Use of complete medication history to identify and correct transitions-of-care medication errors at psychiatric hospital admission.

Methods for categorizing the scale and severity of medication errors corrected by pharmacy staff during admission medication reconciliation using complete medication history continue to evolve. We established a rating scale that is effective for generating error reports to health system quality leadership. These reports are needed to quantify the value of investment in transitions-of-care pharmacy staff. All medication errors that were reported by pharmacy staff in the admission medication reconciliation process during a period of 6 months were eligible for inclusion. Complete medication history data source was utilized by admitting providers and all pharmacist staff and a novel medication error scoring methodology was developed. This methodology included: medication error category, medication error type, potential medication error severity, and medication non-adherence. We determined that 82 medication errors were detected from 72 patients and assessed that 74 of these errors may have harmed patients if they were not corrected through pharmacist intervention. Most of these errors were dosage discrepancies and omissions. With hospital system budgets continually becoming leaner, it is important to measure the effectiveness and value of staff resources to optimize patient care. Pharmacists performing admission medication reconciliation can detect subtle medication discrepancies that may be overlooked by other clinician types. This methodology can serve as a foundation for error reporting and predicting the severity of adverse drug events.

Differences in Prescription Stimulant Misuse Motives Across Adolescents and Young Adults in the United States.

OBJECTIVE: While prescription stimulant misuse (PSM) is common in adolescents and young adults (AYAs), PSM motives are poorly understood. This study examined a number of PSM motives across the AYA age spectrum using the 2015-2018 National Survey on Drug Use and Health. METHODS: In all, 86,918 AYAs (aged 14-25 years) were included. Individual PSM motives (eg, to study) and motive categories (ie, cognitive enhancement only, recreational only, weight loss only, and combined motives) were examined by age. Logistic regression models examined links between individual motives or motive categories and educational status, substance use, DSM-IV substance use disorders (SUD), and mental health correlates. RESULTS: Significant differences were found across AYAs in cognitive enhancement only (14 years = 40.4%; 24 and 25 years = 71.2%; P < .0001) and recreational only (14 years = 25.8%; 24 and 25 years = 9.8%; P < .0001) or combined PSM motives, (14 years = 32.3%; 24 and 25 years = 18.0%; P = .008); college students and graduates had particularly high rates of cognitive enhancement only (college = 78.2%; graduates = 74.7%; non-college = 63.5%). Recreational-only and combined motives were significantly elevated in AYAs with any past-year SUD, especially to get high (78%-136% higher in those with SUD; P ≤ .001). While any PSM was associated with higher odds of SUD and mental health outcomes, including suicidal ideation, odds were highest for recreational or combined motives. CONCLUSIONS: Cognitive enhancement with PSM occurs more often in young adults compared to adolescents, college students endorse more cognitive enhancement than those not in school, and the presence of any PSM in AYAs is linked to more substance use, suicidal ideation, and other psychopathology. PSM prevention in adolescents as well as screening and intervention among AYA is highly recommended.

Nonmedical Use of Prescription Stimulants Among US High School Students to Help Study: Results From a National Survey.

OBJECTIVE: Mixed findings exist regarding extent and efficacy of nonmedical use of prescription stimulants (NMUPS) for study enhancement (SE). This national study of US high school seniors examined NMUPS for SE and addressed risk/benefit questions: To what extent are students reporting NMUPS specifically for SE, and do these individuals demonstrate fewer problem behaviors and superior academic performance? METHOD: Total of 15 098 US students surveyed (2009-2015) and divided into 4 subgroups: (1) no past-year NMUPS (nonusers), (2) past-year NMUPS to help study (NMUPS-SE only), (3) past-year NMUPS for study/nonstudy motives (NMUPS-SE+ other), and (4) past-year NMUPS for nonstudy motives (NMUPS-nonSE only). Student characteristics (eg, grade point average [GPA]) and substance-related problems (eg, binge drinking) compared between subgroups. RESULTS: Among students who reported past-year NMUPS (n = 781), 7.4% reported NMUPS-SE only, 40.9% NMUPS-SE+ other, and 51.7% NMUPS-nonSE only. Odds of binge drinking, cigarette smoking, marijuana, and opioid nonmedical use significantly higher among all NMUPS subgroups. GPAs significantly lower among subgroups reporting NMUPS nonstudy motives; did not differ between NMUPS-SE only and nonusers. CONCLUSIONS: 7% of US high school seniors engaged in NMUPS for SE only (0.4% total population). Findings indicate greater substance-related problems without superior academic performance among NMUPS-SE subgroups.

Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults.

BACKGROUND: Prescription drug misuse (PDM) rates are highest in adolescents and young adults. Little research in these high-risk groups has examined PDM differences by educational status or attainment. This investigation attempted to further our understanding of adolescent and young adult prescription drug use and misuse through examining PDM type (i.e., nonmedical misuse, medical misuse and mixed misuse) and substance use disorder (SUD) symptoms from PDM by educational status/attainment. METHODS: Data were from the 2015 National Survey on Drug Use and Health, with 13,585 adolescent and 14,553 young adult respondents. Participants were categorized by educational status separately in adolescents and young adults. Outcomes were rates of past-year prescription drug use, PDM, PDM type, and SUD symptoms, with analyses performed separately by age group and for opioids, stimulants and sedatives/tranquilizers. Analyses used logistic regression and controlled for age, race/ethnicity and sex. RESULTS: In adolescents and across medication classes, the highest rates of any use, PDM, medical misuse, nonmedical misuse and presence of two or more SUD symptoms were seen in those with poor school adjustment or not in school. In young adults, opioid-PDM and related outcomes were more prevalent in those not in school, especially high school dropouts. For stimulants, rates were highest in full-time college students and college graduates. CONCLUSIONS: These results further suggest the importance of assessing educational status in adolescent and educational attainment in young adult PDM investigations. Adolescents poorly engaged in school or not in school appear especially in need of interventions to limit PDM and associated SUD symptoms.

Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US.

BACKGROUND: Prescription tranquilizer/sedative (e.g., alprazolam, zolpidem) misuse (i.e., use in ways not intended by the prescriber or without a prescription) is understudied, with little research identifying misuse correlates. Identification of key correlates could identify subgroups more likely to engage in misuse, allowing for targeted treatment. This work examines tranquilizer/sedative use and misuse prevalence rates and misuse correlates across U.S. age cohorts, using nationally representative data. METHODS: Data were from the 2015-16 National Survey on Drug Use and Health (n = 114,043). Analyses used design-based logistic regression for past-year tranquilizer/sedative misuse correlates across participants or those engaged in past-year use; past-month misuse correlates were also examined in those with past-year misuse. RESULTS: Young adults (18-25 years) had the highest prevalence of past-year and past-month tranquilizer/sedative misuse, with 42.8% of those with past-year use also engaged in misuse. Mental health correlates were associated with past-year misuse, while substance use, particularly opioid misuse, was associated with both past-year and past-month misuse. Substance use correlate strength was most likely to vary by age group, with older adults (65 years and older) having fewer significant correlates overall. CONCLUSIONS: This work highlighted young adults and those with other substance use as most likely to engage in tranquilizer/sedative misuse. In particular, those endorsing suicidality and reporting opioid misuse are a subgroup of concern, given their especially elevated rates of misuse and the increased risk for overdose imparted by tranquilizer/sedative medication. Workplace-based interventions for young adults and school-based universal prevention may be warranted to limit tranquilizer/sedative misuse in these groups.

Sources of opioid medication for misuse in older adults: results from a nationally representative survey.

Despite increasing rates of prescription opioid (PO) misuse in adults 50 years of age and older, little research has investigated such misuse in this population. This work aimed to examine sources of misused opioid medication in adults 50 years and older, with comparisons to younger groups. Data were from the 2009 to 2014 National Survey on Drug Use and Health surveys. Prevalence rates of PO sources, misuse, and PO use disorder (POUD) symptoms were estimated. Design-based logistic regression investigated age-based differences in these factors and the association of sources with POUD symptoms and other concurrent substance use. Nearly half (47.7%) of adults 65 years and older used physician sources for past 30-day PO misuse, with the second highest rates in those 50 to 64 years old (39.2%). Conversely, use of theft (5.3%), purchases (8.5%), or friends/family (for free; 23.2%) to obtain opioids were least common in adults 65 years and older, with prevalence rates of these sources in those 50 years and older closer to those of younger groups. Across those 50 years and older, use of purchases, physician, or multiple sources were associated with elevated POUD symptom prevalence. Older adults, particularly those 65 years and older, use a different pattern of PO sources than adolescents or younger adults, and those using physician sources have elevated POUD symptoms. Physicians are a key avenue for older adults to obtain opioids for misuse, highlighting the potential role of clinicians in limiting such misuse.

Sources of Prescription Medication Misuse Among Young Adults in the United States: The Role of Educational Status.

OBJECTIVE: This study examined prescription drug misuse (PDM), sources of PDM, and substance use disorder (SUD) symptoms as a function of educational status among US young adults based on a large nationally representative sample. METHODS: Data from the 2009-2014 National Survey on Drug Use and Health came from a sample of 106,845 young adults aged 18-25 years. Respondents were categorized by educational status and PDM, sources of PDM, other substance use, and SUD symptoms, with analyses performed separately for prescription opioids, stimulants, and sedatives/tranquilizers. RESULTS: Prescription opioid (past-year: 11.9%) and sedative/tranquilizer (past-year: 5.8%) misuse were most prevalent among young adults not attending college, especially among high school dropouts. In contrast, full-time college students and college graduates had the highest rates of prescription stimulant misuse (past-year: 4.3% and 3.9%, respectively). Obtaining prescription medications from friends/relatives for free was the most common source of PDM, especially among college students/graduates. Prescription drug misusers who obtained medications from theft/fake prescriptions, purchases, or multiple sources were more likely to report past-year SUDs and had the most severe overall risk profile of concurrent substance use and SUD. More than 70% of past-month prescription drug misusers who reported multiple sources for PDM had at least 1 past-year SUD. CONCLUSIONS: Sources of PDM vary by educational status among US young adults, and the college environment is associated with sharing prescription medications. Clinicians can help assess an individual's risk for SUD by determining whether the individual engaged in PDM and the source of prescription medication the individual is misusing.

Prevalence and correlates of co-ingestion of prescription tranquilizers and other psychoactive substances by U.S. high school seniors: Results from a national survey.

INTRODUCTION: Nonmedical tranquilizer use (NMTU) is a concerning and understudied phenomenon in adolescents, despite being the second most prevalent form of nonmedical use in this population. Thus, this work aimed to examine the sociodemographic and substance use correlates of past-year co-ingestion of a prescription tranquilizer and another substance among adolescents. METHODS: Data were from the Monitoring the Future study, a nationally representative survey of U.S. high school students. Data from 11,444 seniors (12th graders) completing form 1 of the survey were used. The participants represented a population that was 52.7% female, 61.8% White, and had a modal age of 18. Weighted frequencies and Rao-Scott chi-square analyses were computed to describe the target population and examine associations of interest. RESULTS: An estimated 5.3% of the population engaged in past-year NMTU during this time period, with an estimated 72.6% of those users engaged in past-year co-ingestion of a tranquilizer and another substance. Marijuana and alcohol were the most commonly co-ingested substances. Those engaged in co-ingestion were more likely than past-year nonmedical users without co-ingestion to be engaged in other substance or nonmedical use (including past year nonmedical Xanax® (alprazolam) use), have an earlier onset of NMTU, and endorse recreational motives. CONCLUSIONS: Adolescent nonmedical tranquilizer users engaged in co-ingestion may be a particularly vulnerable population, with higher rates of other substance use, other nonmedical use and problematic NMTU characteristics than nonmedical users without co-ingestion. Identification of and intervention with adolescent co-ingestion users are important avenues for future research and clinical practice.

Simultaneous co-ingestion of prescription stimulants, alcohol and other drugs: a multi-cohort national study of US adolescents.

OBJECTIVE: To determine the past-year prevalence rates and correlates of simultaneous co-ingestion of prescription stimulants and other substances among US high school seniors. METHODS: Nationally representative probability samples of US high school seniors were surveyed as a part of the Monitoring the Future study. The sample consisted of five cohorts including a total of 12,431 high school seniors (modal age: 18 years) and represented a population that was 53% female. RESULTS: Among past-year nonmedical users of prescription stimulants (n = 835), the estimated prevalence of any past-year simultaneous co-ingestion of prescription stimulants and other substances was 64.4%. The substances most commonly co-ingested with prescription stimulants included marijuana (51.1%) and alcohol (48.4%). Nonmedical users who co-ingested prescription stimulants with other substances were more likely to report non-oral routes of administration, recreational motives and greater subjective high when using prescription stimulants than nonmedical users who did not co-ingest prescription stimulants with other substances. CONCLUSIONS: The majority of past-year nonmedical users of prescription stimulants reported simultaneous co-ingestion of prescription stimulants and other substances. The findings indicate that co-ingestion of prescription stimulants and other substances is a pervasive behavior among US adolescents who engage in nonmedical use of prescription stimulants and should be carefully considered in future clinical practice and research.

Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots.

OBJECTIVES: To examine trends in the lifetime and past-year prevalence of medical use, diversion, and nonmedical use of four prescription medication classes (i.e., sedative/anxiety, opioid, sleeping, and stimulant) among college students between 2003 and 2013; and to identify demographic and background characteristics associated with trends in past-year nonmedical use of prescription medications. METHODS: A self-administered, cross-sectional Web survey was conducted in 2003, 2005, 2007, 2009, 2011, and 2013 at a large public four-year university in the Midwest United States. RESULTS: Approximately one in every five individuals reported nonmedical use of at least one prescription medication class in their lifetime. The past-year prevalence of medical use, diversion and nonmedical use of prescription stimulants increased significantly between 2003 and 2013 while the past-year prevalence of medical use, diversion and nonmedical use of prescription opioids decreased significantly over this same time period. The odds of past-year nonmedical use of each prescription medication class were generally greater among males, Whites, members of social fraternities and sororities, and those with a lifetime history of medical use of prescription medications or a past-year history of being approached to divert their prescription medications. CONCLUSIONS: The present study represents the first investigation to demonstrate that trends in medical use of controlled medications parallel changes in diversion and nonmedical use of the same medication class among college students. The findings reinforce the importance of continued monitoring of prescription medication use at colleges to help guide prevention and intervention efforts.

Co-ingestion of prescription opioids and other drugs among high school seniors: results from a national study.

BACKGROUND: The objective of this study was to determine the past-year prevalence rates and behavioral correlates of co-ingestion of prescription opioids and other drugs among high school seniors in the United States. METHODS: Nationally representative probability samples of high school seniors in the United States were surveyed as a part of the Monitoring the Future (MTF) study. Data were collected in schools via self-administered paper-and-pencil questionnaires during the spring of each cohort's senior year. The sample consisted of five cohorts (senior years of 2002-2006) made up of 12,441 high school seniors (modal age 18), of which 53% were women. RESULTS: The estimated prevalence of any past-year co-ingestion of prescription opioids and other drugs for these cohorts was 4.4%, and 69.8% among nonmedical users of prescription opioids. The substances most commonly co-ingested with prescription opioids included marijuana (58.5%), alcohol (52.1%), cocaine (10.6%), tranquilizers (10.3%), and amphetamines (9.5%). Nonmedical users who co-ingested prescription opioids with other drugs were more likely to report intranasal administration, recreational motives, oxycodone use, and greater subjective high when using prescription opioids than nonmedical users who did not co-ingest prescription opioids and other drugs. CONCLUSIONS: Nearly 7 out of every 10 nonmedical users of prescription opioids reported co-ingestion of prescription opioids and other drugs in the past year. The findings indicate that the co-ingestion of prescription opioids and other drugs by high school seniors in the United States serves as a marker for substance abuse and represents a significant public health concern.

Medical and nonmedical use of prescription opioids among high school seniors in the United States.

OBJECTIVES To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States and to assess substance use behaviors based on medical and nonmedical use of prescription opioids. DESIGN Nationally representative samples of high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING Data were collected in public and private high schools. PARTICIPANTS The sample consisted of 7374 students from 3 independent cohorts (2007, 2008, and 2009). OUTCOME MEASURES Self-reports of medical and nonmedical use of prescription opioids and other substance use. RESULTS An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Sex differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. More than 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. CONCLUSIONS Nearly 1 in every 4 high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication.

Adolescent nonmedical users of prescription opioids: brief screening and substance use disorders.

OBJECTIVES: The objectives of this study are to examine the associations among a positive score on the CRAFFT (a substance use brief screening test for adolescents) and demographic characteristics, diversion sources, routes of administration, substance use behaviors and motivations associated with the use of prescription opioids without a legal prescription. METHODS: In 2009-2010, a sample of 2744 middle and high school students from two Midwestern school districts in the United States self-administered a Web-based survey. RESULTS: Approximately 5.6% (n=148) of respondents reported past-year nonmedical use of prescription opioids (NMUPO). Of those reporting NMUPO, approximately 35.1% (n=52) screened positive for substance use disorders based on the CRAFFT. Multiple logistic regression analyses indicated that the odds of buying prescription opioids, obtaining opioids from multiple diversion sources, administering opioids intranasally, and using opioids to get high were greater for nonmedical users with a positive CRAFFT screen as compared to NMUPO with a negative CRAFFT screen. NMUPO with a positive screen was motivated primarily for recreational purposes, while NMUPO with a negative screen was motivated almost exclusively by pain relief. CONCLUSIONS: The CRAFFT brief screening test for adolescents can be used to identify a subgroup of NMUPO at the highest risk for a substance use disorder as well as a subgroup of NMUPO who would benefit from appropriate pain management.

Misuse of prescribed stimulant medication for ADHD and associated patterns of substance use: preliminary analysis among college students.

OBJECTIVES: To explore the prevalence and characteristics associated with college students who misuse their prescribed stimulants for attention-deficit hyperactivity disorder (ADHD) and examine diversion and substance use behaviors as a function of misuse. METHODS: Cohort of 55 past-year prescribed stimulant users was identified from a random sample (n = 1738) at a large Midwestern research university following the self-administration of a web-based survey. An index was created to assess misuse of prescribed stimulants (i.e., Misuse Index). RESULTS: Of 55 college students who reported past-year use of prescribed stimulants for ADHD, 22 (40%) endorsed at least one item on the misuse index. The most frequently endorsed misuse items were used too much (36%), self-reported misuse (19%), and intentionally used with alcohol or other drugs (19%). Misusers of prescribed stimulant medication were more likely to report cigarette smoking (p = 0.022), binge drinking (p = 0.022), illicit use of cocaine (p = 0.032), and screen positive on the Drug Abuse Screening test (DAST-10) criteria (p = 0.002). The bivariate odds ratio for the DAST-10 findings was 8.4 (95% CI: 2.0-34.6). Diversion of prescribed stimulants was common (36%) and occurred more frequently among stimulant misusers (57%; p = 0.008). CONCLUSION: There is a strong relationship between misuse of prescribed stimulants for ADHD and substance use behaviors, as well as other deleterious behaviors such as diversion. These findings suggest the need for close screening, assessment, and therapeutic monitoring of medication use in the college population.

Medical misuse of controlled medications among adolescents.

OBJECTIVES: To determine the past-year medical misuse prevalence for 4 controlled medication classes (pain, stimulant, sleeping, and antianxiety) among adolescents, and to assess substance use outcomes among adolescents who report medical misuse. DESIGN: A Web-based survey was self-administered by 2744 secondary school students in 2009-2010. SETTING: Two southeastern Michigan school districts. PARTICIPANTS: The sample had a mean age of 14.8 years and was 51.1% female. The racial/ethnic distribution was 65.0% white, 29.5% African American, 3.7% Asian, 1.3% Hispanic, and 0.5% other. MAIN OUTCOME MEASURES: Past-year medical use and misuse of 4 controlled medication classes. RESULTS: Eighteen percent of the sample reported past-year medical use of at least 1 prescribed controlled medication. Among past-year medical users, 22.0% reported misuse of their controlled medications, including taking too much, intentionally getting high, or using to increase alcohol or other drug effects. Medical misusers were more likely than nonmisusers to divert their controlled medications and to abuse other substances. The odds of a positive screening result for drug abuse were substantially higher among medical misusers (adjusted odds ratio, 7.8; 95% confidence interval, 4.3-14.2) compared with medical users who used their controlled medications appropriately. The odds of drug abuse did not differ between medical users who used their controlled medications appropriately and nonusers. CONCLUSIONS: Most adolescents who used controlled medications took their medications appropriately. Substance use and diversion of controlled medications were more prevalent among adolescents who misused their controlled medications. Careful therapeutic monitoring could reduce medical misuse and diversion of controlled medications among adolescents.

Medication adherence and attitudes in patients with bipolar disorder and current versus past substance use disorder.

We examined the impact of substance use disorder (SUD) history among patients with bipolar I disorder (BD) in regards to medication-taking behaviors and attitudes. Interviews were conducted with inpatients hospitalized for BD, which included diagnostic instruments and measures of attitudes concerning psychiatric medications. We compared patients with BD and no history of SUD (BD-NH), BD and past history of SUD (BD-PH), and BD and current SUD (BD-C). The primary outcome variable was a standardized medication adherence ratio (SMAR) of [medication taken]/[medication prescribed]. Fifty-four patients with a BD diagnosis participated, which included BD-NH (n=26), BD-PH (n=19), and BD-C (n=9). The SMAR was significantly different among the three groups; post-hoc analyses revealed the SMAR was significantly lower among BD-C (M=0.70) compared to BD-NH (M=0.90) and BD-PH (M=0.97) patients. This finding remained significant after controlling for numerous patient characteristics. Attitudes regarding medications, measured by the Drug Attitude Inventory (DAI), were positive among a significantly higher percentage of BD-PH (89.47%) and BD-NH (65.38%) compared to BD-C (44.44%) patients. In conclusion, patients with BD-C demonstrated poor medication adherence and attitudes concerning medication management. Helping patients with BD achieve remission from SUD may lead to a more successful course of BD pharmacotherapy.

Characteristics associated with the diversion of controlled medications among adolescents.

BACKGROUND: The objective of this study was to estimate the lifetime prevalence of diversion (i.e., trading, selling, giving away or loaning) of four classes of controlled medications (pain, stimulant, anti-anxiety, and sleeping) among adolescents, and to identify demographic and behavioral characteristics of adolescents who divert their own controlled medications. METHODS: A web-based survey was self-administered by 2744 secondary school students from two southeastern Michigan school districts in 2009-2010. The sample consisted of 51% females, 65% Whites, 29% African-Americans, 4% Asians, 1% Hispanics and 1% from other racial categories. RESULTS: Thirty-three percent of the students had ever been prescribed at least one controlled pain, stimulant, anti-anxiety, or sleeping medication. Approximately 13.8% (n=117) of lifetime prescribed users of controlled medications (n=848) had ever traded, sold, given away or loaned their medications. Multiple logistic regression analyses indicated that being approached to divert medications, nonmedical use of prescription medications, externalizing behaviors, and being non-White were significantly associated with the diversion of controlled medications. Multiple logistic regression analysis indicated that the odds of substance use and abuse for lifetime prescribed users who diverted their controlled medications were significantly greater than prescribed users who never diverted. CONCLUSIONS: The findings indicate that approximately one in seven prescribed users had diverted their controlled medications in their lifetimes. Being approached to divert medications and substance use are more prevalent among adolescents who diverted their controlled medications. Careful assessments, diligent prescribing and monitoring of controlled medications, and continual patient education could be useful in reducing medication diversion.

Nonmedical use of prescription stimulants and depressed mood among college students: frequency and routes of administration.

Studies demonstrate associations between nonmedical use of prescription stimulants (NMUPS) and depressed mood; however, relevance of NMUPS route of administration and frequency of use have not been examined. We hypothesized frequent NMUPS and nonoral routes would be significantly associated with depressed mood. A Web survey was self-administered by a probability sample of 3,639 undergraduate students at a large U.S. university. The survey contained substance use (e.g., frequency, route of administration) and depressed mood measurement. Past-year prevalence of NMUPS was 6.0% (n = 212). Approximately 50% of frequent or nonoral NMUPS reported depressed mood. Adjusted odds of depressed mood were over two times greater among frequent monthly NMUPS (adjusted odds ratio [AOR] = 2.3, 95% confidence interval [CI] = 1.01-5.15) and nonoral routes of administration (AOR = 2.2, 95% CI = 1.36-3.70), after controlling for other variables. Nonmedical users of prescription stimulants should be screened for depressed mood, especially those who report frequent and nonoral routes of administration.

Motives for nonmedical use of prescription opioids among high school seniors in the United States: self-treatment and beyond.

OBJECTIVES: To assess motives for nonmedical use of prescription opioids among US high school seniors and examine associations between motives for nonmedical use and other substance use behaviors. DESIGN: Nationally representative samples of US high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING: Data were collected in public and private high schools. PARTICIPANTS: The sample consisted of 5 cohorts (2002-2006) of 12 441 high school seniors. MAIN OUTCOME MEASURES: Self-reports of motives for nonmedical use of prescription opioids and substance use behaviors. RESULTS: More than 1 in every 10 high school seniors reported nonmedical use of prescription opioids and 45% of past-year nonmedical users reported "to relieve physical pain" as an important motivation. The odds of heavy drinking and other drug use were lower among nonmedical users of prescription opioids motivated only by pain relief compared with nonmedical users who reported pain relief and other motives and those who reported non-pain relief motives only. The odds of medical use of prescription opioids were lower among nonmedical users who reported only non-pain relief motives compared with other types of nonmedical users. CONCLUSIONS: The findings indicate motives should be considered when working with adolescents who report nonmedical use of prescription opioids. Future efforts are needed to identify adolescents who may need appropriate pain management and those at increased risk for prescription opioid abuse.

Subtypes of nonmedical prescription drug misuse.

This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping, and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3639 undergraduate students attending a large midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication.