Prescribing of Controlled Medications to Adolescents and Young Adults in the United States

Abstract

WHAT'S KNOWN ON THIS SUBJECT:The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana and has become an increasing public health concern. Adolescents and young adults are in the most likely age groups to abuse prescription medications. WHAT THIS STUDY ADDS: OBJECTIVE:The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana, yet little is known about prescribing patterns. We examined the prescribing of controlled medications to adolescents aged 15 to 19 and young adults aged 20 to 29. METHODS:We used cross-sectional data from the National Ambulatory Medical Care Survey (N ϭ 4304 physicians) and the National Hospital Ambulatory Medical Care Survey (N ϭ 2805 clinics; N ϭ 1051 emergency departments) between 2005 and 2007. We also used consecutive data from 1994 to describe trends. RESULTS:A controlled medication was prescribed at 2.3 million visits by adolescents and 7.8 million visits by young adults in 2007. Between 1994 and 2007, controlled medications were prescribed at an increasing proportion of visits from adolescents (6.4%-11.2%) and young adults (8.3%-16.1%) (P Ͻ .001 for trend). This increase was seen among males and females, in ambulatory offices and emergency departments, and for injury-related and non-injury-related visits (all P Ͻ .001). A controlled medication was prescribed during 9.6% of all adolescent visits and 13.8% of young-adult visits for non-injury-related indications and at 14.5% of adolescent visits and 27.0% of young-adult visits for injury-related reasons. Controlled medications were prescribed at a substantial proportion of visits for common conditions, such as back pain, to both adolescents (23.4%) and young adults (36.9%). CONCLUSIONS:Controlled medications are prescribed at a considerable proportion of visits from adolescents and young adults, and prescribing rates have nearly doubled since 1994. This trend and its relationship to misuse of medications warrants further study. Pediatrics

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

“…Consistent with prior studies, 2,4 we found that black patients were prescribed opioids less frequently than white patients for moderate to severe pain in the emergency setting. This relationship remained consistent across each aspect of neighborhood-level SES, while accounting for other factors including pain level, type of visit, age, gender, frequency of prior ED visits, and hospital location.…”

“…Based on prior literature, we included patient race, ethnicity, gender, patient age, pain severity, region of country, hospital location (urban/ Metropolitan Statistical Areas (MSA)), hospital ownership, and whether the visit was related to an injury or trauma in our models. 2,4 To control for whether a patient was a frequent visitor to the ED, we also included the frequency of prior visits to the ED within the past year and whether the patient had been seen in the ED within the past 72 hours. All covariates were included based clinical significance and statistical significance in bivariate analyses.…”

“…23 We also found that prescribing patterns varied according to geographic region, consistent with the previous litera- ture. 2,4 Opioids were prescribed more frequently at ED visits in the South and West regions as compared to the Northeast. According to the most recent US Census data, however, Southern and Midwest states had lower per capita incomes as compared to states in the Northeast.…”

“…1 Several studies have consistently documented disparities in opioid prescribing in the emergency department (ED) based on race and ethnicity. [2][3][4][5][6][7] For instance, one study demonstrated that Hispanic patients were twice as likely as non-Hispanic white patients to receive no analgesia for isolated bone fractures in EDs. 5 Further, a recent study demonstrated that the prescribing gap in opioid prescribing by race and ethnicity did not diminish between 1993 and 2005.…”

“…5 Further, a recent study demonstrated that the prescribing gap in opioid prescribing by race and ethnicity did not diminish between 1993 and 2005. 2 Although racial and ethnic disparities in opioid prescribing in the emergency departments remains steady, the broader influence of socioeconomic status (SES) on the treatment of patients' pain is unknown. Additionally, it is unknown whether differences in SES may explain some of the racial and ethnic disparities previously observed in opioid prescribing in the emergency setting.…”