Lifetime Prescription Drug Use, 7th-12th grade, 2005 ..

1
Nonmedical Use of Prescription Drugs Among
Adolescents and Young Adults

• Christian J. Teter, Pharm.D., BCPP
• Assistant Professor
• Northeastern University School of Pharmacy
• c.teter_at_neu.edu
• Clinical Research Pharmacist
• McLean Hospital Alcohol and Drug Abuse
• Treatment Program
• cteter_at_mclean.harvard.edu

2
Balance Medical Necessity
This trend pisses me off. I've been taking
Adderall for my ADHD since the 6th grade (was on
something else years prior), and have never
abused it. Because of all of this abuse by other
students, I feel like a druggie or something
because everybody is always talking about "my
medication" essentially. I now pretend like I
don't use it, so people won't ask me for some. If
they end up outlawing this drug, or make it more
complicated to get, or my insurance company takes
it off of the co-pay because it is being abused,
I'm gonna be SOL because it's the only ADHD
medication that has ever worked on me. The other
one's give me massive headaches... (student,
12/6/05)

3
Stimulant Medications From Peers

• Whenever I want Ritalin, I just ask my friend he
  has a prescription.
• Everyone at my school uses Adderall and they
  share it the kids that do best at school use
  it.
• At school, it (ADD/ADHD medication) is free,
  friends will just give it to you.
• Its better than Red Bull!

4
School Nurses

• Despite the limitations of this study, there are
  several implications for practice, policy, and
  future research. Physicians, parents,
  pharmacists, school nurses, social workers,
  counselors, and principals should be educated and
  pay particular attention to the use and misuse of
  prescription medication among school-age children
  and adolescents.

Source McCabe, Teter, and Boyd. Substance Use
and Misuse 2004
5
Abuse Potential

• Scheduling (PROXY for abuse potential)
• Controlled Substances Act (CSA) of 1970
  categorizes drugs based upon the substance's
  medicinal value, harmfulness, and potential for
  abuse or addiction www.dea.gov

6
An Issue of Balance

• Balance Medical Necessity vs. Abuse Risk
• Stimulant medications
• Effective first-line treatment for the symptoms
  of ADHD
• Prescription opioids
• Cornerstone of moderate to severe pain management

7
Studies of Nonmedical Use

• MTF
• NSDUH
• SLS
• CAS

8
Key Definitions

• Nonmedical use of prescription drugs
• National Survey on Drug Use and Health (NSDUH)
  not prescribed for you, or that you took for
  the experience or feeling it caused
• Monitoring the Future (MTF) study without a
  doctors orders
• Student Life Survey (SLS) NOT prescribed to
  you
• CAS Do not include anything you used under a
  doctors orders

9
Race and Nonmedical Use of Vicodinby U.S. 12th
grade students, MTF 2002

reporting nonmedical use of Vicodin

p lt 0.01, p lt 0.001 based on logistic
regression using Whites as reference group and
adjusting for gender, race, region, GPA and grade
level.
Source McCabe, Boyd Teter. Journal of
Substance Abuse Treatment 2005
10
Race and Nonmedical Use of Ritalin by U.S. 8th,
10th 12th grade students, MTF 2001
reporting nonmedical use of Ritalin


p lt 0.001 based on logistic regression using
Whites as reference group and adjusting for
gender, race, region and grade level.
Source McCabe, Teter, Boyd Guthrie. Journal of
Adolescent Health 2004
11
Lifetime Prescription Drug Use, 7th-12th grade,
2005(includes opioid, stimulant, sedative and
sleeping medication)
reporting lifetime prescription drug use
n511 n331
n184 n35
Source McCabe et al., under review
12
College Studies RX Stimulants
13
National Studies RX Stimulants
14
Gender Differences in Drug Use Among
Undergraduate Students in the Past Year, SLS 2005





Note The past-year prevalence rate for heroin,
LSD and crystal methamphetamine was less than 1.
15
Source Teter et al. Pharmacotherapy (in press)
16
Source Teter et al. Pharmacotherapy (in press)
17

NOTE those approached to trade, sell or give
away their prescribed medication.
Source McCabe, Teter Boyd. J Am Coll Health
2006
18
Sources of Past-year Illicit Use of Prescription
Stimulants, SLS 2003 (n 458)

• Peer category consisted of friends, peers,
  roommate, boyfriend, girlfriend and teammate.
• Family category consisted of mother, family,
  parent, father, sibling, aunt, brother, husband
  and cousin.
• Other category consisted of dont know,
  over-the-counter, self, drug dealer, and abroad.

Source McCabe, Teter Boyd. J Psychoactive
Drugs 2006
19
Motives

• Research on the motives for alcohol use has added
  to our understanding of drinking behavior
• We hypothesized that understanding the motives
  for the illicit use of prescription stimulants
  would help provide insight into this behavior

20
Source Teter et al. Journal of American College
Health 2005
21
Motives

• Results (Study 1)
• Motives that were found in the open-ended
  responses included
• curiosity and experimentation
• to study
• Motives did not differ based upon having a
  prescription for stimulant medication

Source Teter et al. Journal of American College
Health 2005
22
STUDY 2 Motives of Lifetime Illicit Use of
Prescription Stimulants, SLS 2005 (n 382)





Source Teter et al. Pharmacotherapy (in press)
23

• STUDY 2 Motives for the illicit use of
  prescription stimulants as a function of
• Gender
• Age of initiation
• (n382)
• --------------------
• ltGendergt and ltcollege vs. pre-college initiationgt
  differences were statistically significant at
• p lt 0.05 and p lt 0.01, respectively.

Source Teter et al. Pharmacotherapy (in press)
24
Motives of Lifetime Nonmedical Use of
Prescription Opioids, SLS 2005




plt.05, plt.01, plt.001
Source McCabe et al, under review
25
Alcohol Other Drugs

• Cluster problem behavior
• Students who report the illicit use of
  prescription medications report much higher rates
  of AOD use

26
AOD Use Among College Students (SLS 2001)
Past-year illicit
Past-year RX Past-year
MPH users stimulant users
non-stimulant users Got drunk in high
98.2 54.2 58.3 school
or before Binge drinking in 98.2
69.6 48.3 the past
two weeks   Used marijuana in 91.2
50.0 28.1 high school or
before   Marijuana use in the 100.0
50.0 29.9 past year Ecstasy (MDMA)
use 57.9 12.5 5.3 in
the past year Any cigarette use in 77.2
32.0 22.0 the past month
Source Teter et al. Pharmacotherapy 2003
27
AOD Use Among College Students (SLS 2001)
Past-year illicit
Past-year RX stimulant
Past-year non-stimulant MPH
users
users users Illicit drugs used
3.84 (0.14) 1.25 (0.21) 0.49
(0.02) in the past year, not including
illicit Ritalin (0-16)   Illicit drugs used in
1.95 (0.08) 0.67 (0.13) 0.22
(0.01) the past month, not including illicit
Ritalin (0-16) Pre-college illicit
2.30 (0.13) 1.10 (0.20) 0.44
(0.02) drugs used, not including
illicit Ritalin (0-16)   Drinks per occasion
7.02 (0.37) 4.70 (0.58) 4.10 (0.06)
in the past 30 days (0-12)   Primary
AOD-related 9.68 (0.52)
4.39 (0.81) 3.90
(0.09) consequences index (0-23) Secondary
AOD-related 5.28 (0.31)
3.60 (0.46) 3.20
(0.05) consequences index (0-10)  
Source Teter et al. Pharmacotherapy 2003
28
?2 test results indicate the differences in the
prevalence rates of AOD use between those
endorsing a particular motive and the remaining
illicit prescription stimulant users (i.e., the
illicit stimulant users not endorsing that
particular motive) due to multiple comparisons
alpha was adjusted to 0.001.
Source Teter et al. Journal of American College
Health 2005
29
Drug Abuse Screening Test by Motive for
Nonmedical Use of Prescription Opioids, SLS 2005


reporting three or more DAST-10 items
n1901 n113 n199
n1936 n140 n181
plt.001 based on logistic regression adjusting
for race/ethnicity, class year and living
arrangement
Source McCabe et al, under review
30
Substance Use by Past Year Nonmedical Use of
Ritalin, U.S. 8th, 10th 12th grade students,
MTF 2001




Source McCabe, Teter, Boyd Guthrie, Journal of
Adolescent Health 2004
p lt 0.001 based on Chi-square tests
31
Substance Use by Lifetime Use of Prescription
Stimulants, Secondary School Students, SLS 2002
Source McCabe, Teter Boyd. Substance Use
Misuse 2004
32
Substance Use in the Past Year by Nonmedical Use
of Prescription Stimulants Among U.S. College
Students, CAS 2001 (n 10,904)





Source McCabe et al. Addiction 2005
33
Drug Abuse Screening Test Results by Lifetime Use
of Prescription Drugs, 7th-12th graders, 2005


reporting three or more DAST-10 items
n511 n331
n184 n35
p lt 0.001 based on logistic regression using
non-users as reference group and adjusting for
gender, race/ethnicity and grade level.
Source McCabe et al., under review
34
Medical Illicit Use

• Relationships between medical and illicit use
  suggest that prescription stimulants have the
  highest illicit to medical use ratio

35
Past Year Medical Use of Prescription Drugs Among
College Students (SLS 2003)

Sleeping Medication n8489
Sedative Medication n8487
Stimulant Medication n8487
Pain Medication n8476
Source McCabe, Teter Boyd. J Am Coll Health
2006
36
Source McCabe, Teter Boyd. J Am Coll Health
2006
37
Sleeping medication
Sedative medication
Stimulant medication
Pain medication
n8489
n8487
n8487
n8476
Source McCabe, Teter Boyd. J Am Coll Health
2006
38
Risk Factors

• Men (vs. women)
• White students
• Northeast colleges (vs. other regions)
• Competitive admission criteria
• Fraternity/Sorority member

39
Gender Differences in Illicit Use of
Prescription Stimulants, CAS 2001 (n10,904)

Source McCabe et al. Addiction 2005
40
Racial Differences in Illicit Use of
Prescription Stimulants, CAS 2001 (n10,904)


Source McCabe et al. Addiction 2005
41
Fraternity/Sorority Membership and Illicit Use
of Prescription Stimulants, CAS 2001 (n10,904)

Source McCabe et al. Addiction 2005
42
Admission Criteria and Illicit Use of
Prescription Stimulants, CAS 2001 (n10,904)


Source McCabe et al. Addiction 2005
43
Race and Nonmedical Use of Prescription Drugs,
CAS 2001




N10,904
N10,904
p lt 0.001 based on logistic regression
results using White as reference group
Sources McCabe et al, Addiction 2005 McCabe et
al Addictive Behav. 2005
44
Admission Criteria and Nonmedical Use of
Prescription Drugs, CAS 2001





n10,904
n10,904
p lt 0.05, p lt 0.01 based on logistic
regression results using less competitive as
reference group.
Sources McCabe et al, Addiction 2005 McCabe et
al Addictive Behav. 2005
45
Past Year Nonmedical Use of Prescription
Stimulants by Race/Ethnicity (n 4,478)
Source Teter et al. Pharmacotherapy (in press)
46
Past Year Nonmedical Use of Prescription
Stimulants Across 119 Colleges, 2001 CAS (n
10,904 students)
Source McCabe et al. Addiction 2005
47
Conclusions

• Students are using prescription medications
  nonmedically for many purposes
• AOD use are significantly higher among those who
  use prescription medications nonmedically
• Possible exception pain only motive
• Our findings suggest that factors associated with
  nonmedical use of prescription medications are
  similar to other illicit substances

48
Conclusions

• Prevention efforts must strike a balance between
  the medical necessity to effectively treat
  patients and the need to reduce nonmedical use of
  these abusable medications

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Conclusions

• Clinical implications
• Education for clinicians in all disciplines
  regarding the prevalence and risks of
  prescription drug abuse
• Screening and intervention training for
  clinicians (e.g., similar to the CAGE or AUDIT
  for alcoholism)

Source U.S. Food and Drug Administration, FDA
Consumer magazine, September-October 2001,
Prescription Drug Use and Abuse
50
Acknowledgements

• Drs. Sean McCabe, Carol Boyd, Jim Cranford
  Sally Guthrie
• National Institutes of Health, National Institute
  on Drug Abuse research grants
• T32DA07267 (PI Boyd)
• R03DA018239 (PI McCabe)
• R03DA018271 (PI Boyd)
• R03DA019492 (PI McCabe)
• The University of Michigan Northeastern
  University McLean Hospital
• Harvard College Alcohol study (Dr. Henry
  Wechsler)
• Monitoring the Future study staff

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Questions ?