Many teens and young adults misuse prescribed psychoactive drugs
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A significant proportion of teens and young adults in the United States prescribed a psychoactive drug reported misusing that drug, according to study results published in Family Medicine and Community Health.
“This study draws attention to the silent epidemic of prescription stimulant use among school/college-aged youth; misuse of prescription stimulants among our study population exceeded their misuse of prescription opioids,” Israel Agaku, DMD, MPH, PhD, of Harvard School of Dental Medicine, told Healio Psychiatry. “With increasing popularity of performance-enhancing stimulants within school environments, it is imperative for policy makers, school administrators, health care professionals and parents to become more aware of this emerging danger and take appropriate steps, similar to what has been done for the opioid epidemic. Secondly, the study underscores the need for comprehensive strategies especially given the strong associations between use of non-prescription substances, such as tobacco and alcohol, and the misuse of prescription substances.”
Agaku and colleagues sought to evaluate prevalence and correlates of medical use and misuse of psychoactive prescription medications among 110,556 youth and young adults aged 12 to 25 years in the U.S. They analyzed data obtained from cross-sectional, self-reported surveys included in the 2015 to 2018 National Survey of Drug Use and Health, which utilized probabilistic and nationally representative sampling. Participants included individuals from households and non-institutional group quarters, such as college dormitories, as well as civilians living on military bases, all of whom used computer-assisted self-interview methods to complete questionnaires. The researchers defined psychoactive prescription medication misuse as a report by the participant that they had past-year psychoactive prescription medication use in any way not directed or prescribed for them and medical use as past-year use without a report of misuse. They restricted the multivariable analysis to identify correlates of misuse to 55,690 young adults aged 18 to 25 years, since certain variables were assessed only among adults.
Results showed 25% of U.S. youth aged 12 to 17 years reported use of any psychoactive prescription medication assessed, and 5.7% reported past-year use of two or more psychoactive prescription medications. A total of 20.9% of those who used any psychoactive prescription medications reported misuse, of whom 3.4% had substance use disorder. The researchers noted past-year use of each psychoactive prescription medication as 19% for opioids, 7.2% for stimulants, 4.3% for tranquilizers and 2.2% for sedatives.
The estimated percentage of misuse of each psychoactive prescription medication was as follows:
- 17.6% for opioids;
- 24.2% for stimulants;
- 40.1% for tranquilizers; and
- 14.2% for sedatives.
Users of each psychoactive prescription medication who had substance use disorder was estimated at 2.6% for opioids, 3% for stimulants, 7% for tranquilizers and 3.6% for sedatives. Compared with individuals who never used nonprescription substances, such as alcohol, tobacco, marijuana, cocaine and heroin, young adults aged 18 to 25 years who misused opioids exhibited increases in misuse associated with more recent use of non-prescription substances and a higher number of substances used. Agaku and colleagues observed similar patterns for stimulants, tranquilizers and sedatives.
“For health care providers, there should be a recognition that holistic care involves more than just prescribing medications,” Agaku said. “Increased quality of patient-provider communication, including offering behavioral counseling when needed, may avert unnecessary prescriptions. Parents and other family members who are prescribed these medications should be encouraged to take more responsibility to keep them locked and out of the hands of youth and young adults. Parents/caregivers/guardians, pharmacists and clinicians need to be alert for behavioral markers of prescription medication misuse.”
Perspective
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More than 18 million Americans misuse and abuse prescription drugs every year. This “growing, deadly epidemic” kills at least 100 Americans daily. Prescription drug misuse (PDM) is the fastest growing drug problem in youth and young adults. This study by Agaku and colleagues with over 110,000 participants further validates these findings.
Despite the inherent limitations of the design, this study offers notable clinical implications. First, greater focus is warranted to address PDM among young adults aged 18 to 25 years based on the higher rates of misuse in this vulnerable population. Second is the urgent need to address psychological distress in this group. Third is the majority of the misused drugs do not come directly from the prescribers.
This problem needs a more comprehensive integrated approach. Parents and children, as well as prescribers, must be continuously educated on the serious medical consequences of PDM on the developing brain. Safe storage and disposal of medications diminish opportunities for easy access. Additionally, frequent use of a prescription drug-monitoring program by the prescribers limits the extent of “doctor shopping.” Clearly, the misuse of psychoactive substances is neither a poor or rich issue, nor a red or blue issue; it is an “everyone” issue.
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