Skip to main content

Advertisement

SpringerLink
Log in

Nonmedical Prescription Drug Use Among Adolescents: Global Epidemiological Evidence for Prevention, Assessment, Diagnosis, and Treatment

  • Adolescent / Young Adult Addiction (T Chung, Section Editor)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper reviews the most recent epidemiological evidence on adolescent NMPD use. Particular attention is given to prevention, assessment and diagnosis of disorder, and treatment.

Recent Findings

While international in scope, global evidence is only available for NMPD use, morbidity, and mortality estimates. Prevention strategies, assessment, and treatment are US-centric. The literature on prevention strategies lacks high-quality evidence. Assessment, diagnosis, and treatment of NMPD use disorder have more robust evidence bases. Despite this, screening for NMPD (and other drug) use disorders is infrequent and insensitive, leading to incomplete treatment provision. Treatments are shown to be safe and effective, but disparities in provision prevent wide-scale amelioration of the adolescent NMPD use problem.

Summary

Mental healthcare professionals and primary care physicians with adolescent patient populations should become involved in preventative strategies mentioned in this review. Additionally, higher screening rates will lead to less downstream problems related to NMPD use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. No data on opioids or stimulants was collected in the European School Survey Project on Alcohol and Other Drugs

  2. Described as commonly used traditional Chinese medicines and potentially addictive if used in high doses

  3. Codeine, Percocet, and Tramadol are prescription opioids.

  4. The biopsychosocial vulnerability model suggests that coping and effective family management protects against family conflict and financial strain. The resiliency model emphasizes seven skills: emotional management, interpersonal/social, reflection, academic/professional, restoration of self-esteem, planning, and problem-solving.

  5. S2BI uses forced-choice questions in which an affirmative answer for NMPD use results in a follow-up question about its frequency, which must be answered.

  6. The diagnosis of SUD, including NMPD use disorder, is made using the DSM-5. The DSM-5 is used for clinical, policy, research, and insurance reimbursement purposes. The DSM-5 made the following changes to address concerns from the DSM-IV [43] First, substance abuse and dependence criteria were combined into a unidimensional construct called SUD. Research showed that abuse and dependence factored into the same latent construct and that maintaining the two dimensions created an underdiagnosed category of patients called “diagnostic orphans.” Second, the abuse criterion related to trouble with the law was dropped. Evidence suggested that it was not useful in diagnosing SUDs [43]. A craving criterion was added on its relevance from behavioral, imaging, pharmacological, epidemiological, and genetic studies. Third, a diagnostic threshold of endorsing at least two criteria was accepted. Fourth, an overall severity indicator was derived from the criteria, with increasing numbers of endorsements indicating a more severe diagnosis. Fifth, specifiers of physiological dependence were eliminated due to lack of utility. Sixth, changes were implemented to meet the diagnosis of substance-induced mental disorder (i.e., evidence that the substance used is capable of producing the attributed psychiatric symptoms). Seventh, the use of drugs’ metabolites as biomarkers was discouraged to establish a diagnosis of SUD. Finally, a dependence diagnosis had to have at least two criteria attributable to one substance. A dependence diagnosis could no longer be made if two criteria were endorsed based on use of two substances [43].

  7. Resources to help identify treatment options in the USA are available from the SAMHSA’s website: www.samhsa.gov/treatment/index.aspx

  8. All opioids

  9. Social functioning is measured as integration at school or at work and family relationships

  10. Both interventions included 12 weeks of psychosocial treatment

Abbreviations

BSTAD:

Brief Screener for Tobacco Alcohol and Other Drugs

CRAFFT:

Car, Relax, Alone, Friends/Family, Forget, Trouble

DSM-5:

Diagnostic and Statistical Manual of Mental Disorders, 5th edition

DSM-IV:

Diagnostic and Statistical Manual of Psychiatric Disorders, 4th edition

DAWN:

Drug Abuse Warning Network

ED:

Emergency department

ISFP:

Iowa Strengthening Families Program

MAT:

Medication-assisted treatment

MTF:

Monitoring the Future

NIAAA:

National Institute on Alcohol Abuse and Alcoholism

NSDUH:

National Survey on Drug Use and Health

NMPD Use:

Nonmedical Prescription Drug Use

OUD:

Opioid use disorder

OTC:

Over-the-counter

PO:

Prescription opioid

PT:

Prescription tranquilizer

PS:

Prescription stimulant

S2BI:

Screening to Brief Intervention

SBIRT:

Screening, brief intervention, and referral to treatment

SAMHSA:

Substance Abuse and Mental Health Services Administration

SUD:

Substance use disorder

AAP:

The American Academy of Pediatrics

USA:

United States of America

WHO:

World Health Organization

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ford JA. Nonmedical prescription drug use among adolescents: the influence of bonds to family and school. Youth Soc. 2009;40(3):336–52.

    Article  Google Scholar 

  2. Martins SS, Ghandour LA. Nonmedical use of prescription drugs in adolescents and young adults: not just a western phenomenon. World Psychiatry. 2017;16(1):102–4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration 2016.

  4. Novak SP, Hakansson A, Martinez-Raga J, Reimer J, Krotki K, Varughese S. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry. 2016;16:274.

    Article  PubMed  PubMed Central  Google Scholar 

  5. UNODC. The non-medical use of prescription drugs policy direction issues. United Nations Office on Drug and Crime; 2011.

  6. UNODC. Misuse of prescription drugs: a South Asia perspective. United Nations Office on Drug and Crime; 2011.

  7. Hughes A, Williams MR, Lipari RN, Bose J, Copello EAP, Kroutil LA. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016.

  8. Dick B, Ferguson BJ. Health for the world’s adolescents: a second chance in the second decade. J Adolesc Health. 2015;56(1):3–6.

    Article  PubMed  Google Scholar 

  9. Hedden SL. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. 2015.

  10. • Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use, 1975–2015: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. 2016. The authors are researchers at the University of Michigan and responsible for the annual national survey Monitoring the Future (MTF). MTF is a long-term study conducted since 1975 that gathers data on substance use by American adolescents through the age of 55 years. The 2015 survey included responses from around 44,900 adolescents from 382 secondary schools. In the 2015 publication, the most striking finding is that no statistically significant increase in drug use was observed among more than 50 licit or illicit drug classes and subclasses. Substance use among young populations is an ever-changing phenomenon that requires timely national responses. The availability of reliable data in this domain is important to inform policymakers and public health institutions of emerging substance abuse problems among adolescents, a particularly vulnerable population. MTF offers statistical summaries, trends, and prevalence data for the use of each drug class.

  11. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Miech RA. Monitoring the Future national survey results on drug use, 1975–2015: Volume 2, College students and adults ages 19–55. Ann Arbor: Institute for Social Research, The University of Michigan. 2016.

  12. Chen LY, Crum RM, Strain EC, Martins SS, Mojtabai R. Patterns of concurrent substance use among adolescent nonmedical ADHD stimulant users. Addict Behav. 2015;49:1–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. McCabe SE, West BT, Wechsler H. Trends and college-level characteristics associated with the non-medical use of prescription drugs among US college students from 1993 to 2001. Addiction. 2007;102(3):455–65.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chambers RA, Taylor JR, Potenza MN. Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatr. 2003;160(6):1041–52.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bachman JG. The education-drug use connection: how successes and failures in school relate to adolescent smoking, drinking, drug use, and delinquency. Psychology Press; 2008.

  16. Levy S, Sherritt L, Gabrielli J, Shrier LA, Knight JR. Screening adolescents for substance use-related high-risk sexual behaviors. J Adolesc Health. 2009;45(5):473–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hingson RW, Zha W. Age of drinking onset, alcohol use disorders, frequent heavy drinking, and unintentionally injuring oneself and others after drinking. Pediatrics. 2009;123(6):1477–84.

    Article  PubMed  Google Scholar 

  18. Adams KT, Adams T, Aldworth J, Asman KJ, Barnett SN, Bishop E, et al. Results from the 2016 National Survey on Drug Use and Health: detailed tables. Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), RTI International; 2016.

  19. Roy ÉMDM, Nolin M-AM, Traoré IM, Leclerc PM, Vasiliadis H-MMP. Nonmedical use of prescription medication among adolescents using drugs in Quebec. Can J Psychiatr. 2015;60(12):556–63.

    Article  Google Scholar 

  20. Kokkevi A, Fotiou A, Arapaki A, Richardson C. Prevalence, patterns, and correlates of tranquilizer and sedative use among European adolescents. J Adolesc Health. 2008;43(6):584–92.

    Article  PubMed  Google Scholar 

  21. Guo L, Xu Y, Deng J, Huang J, Huang G, Gao X, et al. Association between nonmedical use of prescription drugs and suicidal behavior among adolescents. JAMA Pediatr. 2016;170(10):971–8.

    Article  PubMed  Google Scholar 

  22. Guo L, Xu Y, Deng J, He Y, Gao X, Li P, et al. Non-medical use of prescription pain relievers among high school students in China: a multilevel analysis. BMJ Open. 2015;5(7):e007569.

    Article  PubMed  PubMed Central  Google Scholar 

  23. National Drug Strategy Household Survey (NDSHS) 2016. Australian Institute of Health and Welfare; 2016.

  24. Zahlan L, Ghandour L, Yassin N, Afifi R, Martins SS. Double trouble: exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents. Drug Alcohol Depend. 2014;145:217–23.

    Article  PubMed  Google Scholar 

  25. Ross-Durow PL, McCabe SE, Boyd CJ. Adolescents’ access to their own prescription medications in the home. J Adolesc Health. 2013;53(2):260–4.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ghandour LA, El Sayed DS, Martins SS. Prevalence and patterns of commonly abused psychoactive prescription drugs in a sample of university students from Lebanon: an opportunity for cross-cultural comparisons. Drug Alcohol Depend. 2012;121(0):110–7.

    Article  PubMed  Google Scholar 

  27. Spoth R, Trudeau L, Shin C, Ralston E, Redmond C, Greenberg M, et al. Longitudinal effects of universal preventive intervention on prescription drug misuse: three randomized controlled trials with late adolescents and young adults. Am J Public Health. 2013;103(4):665–72.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Haffajee RL, Jena AB, Weiner SG. Mandatory use of prescription drug monitoring programs. JAMA. 2015;313(9):891–2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. • Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74. The authors are a collaborative group from Brandeis and Johns Hopkins Universities and the University of North Florida, who used several bodies of evidence (NSDUH, TEDS, DAWN) to make the case that increased overprescribing of POs in terms of sales coincided with increased mortality and treatment rates over an identical time period. The authors, in describing the history of PO marketing and who PO users are, identify that middle-aged people who use medically are those most likely to die from PO-related overdoses, while 15–24-year-olds are most likely to use POs nonmedically, consistent with DSM-IV abuse. PDMPs, if widely adopted by states, and subsequently, physicians, have the capability to limit distribution to both adolescents and adults. This of course depends on linking overprescribers with PO education and patients themselves with chronic care. PDMPs, more so than other prevention interventions, are important due to their scale and automatability.

    Article  PubMed  Google Scholar 

  30. Ma CS, Batz F, Juarez DT, Ladao LC. Drug take back in Hawai’i: partnership between the University of Hawai’i Hilo College of Pharmacy and the narcotics enforcement division. Hawai’i J Med Public Health. 2014;73(1):26–31.

    Google Scholar 

  31. Gray J, Hagemeier N, Brooks B, Alamian A. Prescription disposal practices: a 2-year ecological study of drug drop box donations in Appalachia. Am J Public Health. 2015;105(9):e89–94.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Friese B, Moore RS, Grube JW, Jennings VK. How parents of teens store and monitor prescription drugs in the home. J Drug Educ. 2013;43(3):223–33.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Twombly EC, Holtz KD, Agnew CB. Resonant messages to prevent prescription drug misuse by teens. J Alcohol Drug Educ. 2011;55(1):38–52.

    Google Scholar 

  34. Harris SK, Herr-Zaya K, Weinstein Z, Whelton K, Perfas F Jr, Castro-Donlan C, et al. Results of a statewide survey of adolescent substance use screening rates and practices in primary care. Subst Abus. 2012;33(4):321–6.

    Article  PubMed  Google Scholar 

  35. Ozer EM, Adams SH, Lustig JL, Gee S, Garber AK, Gardner LR, et al. Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics. 2005;115(4):960–8.

    Article  PubMed  Google Scholar 

  36. Levy S. Brief interventions for substance use in adolescents: still promising, still unproven. Can Med Assoc J. 2014;186(8):565–6.

    Article  Google Scholar 

  37. U.S. Preventive Services Task Force. Evidence summary: drug use, illicit: primary care interventions for children and adolescents 2015 [Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/evidence-summary24/drug-use-illicit-primary-care-interventions-for-children-and-adolescents.

  38. Levy SJ, Williams JF. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138(1):e20161211.

    Article  PubMed  Google Scholar 

  39. Beaton A, Shubkin CD, Chapman S. Addressing substance misuse in adolescents: a review of the literature on the screening, brief intervention, and referral to treatment model. Curr Opin Pediatr. 2016;28(2):258–65.

    Article  PubMed  Google Scholar 

  40. Substance Abuse and Mental Health Services Administration. About Screening, brief intervention, and referral to treatment (SBIRT). [Available from: www.samhsa.gov/sbirt/about.

  41. Whiteside LK, Walton MA, Bohnert AS, Blow FC, Bonar EE, Ehrlich P, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics. 2013;132(5):825–32.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Spirito A, Monti PM, Barnett NP, Colby SM, Sindelar H, Rohsenow DJ, et al. A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. J Pediatr. 2004;145(3):396–402.

    Article  PubMed  Google Scholar 

  43. Bernstein E, Edwards E, Dorfman D, Heeren T, Bliss C, Bernstein J. Screening and brief intervention to reduce marijuana use among youth and young adults in a pediatric emergency department. Acad Emerg Med. 2009;16(11):1174–85.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Young MM, Stevens A, Galipeau J, Pirie T, Garritty C, Singh K, et al. Effectiveness of brief interventions as part of the screening, brief intervention and referral to treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Syst Rev. 2014;3(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Results from the 2012 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-46, HHS Publication No(SMA) 13–4795: Substance Abuse and Mental Health Services Administration Rockville, MD; 2013.

  46. Substance Abuse and Mental Health Services Administration. Substance abuse treatment admissions referred by the criminal justice system. Rockville, MD 2009 [Available from: https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=250151.

  47. Allen JP, Mattson ME. Psychometric instruments to assist in alcoholism treatment planning. J Subst Abus Treat. 1993;10(3):289–96.

    Article  CAS  Google Scholar 

  48. Wu L-T, Blazer DG, Li T-K, Woody GE. Treatment use and barriers among adolescents with prescription opioid use disorders. Addict Behav. 2011;36(12):1233–9.

    Article  PubMed  PubMed Central  Google Scholar 

  49. • Chen L-Y, Crum RM, Strain EC, Alexander GC. Prescriptions, nonmedical use, and emergency department visits involving prescription stimulants. J Clin Psychiatry. 2016;77(3):e297–304. The authors are researchers at the Taipei City Psychiatric Center in Taiwan. In this article, the authors used 2006-2011 data from the National Disease and Therapeutic Index, the National Survey on Drug Use and Health, and the Drug Abuse Warning Network to assess trends in nonmedical use, treatment utilization, and ED visits involving prescription stimulants among adolescents in the USA. This study focused specifically on trends involving dextroamphetamine-amphetamine and methylphenidate. It found that adolescent treatment visits involving dextroamphetamine-amphetamine these substances decreased over time, while nonmedical dextroamphetamine-amphetamine use remained stable and nonmedical methylphenidate use declined significantly. During this time period, ED visits involving these substances among adolescents also remained stable. This study is important because it simultaneously examines trends in PS users admitted to EDs and which visits were for nonmedical PS use, thereby identifying occasions at which interventions could have taken place.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Gonzales R, Brecht ML, Mooney L, Rawson RA. Prescription and over-the-counter drug treatment admissions to the California public treatment system. J Subst Abus Treat. 2011;40(3):224–9.

    Article  Google Scholar 

  51. Minozzi S, Amato L, Bellisario C, Davoli M. Detoxification treatments for opiate dependent adolescents. Cochrane Database Syst Rev. 2014;(4)

  52. Minozzi S, Amato L, Bellisario C, Davoli M. Maintenance treatments for opiate -dependent adolescents. Cochrane Database Syst Rev. 2014;(6)

  53. Woody GE, Poole SA, Subramaniam G, Dugosh K, Bogenschutz M, Abbott P, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA. 2008;300(17):2003–11.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Warden D, Subramaniam GA, Carmody T, Woody GE, Minhajuddin A, Poole SA, et al. Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth. Addict Behav. 2012;37(9):1046–53.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Hadland SE, Wharam JF, Schuster MA, Zhang F, Samet JH, Larochelle MR. Trends in receipt of buprenorphine and naltrexone for opioid use disorder among adolescents and young adults, 2001-2014. JAMA Pediatr. 2017;171(8):747–55.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St. Rm. 509, New York, NY, 10032, USA

    Alexander S. Perlmutter, Myrela Bauman, Shivani Mantha, Luis E. Segura & Silvia S. Martins

  2. Centre de Recherche d’Épidémiologie et Statistique Paris Sorbonne-Cité, Hôpital Hôtel-Dieu, Université Paris Descartes, 1 Place du Parvis-Notre Dame, 75004, Paris, France

    Alexander S. Perlmutter

  3. School of International and Public Affairs, Columbia University, 420 W 118th St #1410, New York, NY, 10027, USA

    Myrela Bauman

  4. Department of Epidemiology & Population Health, Faculty of Health Sciences (FHS), American University of Beirut, P.O.Box 11-0236, Beirut, 1107 2020, Lebanon

    Lilian Ghandour

Authors
  1. Alexander S. Perlmutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myrela Bauman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivani Mantha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis E. Segura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lilian Ghandour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Silvia S. Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Silvia S. Martins.

Ethics declarations

Conflict of Interest

The authors declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Adolescent / Young Adult Addiction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perlmutter, A.S., Bauman, M., Mantha, S. et al. Nonmedical Prescription Drug Use Among Adolescents: Global Epidemiological Evidence for Prevention, Assessment, Diagnosis, and Treatment. Curr Addict Rep 5, 120–127 (2018). https://doi.org/10.1007/s40429-018-0194-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-018-0194-y

Keywords

Search

Navigation