Nonmedical Prescription Opioid and Sedative Use Among Adolescents in the Emergency Department

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Unintentional overdose and emergency department visits secondary to nonmedical use of prescription drugs are on the rise with peak age of onset in midadolescence for these risk behaviors. Also, risk behaviors, such as substance use and violence, tend to cluster. WHAT THIS STUDY ADDS:Approximately 1 in 10 adolescents or young adults using the emergency department endorse nonmedical prescription opioid or sedative use in the past year. Rates of current opioid or sedative prescriptions are low among this group. abstract OBJECTIVES: Nonmedical prescription opiate use (NPOU) and nonmedical prescription sedative use (NPSU) are serious public health concerns. The objectives of this study were to determine the prevalence and emergency department (ED) visit characteristics and other correlates associated with past-year NPOU and NPSU among adolescents and young adults using the ED. METHODS:Participants aged 14 to 20 presenting to the ED at the University of Michigan Medical Center between September 2010 and September 2011 were systematically recruited. A computerized self-report screening survey with validated items measuring past-year NPOU, NPSU, substance use, and violence was delivered to participants, and a retrospective chart review was performed. RESULTS:Of the 2135 participants (86.0% response rate), 222 (10.4%) reported either NPOU or NPSU. Among the 185 (8.7%) participants that reported NPOU, 14.6% had a current home prescription for an opioid and among the 115 (5.4%) with NPSU, 12.3% had a current home prescription for a sedative. After controlling for demographics (age, gender, race, public assistance), correlates of NPOU or NPSU included other substance use, and drinking and driving or riding with a drinking driver. Additional correlates of NPOU included receiving an intravenous opioid in the ED and for NPSU, dating violence, presenting to the ED for a noninjury complaint, and previous ED visit in the past year.CONCLUSIONS: Nearly 1 in 10 young people who use the ED for care report NPOU or NPSU, and only 12.3% and 14.6% report having current home prescriptions for sedatives and opioids. The ED represents a key location for screening and intervention efforts. Pediatrics 2013;132:825-832

Physical and Sexual Dating Violence and Nonmedical Use of Prescription Drugs

“…We observed that NMUPD was associated with DVV, although there was some variation in associations by type of victimization (sexual or physical DVV) and sex of the respondent. Our findings are consistent with some of the limited available literature, 11,27 although direct comparisons are difficult because assessment of DVV in our study varied substantially from that of other studies. For example, the few studies in the literature focused on NMUPD and DV among adolescent populations include both DVV and perpetration, 11,27 making it difficult to interpret findings from the perspective of developing targeted DV and substance use prevention efforts.…”

“…Our findings are consistent with some of the limited available literature, 11,27 although direct comparisons are difficult because assessment of DVV in our study varied substantially from that of other studies. For example, the few studies in the literature focused on NMUPD and DV among adolescent populations include both DVV and perpetration, 11,27 making it difficult to interpret findings from the perspective of developing targeted DV and substance use prevention efforts. Furthermore, in our study we differentiated associations by physical DVV only, sexual DVV only, and experiences with both physical and sexual DVV for both male and female adolescents.…”

“…The authors of studies that focused on adult populations suggest that IPV is associated with NMUPD, 24 -26 but evidence among adolescent populations is both scarce and conflicting. Only a few studies relating to the associations between substance use and DV among adolescent populations have been published, 11,21,27 the majority of which rely on ED data, which have utility for capturing more extreme outcomes and thus are not generalizable. For example, researchers in 1 study of the nonmedical use of prescription opioids and sedatives conducted among adolescents aged 14 to 20 years in the University of Michigan ED reported that the nonmedical use of prescription opioids was not associated with DV, but the nonmedical use of prescription stimulants was associated with DV.…”

“…For example, researchers in 1 study of the nonmedical use of prescription opioids and sedatives conducted among adolescents aged 14 to 20 years in the University of Michigan ED reported that the nonmedical use of prescription opioids was not associated with DV, but the nonmedical use of prescription stimulants was associated with DV. 27 Researchers of another study who used data collected from ED patients in Michigan and focused on youth aged 14 to 24 years who screened positive for substance use, reported that prescription sedative and opioid misuse were more likely to be reported before DV than alcohol use or alcohol and marijuana use. 11 It should be noted that DV as assessed in both of these studies combined DV aggression and victimization into a single DV measure, and there was no exploration of different types of DV (eg, sexual or physical).…”

The Cultural Influence of Adolescent Prescription Drug Abuse

“…Referral to treatment provides those identified as needing more extensive treatment with access to specialty care (SAMHSA, 2012). One study also raises the possibility that emergency room visits, for any reason, could become important occasions for detecting and addressing prescription drug problems among young people (Whiteside et al, 2013).…”