Age and Cohort Patterns of Medical and Nonmedical Use of Controlled Medication Among Adolescents

Abstract

Objectives We identified peak annual incidence rates for medical and nonmedical use of prescription opioid analgesics, stimulants, sedatives and anxiolytics (controlled medication), and explored cohort effects on age of initiation. Methods Data were gathered retrospectively between 2009–2012 from Detroit area students (n=5185). Modal age at last assessment was 17 years. A meta-analytic approach produced age-, year-, and cohort-specific risk estimates of first-time use of controlled medication. Cox regression models examined cohort patterns in age of initiation for medical and nonmedical use with any of four classes of controlled medication (opioid analgesics, stimulants, sedatives or anxiolytics). Results Peak annual incidence rates were observed at age 16, when 11.3% started medical use, and 3.4% started using another person’s prescription for a controlled medication (i.e., engaged in nonmedical use). In the more recent birth cohort group (1996–2000), 82% of medical users and 76% of nonmedical users reported initiating such use by age 12. In contrast, in the less recent birth cohort group (1991–1995), 42% of medical users and 35% of nonmedical users initiated such use by age 12. Time to initiation was 2.6 times less in the more recent birth cohort group (medical use: adjusted hazard ratio [aHR]=2.57 [95% confidence interval (CI)= 2.32, 2.85]; nonmedical use: aHR=2.57 [95% CI=2.17, 3.03]). Conclusions Peak annual incidence rates were observed at age 16 for medical and nonmedical use. More recent cohorts reported initiating both types of use at younger ages. Earlier interventions may be needed to prevent adolescent nonmedical use of controlled medication.

Developmental course of non‐medical use of prescription drugs from adolescence to adulthood in the United States: national longitudinal data

“…and national longitudinal studies examining the general patterns of binge drinking, marijuana use, non-medical use of prescription opioids and other illicit drug use during the transition from secondary school to young adulthood [13][14][15][16][17]20,22]. Furthermore, the modal age of onset among non-medical users of prescription sedatives, stimulants and tranquilizers (9th grade) and opioids (10th grade) in the present study was consistent with prior research [23][24][25]. Taken together, these findings reinforce the importance of implementing preventive intervention efforts in early adolescence before NUPD is initiated and reaches peak levels.…”

“…antidepressants). Regional and national cross-sectional studies indicate the peak ages of risk for initiating non-medical use of prescription anxiolytics, opioids, sedatives and stimulants were concentrated between 16 and 19 years of age and onset dropped off considerably following 19 years of age [23][24][25].…”

Peak ages of risk for starting nonmedical use of prescription stimulants

“…Past-year and lifetime prevalence rates for nonmedical use are informative, but ultimately may convey more information about persistence in nonmedical use than the timing of initiation among youth. To produce reliable age-specific incidence rates for nonmedical use (i.e., peak ages of onset), it is necessary to separate first-time users from sporadic or persistent nonmedical users by excluding the latter from the sample, or by separately analyzing data from these two different types of users (Austic et al, in press; Deandrea et al, 2013; Harris et al, 2008; Meier et al, 2012). The present study is one of only a few to estimate peak age of onset for nonmedical use (Austic et al, in press; Deandrea et al, 2013; Meier et al, 2012), and is the only nationally representative study to produce age-specific incidence rates for nonmedical use of stimulants among young people in the United States (US).…”

“…To produce reliable age-specific incidence rates for nonmedical use (i.e., peak ages of onset), it is necessary to separate first-time users from sporadic or persistent nonmedical users by excluding the latter from the sample, or by separately analyzing data from these two different types of users (Austic et al, in press; Deandrea et al, 2013; Harris et al, 2008; Meier et al, 2012). The present study is one of only a few to estimate peak age of onset for nonmedical use (Austic et al, in press; Deandrea et al, 2013; Meier et al, 2012), and is the only nationally representative study to produce age-specific incidence rates for nonmedical use of stimulants among young people in the United States (US). Age-specific incidence rates for youth provide crucial information needed to design timely and effective primary prevention initiatives because they identify ages of lower risk directly preceding ages of peak risk for starting to misuse another person’s prescription or misuse one’s own prescription without a physician’s knowledge (Deandrea et al, 2013).…”

“…Each year the NSDUH is administered to a new nationally representative sample of the US population and asks about past-year and lifetime nonmedical use of a broad range of prescription stimulants. In contrast with studies reporting mean age of onset (see results from the 2012a NSDUH study, SAMHSA, 2013a), the present study uses a meta-analytic approach that treats each NSDUH year’s independent sample – from 2004 to 2012 – as a separate study to identify peak ages at which young people in the US are most likely to start nonmedical use of prescription stimulants (i.e., first time nonmedical use in the past-year; Austic et al, in press; Deandrea et al, 2013; Harris et al, 2008; Meier et al, 2012). Based on epidemiological estimates previously published, it was anticipated that the present study would identify a peak risk for first time nonmedical use of prescription stimulants starting during the early college years (McCabe et al, 2014; McCabe and West, 2013).…”