The present study examined associations between nonmedical use of prescription opioids and serious psychological distress, suicidal ideation, and suicide attempts, and tested whether age and sex moderate these relationships.
Data on 5582 adolescents were obtained from a representative province-wide survey of students in grades 7 through 12 (mean age: 15.3 years) across Ontario, Canada. Nonmedical use of prescribed opioids in the last 12 months was categorized in “no use”, “infrequent use (1–2 times)”, and “regular use (3 times or more)”. Logistic regression analysis was adjusted for age, sex, ethnicity, subjective socioeconomic status, and other substance use (i.e., tobacco cigarette, alcohol, cannabis).
Overall, regular nonmedical use of prescription opioids was strongly associated with greater odds of serious psychological distress (OR: 3.47; 95% CI 1.42–8.45), suicidal ideation (OR: 2.73; 95% CI 1.84–4.05), and suicide attempts (OR: 3.21; 95% CI 1.40–7.37). However, infrequent nonmedical use of prescription opioids was associated with greater odds of serious psychological distress (OR: 1.79; 95% CI 1.08–2.98) and suicidal ideation (OR: 1.63; 95% CI 1.20–2.21), but not suicide attempts (OR: 1.84; 95% CI 0.76–4.45). Age-stratified analyses showed that both infrequent (OR: 1.61; 95% CI 1.01–2.58) and regular (OR: 3.40; 95% CI 2.11–5.46) nonmedical use of prescription opioids was strongly associated with greater odds of suicidal ideation among 15- to 20-year-olds, but not 11- to 14-year-olds.
These findings suggest that nonmedical use of prescription opioids is strongly associated with mental health problems among adolescents. Future research using a longitudinal design is needed to confirm age differences and temporality.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Our data cannot be made available in the manuscript, the supplemental files or a public repository due to the Centre for Addiction and Mental Health’s and The Ontario Public and Catholic School Board’s institutional Research Ethics Board agreements. Qualified, interested researchers may request access to the data at the Centre for Addiction and Mental Health.
McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ (2017) Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics 139(4):e20162387
Sung HE, Richter L, Vaughan R, Johnson PB, Thom B (2005) Nonmedical use of prescription opioids among teenagers in the United States: trends and correlates. J Adolesc Health 37(1):44–51
Martins SS, Ghandour LA (2017) Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon. World Psychiatry 16(1):102–104
Belzak L, Halverson J (2018) The opioid crisis in Canada: a national perspective. Health Promot Chronic Dis Prev Can 38(6):224–233
Boak A, Elton-Marshall T, Mann RE, Hamilton HA (2020) Drug use among Ontario students, 1977–2019: detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS). Centre for Addiction and Mental Health, Toronto
Compton WM, Volkow ND (2006) Abuse of prescription drugs and the risk of addiction. Drug Alcohol Depend 83:S4–S7
Giedd JAY (1999) Brain development, IX: human brain growth. Am J Psychiatry 156(1):4
Guo L, Xu Y, Deng J, Huang J, Huang G, Gao X et al (2016) Association between nonmedical use of prescription drugs and suicidal behavior among adolescents. JAMA Pediatr 170(10):971–978
Kelley-Quon LI, Cho J, Strong DR, Miech RA, Barrington-Trimis JL, Kechter A et al (2019) Association of nonmedical prescription opioid use with subsequent heroin use initiation in adolescents. JAMA Pediatr 173(9):e191750-e
Florence CS, Zhou C, Luo F, Xu L (2016) The economic burden of prescription opioid overdose, abuse, and dependence in the United States. Med Care 54(10):901–906
Johnson KF, Worth A, Brookover D (2019) Families facing the opioid crisis: content and frame analysis of youtube videos. Fam J 27(2):209–220
Young A, McCabe SE, Cranford JA, Ross-Durow P, Boyd CJ (2012) Nonmedical use of prescription opioids among adolescents: subtypes based on motivation for use. J Addict Dis 31(4):332–341
McCabe SE, Boyd CJ, Cranford JA, Teter CJ (2009) Motives for nonmedical use of prescription opioids among high school seniors in the United States: self-treatment and beyond. Arch Pediatr Adolesc Med 163(8):739–744
Fischer B, Lusted A, Roerecke M, Taylor B, Rehm J (2012) The prevalence of mental health and pain symptoms in general population samples reporting nonmedical use of prescription opioids: a systematic review and meta-analysis. J Pain 13(11):1029–1044
Ashrafioun L, Bishop TM, Conner KR, Pigeon WR (2017) Frequency of prescription opioid misuse and suicidal ideation, planning, and attempts. J Psychiatr Res 92:1–7
Baiden P, Graaf G, Zaami M, Acolatse CK, Adeku Y (2019) Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States. J Psychiatr Res 112:44–51
Kebbe M, Sampasa-Kanyinga H, Hamilton HA, Colman I, Chaput JP (2020) Correlates of nonmedical use of prescription opioids among a cohort of adolescents in Ontario, Canada. J Psychiatr Res 120:175–184
Cash SJ, Bridge JA (2009) Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr 21(5):613–619
Sampasa-Kanyinga H, Lalande K, Colman I (2018) Cyberbullying victimisation and internalising and externalising problems among adolescents: the moderating role of parent-child relationship and child’s sex. Epidemiol Psychiatr Sci 1:1–10
Boak A, Hamilton HA, Adlaf EM, Mann RE (2017) Drug use among Ontario students, 1977–2017: detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 46). Centre for Addiction and Mental Health, Toronto
Boak A, Hamilton HA, Adlaf EM, Henderson JL, Mann RE (2018) The mental health and well-being of Ontario students, 1991–2017: detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 47). Centre for Addiction and Mental Health, Toronto
Chan SM, Fung TCT (2014) Reliability and validity of K10 and K6 in screening depressive symptoms in Hong Kong adolescents. Vulnerable Child Youth Stud 9(1):75–85
Ferro MA (2019) The psychometric properties of the kessler psychological distress scale (K6) in an epidemiological sample of Canadian youth. Can J Psychiatry 64(9):647–657
May A, Klonsky ED (2011) Validity of suicidality items from the youth risk behavior survey in a high school sample. Assessment 18(3):379–381
Canada S A Portrait of Canadian Youth (2018) Catalogue no 11-631-X ISBN 978-0-660-24687-1
Goodman E, Adler NE, Kawachi I, Frazier AL, Huang B, Colditz GA (2001) Adolescents’ perceptions of social status: development and evaluation of a new indicator. Pediatrics 108(2):E31
Divin AL, Zullig KJ (2014) The association between non-medical prescription drug use and suicidal behavior among united states adolescents. AIMS Public Health 1(4):226–240
Barrett SP, Meisner JR, Stewart SH (2008) What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations. Curr Drug Abuse Rev 1(3):255–262
Boyd CJ, McCabe SE (2008) Coming to terms with the nonmedical use of prescription medications. Subst Abuse Treat Prev Policy 3:22
Sampasa-Kanyinga H, Dupuis LC, Ray R (2017) Prevalence and correlates of suicidal ideation and attempts among children and adolescents. Int J Adolesc Med Health 29(2):20150053
Wong SS, Zhou B, Goebert D, Hishinuma ES (2013) The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol 48(10):1611–1620
Fink DS, Hu R, Cerdá M, Keyes KM, Marshall BDL, Galea S et al (2015) Patterns of major depression and nonmedical use of prescription opioids in the United States. Drug Alcohol Depend 153:258–264
Stein MD, Conti MT, Kenney S, Anderson BJ, Flori JN, Risi MM et al (2017) Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug Alcohol Depend 179:325–329
Volkow ND, Jones EB, Einstein EB, Wargo EM (2019) Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiatry 76(2):208–216
Hawk KF, Vaca FE, D’Onofrio G (2015) Focus: addiction: reducing fatal opioid overdose: prevention, treatment and harm reduction strategies. Yale J Biol Med 88(3):235
The Ontario Student Drug Use and Health Survey, a Centre for Addiction and Mental Health initiative, was funded in part through ongoing support from the Ontario Ministry of Health and Long-Term Care, as well as targeted funding from several provincial agencies.
This research paper was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700 for Ian Colman. The funders had no involvement in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
The 2017 OSDUHS protocol was approved by the Research Ethics Boards at the Centre for Addiction and Mental Health and York University, as well as school board research review committees. The study was conducted in accordance with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
All participants gave informed consent.
Consent to participate
All participants provided their own consent in addition to parental signed consent.
About this article
Cite this article
Sampasa-Kanyinga, H., Bakwa-Kanyinga, F., Chaput, JP. et al. Nonmedical use of prescription opioids, psychological distress, and suicidality among adolescents. Soc Psychiatry Psychiatr Epidemiol 56, 783–791 (2021). https://doi.org/10.1007/s00127-020-01958-x