A large percentage of youths use and abuse psychoactive substances. According to the 2007 Monitoring the Future (MTF) survey, the percentage of US adolescents who used illicit drugs or drank alcohol continued a decade-long drop, revealing that 19% of 8th graders, more than 36% of 10th graders, and 47% of all 12th graders have taken an illicit drug (other than alcohol) during their lifetime.1 According to the National Survey on Drug Use and Health, the rate was 3.3% for misuse or nonmedical use of prescription drugs.2 The misuse of prescription drugs among adolescents was second only to marijuana use. In fact, prescription drugs increasingly have become a part of the repertoire of drug-using adolescents.
When is misuse abuse?
Although too often any nonsanctioned use of psychoactive substances is labeled as “abuse,” there are specific definitions and criteria for terms such as abuse, dependence, misuse, and diversion3:
• Abuse: A pattern of substance use resulting in negative consequences and impairment.
• Dependence: A pattern of substance use and impairment in the presence of salient cognitive, behavioral, and physiological symptoms.
• Misuse: Use for a purpose not consistent with medical guidelines (eg, modified dose, use of substance to achieve euphoria, and so forth) or without a prescription for the individual using the medication. Misuse is synonymous with nonmedical use or without a clinician prescription, which would include ignoring medical instructions (by a physician or his or her designate) to take a medication at a specific dosing regimen for a named symptom or disorder.
• Diversion: The transfer of a medication from the individual for whom it was prescribed to someone for whom it is not prescribed.
Given the low level of regular use of prescription drugs, the prevalence of substance use disorder (SUD) among adolescents is less than 1% for each class of prescription drugs. It is interesting to note that neither misuse nor diversion presumes a pathological level of substance use, although specific characteristics of misuse and misusers may predispose to the development of a SUD.
Data from recent national surveys and other published reports indicate that the lifetime prevalence of nonmedical prescription drug misuse in the United States is 20% (approximately 48 million) of persons 12 years or older.4 Among adults 26 or older who had previously misused any prescription psychotherapeutic drug, the rate of past-year use was higher among those who had initiated use before age 16 (25.7%) than among those who initiated use between the ages of 16 and 20 (18.2%).5 In 2004, 30.9% of adolescents aged 12 through 17 years and 37.3% of those aged 18 through 20 reported their primary substances of abuse as nonheroin opiates, tranquilizers, sedatives, amphetamines, or other stimulants.4
It has been suggested that the misuse of prescription drugs before age 16 leads to a greater risk of substance dependence later in life.5 One-third of all new misusers of prescription drugs in 2005 were adolescents between the ages of 12 and 17 years.2 In the 2005 Partnership for a Drug-Free America Attitude Tracking Study (PATS)—a survey of 7216 adolescents in grades 7 through 12—19% reported using prescription drugs that were not prescribed for them.6 In a 2005 Web-based survey self-administered by 1086 secondary school students in grades 7 through 12, 31.5% reported using prescription medications only as medically prescribed (medical users), 17.5% reported both medical use and other use (ie, misuse), and 3.3% reported prescription drug misuse only.7 Reports of misuse among adolescents being treated for SUDs is more staggering, with 23% to 33% reporting misuse of Schedule II medications.2 Examples of commonly misused prescription drugs are listed in the Table.
Commonly misused medications
Opiate analgesics are the most misused prescription drugs by adolescents. Detailed age breakdowns indicate that the average rate of past-year misuse or misuse of pain relievers increased steadily with age, from 2.5% at age 12 to 12.8% at age 17, and 13.9% at age 19.1 Pain relievers such as hydrocodone/paracetamol and oxycodone are the prescription drugs most commonly misused by teens.5 In a Web-based survey of students aged 10 through 18, misusers of prescription pain medication were 7 times more likely to smoke cigarettes, 5 times more likely to drink alcohol and smoke marijuana, almost 4 times more likely to binge drink, and 8 times more likely to have used other illicit drugs compared with their peers who did not misuse prescription pain medications.8
Among 12th graders, past year abuse of oxycodone increased 30% from 2002 through 2007.1 Annual prevalence rates in 2007 for oxycodone use were reported as 1.8% for 8th graders, 3.9% for 10th graders, and 5.3% for 12th graders. In other words, 1 in every 20 high school seniors had at least tried this drug in the past year. Past-year abuse of hydrocodone/paracetamol was particularly high among 8th, 10th, and 12th graders. Rates of abuse remain close to recent peak levels with nearly 1 in 10 high school seniors reporting misuse; annual prevalence for 2007 was 2.7% for 8th graders, 7.2% for 10th graders, and 9.6% for 12th graders.1
1. University of Michigan News Service.Teen drug use continues down in 2006, particularly among older teens; but use of prescription-type drugs remains high. Published December 21, 2006. http://www.monitoringthefuture.org/pressreleases/06drugpr.pdf. Accessed August 19, 2008.
2. Misuse of Prescription Drugs, National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMHSA). 2006. Updated June 16, 2008. http://www.oas.samhsa.gov/prescription/toc. htm. Accessed August 19, 2008.
3. World Health Organization. Lexicon of alcohol and drug terms published by the World Health Organization. www.who.int/substance_abuse/terminology/ who_lexicon/en/index.html. Accessed August 19, 2008.
4. Substance Abuse Treatment Admissions by Primary Substance of Abuse According to Sex, Age Group, Race, and Ethnicity. 2004 Treatment Episode Data Set(TEDS). 2006. http://wwwdasis.samhsa.gov/teds00/ TEDS_2K_Tables.htm. Accessed August 21, 2008.
5. Department of Health and Human Services. Results from the 2005 National Survey on Drug Use and Health: National Findings. 2006. http://www.oas. samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm.Accessed August 19, 2008.
6. Partnership for a Drug-Free America. The Partnership Attitude Tracking Study (PATS): Teens in grades 7 through 12, 2005. May 16, 2006. http://www. drugfree.org/Files/Full_Teen_Report. Accessed August 19, 2008.
7. McCabe SE, Boyd CJ, Young A. Medical and nonmedical use of prescription drugs among secondary school students. J Adolesc Health. 2007;40:76-83.
8. Boyd CJ, Esteban McCabe S,Teter CJ. Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district. Drug Alcohol Depend. 2006;81:37-45.
9. Nonmedical Stimulant Use, Other Drug Use, Delinquent Behaviors, and Depression Among Adolescents.National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMHSA). 2008. http://www.oas.samhsa. gov/2k8/stimulants/depression.htm. Accessed September 9, 2008.
10. Boyd CJ, McCabe SE, Cranford JA, Young A. Adolescents’ motivations to abuse prescription medications. Pediatrics. 2006;118:2472-2480.
11. The National Center on Addiction and Substance Abuse at Columbia University. CASA* 2006 Teen Survey Reveals: Teen Parties Awash in Alcohol, Marijuana and Illegal Drugs—Even When Parents Are Present; 2006. http://www.casacolumbia.org/absolutenm/templates/PressReleases.aspx? articleid=451&zoneid=56. Accessed August 19, 2008.
12. McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use, and diversion of abusable prescription drugs. J Am Coll Health. 2006;54:269-278.
13. McCabe SE, Boyd CJ. Sources of prescription drugs for illicit use. Addict Behav. 2005;30:1342- 1350.
14. Schepis TS, Krishnan-Sarin S. Characterizing adolescent prescription misusers: a population-based study. J Am Acad Child Adolesc Psychiatry. 2008;47:745-754.
15. Riggs P. Non-medical use and abuse of commonly prescribed medications. Curr Med Res Opin. 2008; 24:869-877.
16. Bukstein OG, Bernet W, Arnold V; Work Group on Quality Issues. Practice parameter for the assessmenand treatment of children and adolescents with substance use disorders. J Am Acad Child Adolesc Psychiatry. 2005;44:609-621.
17. Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/ hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003;111:179-185.
18. Mannuzza S, Klein RG, Moulton JL 3rd. Does stimulant treatment place children at risk for adult substance abuse? A controlled, prospective follow-up study. J Child Adolesc Psychopharmacol. 2003;13: 273-282.
19. Marsch LA, Bickel WK, Badger GJ, et al. Comparison of pharmacological treatments for opioiddependentadolescents: a randomized controlled trial.Arch Gen Psychiatry. 2005;62:1157-1164.
20. Spoth R, Trudeau L, Shin C, Redmond C. Long term effects of universal preventive interventions on prescription drug misuse. Addiction. 2008;103:1160-1168.
Evidence Based References
Bukstein OG, Bernet W,Arnold V; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with substance use disorders. J Am Acad Child Adolesc Psychiatry. 2005;44:609-621.
Marsch LA, Bickel WK, Badger GJ, et al. Comparison of pharmacological treatments for opioid-dependent adolescents. Arch Gen Psychiatry. 2005;62:1157-