsoring agency. The authors thank Amanda McMillan for proofreading the manuscript.

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