Opioid abuse and depression in adolescents: Results from the National Survey on Drug Use and Health.

OBJECTIVE: To investigate the association of major depressive episode (MDE) with nonmedical prescription opioid use (NMPOU) and opioid abuse/dependence among adolescents aged 12 to 17. METHODS: We analyzed 5 years of data from the National Survey on Drug Use and Health (NSDUH). We used logistic regressions to study the relationship between MDE and NMPOU among all adolescents, as well as the relationship of MDE with opioid abuse/dependence among adolescents with NMPOU. Other covariates included: sociodemographics, alcohol abuse/dependence, nonopioid drug abuse/dependence, delinquency, school performance, religious services attendance, and family support/supervision. RESULTS: In the sample of all adolescents, 6% reported past year NMPOU, and 8% reported past year MDE. When NMPOU and MDE were comorbid, MDE usually preceded the NMPOU. In the sample of adolescents with NMPOU, 15% reported past year opioid abuse/dependence, and 20% reported past year MDE. In adjusted logistic regression, MDE was associated with both NMPOU (OR=1.51, p<0.001) among all adolescents and opioid abuse/dependence (OR=2.18, p<0.001) among adolescents with NMPOU. CONCLUSION: MDE occurs commonly in adolescents and is associated with NMPOU and opioid abuse/dependence. In terms of population attributable risk, which is a function of both the prevalence and the strength of the association, MDE is an important risk factor for NMPOU among adolescents and opioid abuse/dependence among adolescents with NMPOU. Preventive and clinical programs to decrease NMPOU and opioid abuse/dependence among adolescents should consider the prominent role of depression.

Medication costs to private insurers of diversion of medications for attention-deficit hyperactivity disorder.

BACKGROUND: The diversion of prescription stimulants for misuse, particularly those used in the treatment of attention-deficit hyperactivity disorder (ADHD), is potentially a significant problem for public health and for healthcare funding and delivery. Most prior research on the diversion of prescription stimulants for misuse, particularly those used in the treatment of ADHD, has focused on the 'end users' of diverted medications rather than the suppliers. Furthermore, little is known about the direct costs of diversion for third-party insurance payers in the US. OBJECTIVES: The objectives of this study were to estimate the prevalence in the US of people whose private insurance paid costs for ADHD prescriptions that they gave or sold to another person (diversion), and to estimate medication costs of diversion to private insurers. METHODS: Estimates are from a cross-sectional survey of respondents from two Internet survey panels targeting individuals aged 18-49 years in the civilian, noninstitutionalized US population, principally for those who filled prescriptions for ADHD medications in the past 30 days that were covered by private health insurance. Analysis weights were post-stratified to control totals from the Current Population Survey and National Health Interview Survey. Weighted prevalence rates and standard errors for diversion are reported, as are the costs of diverted pills using drug prices reported in the 2008 Thomson Reuters RED BOOK™. Sensitivity analyses were conducted that varied the cost assumptions for medications. RESULTS: Among individuals aged 18-49 years whose private insurance paid some costs for ADHD medications in the past 30 days, 16.6% diverted medications from these prescriptions. Men aged 18-49 years for whom private insurance paid some costs of ADHD drugs in the past 30 days were more than twice as likely as their female counterparts to divert medications from these prescriptions (22.5% vs 9.1%; p = 0.03). After a pro-rated co-payment share was subtracted, the estimated value of diverted medications in a 30-day period was $US8.0 million. Lower- and upper-bound estimates were $US6.9 million to $US17 million, for a range of $US83 million to $US204 million annually. Overall, diversion accounted for about 3.6% of the total costs that private insurers paid for ADHD medications (range: 3.5-4.5%). The percentages varied by medication category, although relative differences were sensitive to inclusion of a pro-rated co-payment. A higher percentage of the costs of extended-release (XR) medications was lost to diversion compared with that for immediate-release (IR) medications. CONCLUSIONS: Costs of ADHD medications paid for by private insurers that were lost to diversion were small relative to the total estimated medication costs and relative to total estimated healthcare costs for treating ADHD. Nevertheless, there may be significant cost savings for insurers if diversion can be reduced, particularly for XR medications. These findings represent a first step to informing policies to reduce diversion both in the interest of public health and for direct and indirect cost savings to insurers.

Stimulant formulation and motivation for nonmedical use of prescription attention-deficit/hyperactivity disorder medications in a college-aged population.

There is relatively little research examining motives for nonmedical use (NMU) of attention-deficit/hyperactivity disorder (ADHD) medications and predictors of motivation. We present results of a secondary analysis of an Internet-based epidemiological survey to explore the relationship between stimulant formulation and motivation for NMU of ADHD stimulant medications in a college-aged population. Demographic predictors of motivation to engage in NMU were also explored to investigate the potential correlates of recreational versus performance-enhancement motivations. Respondents scoring higher on the Adult ADHD Self-Report Scale were significantly more likely to engage in NMU of ADHD stimulant medications. Those using extended release (ER) stimulant formulations were less likely to endorse "staying awake" as a reason for NMU compared to those using immediate release (IR) stimulant formulations.

Estimated drug use based on direct questioning and open-ended questions: responses in the 2006 National Survey on Drug Use and Health.

Substance use surveys may use open-ended items to supplement questions about specific drugs and obtain more exhaustive information on illicit drug use. However these questions are likely to underestimate the prevalence of use of specific drugs. Little is known about the extent of such underestimation or the groups most prone to under-reporting. Using data from the 2006 National Survey on Drug Use and Health (NSDUH), a civilian, non-institutionalized population survey of persons aged 12 or older in the United States, we compared drug use estimates based on open-ended questions with estimates from a new set of direct questions that occurred later in the interview. For these drugs, estimates of lifetime drug use based on open-ended questions often were at least seven times lower than those based on direct questions. Among adults identified in direct questions as substance users, lower educational levels were consistently associated with non-reporting of use in the open-ended questions. Given NSDUH's large annual sample size (approximately 67,000 interviews), combining data across future survey years could increase our understanding of characteristics associated with non-reporting of use in open-ended questions and allow drug use trends to be extrapolated to survey years in which only open-ended question data are available.

Prevalence of nonmedical methamphetamine use in the United States.

BACKGROUND: Illicit methamphetamine use continues to be a public health concern in the United States. The goal of the current study was to use a relatively inexpensive methodology to examine the prevalence and demographic correlates of nonmedical methamphetamine use in the United States. METHODS: The sample was obtained through an internet survey of noninstitutionalized adults (n = 4,297) aged 18 to 49 in the United States in 2005. Propensity weighting methods using information from the U.S. Census and the 2003 National Survey on Drug Use and Health (NSDUH) were used to estimate national-level prevalence rates. RESULTS: The overall prevalence of current nonmedical methamphetamine use was estimated to be 0.27%. Lifetime use was estimated to be 8.6%. Current use rates for men (0.32%) and women (0.23%) did not differ, although men had a higher 3-year prevalence rate (3.1%) than women (1.1%). Within the age subgroup with the highest overall methamphetamine use (18 to 25 year olds), non-students had substantially higher methamphetamine use (0.85% current; 2.4% past year) than students (0.23% current; 0.79% past year). Methamphetamine use was not constrained to those with publicly funded health care insurance. CONCLUSION: Through the use of an internet panel weighted to reflect U.S. population norms, the estimated lifetime prevalence of methamphetamine use among 18 to 49 year olds was 8.6%. These findings give rates of use comparable to those reported in the 2005 NSDUH. Internet surveys are a relatively inexpensive way to provide complimentary data to telephone or in-person interviews.

The nonmedical use of prescription ADHD medications: results from a national Internet panel.

BACKGROUND: Emerging evidence suggests that nonmedical use (NMU) of prescription attention deficit/hyperactivity disorder (ADHD) medications is rising, but many previous investigations have used clinical or regionally based samples or limited their investigations to stimulants rather than to medications specifically used to treat ADHD. Using an Internet-based epidemiological survey, this paper advances understanding of the prevalence and correlates of NMU of medications used to treat ADHD, sources of diverted medications, motivations for use, and consumption patterns. METHODS: The study used a self-administered Internet survey of civilian, noninstitutionalized adults (N = 4,297) aged 18 to 49 in the United States. National-level estimates were created using propensity scoring methods and weighting procedures using data from three nationally representative probability surveys: a random-digit dialed telephone survey, the current U.S. Census, and the National Survey on Drug Use and Health (NSDUH). RESULTS: Past-year prevalence of NMU of ADHD medications was approximately 2%, with 4.3% reported among those aged 18 to 25 and 1.3% among those aged 26 to 49. Most respondents reporting NMU used on multiple occasions. Receipt of medications for ADHD was a significant correlate of past-year NMU, though most nonmedical users never had a prescription. Among persons who had never been prescribed medication to treat ADHD, friends or family members were the most common source. Productivity was the most frequently endorsed reason for NMU. Alcohol was the substance most commonly used in combination with ADHD drugs. CONCLUSION: Because most prescription ADHD medications currently are highly regulated, policy options for supply-side reduction of nonmedical use may include identifying those medications with lower abuse liability for inclusion on insurance formularies. Patient and physician education programs also may be useful tools to heighten awareness of intentional and unintentional diversion of ADHD medications for nonmedical purposes.

Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25.

This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among young adults aged 18 to 25. Data from the 2002 National Survey on Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of nonmedical stimulant use. The sample size was 23,645. Multivariate analyses revealed that selling drugs and using marijuana and other illegal drugs were associated with increased odds of both methamphetamine and nonmedical prescription stimulant use. Females, individuals not enrolled in college, and those who had been arrested were more likely than their counterparts to have used methamphetamine, whereas black individuals and less religious individuals were less likely than their counterparts to have used methamphetamine. Psychological distress, sensation seeking, binge drinking, and college enrollment were associated with increased risks of nonmedical prescription stimulant use, whereas Hispanic and other ethnic identification were associated with decreased risks of nonmedical prescription stimulant use. Different intervention strategies are needed to prevent methamphetamine use versus nonmedical prescription stimulant use.

Risk and protective factors for nonmedical use of prescription stimulants and methamphetamine among adolescents.

PURPOSE: This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among adolescents aged 12 to 17 years. METHODS: Data from the 2002 National Survey of Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of illicit stimulant use. The sample size was 17,709. RESULTS: Analyses revealed that mental health treatment utilization and use of marijuana and other illegal drugs were correlated with nonmedical use of prescription stimulants and methamphetamine among adolescents. Females and adolescents who reported low religiosity, binge drinking, and selling drugs were more likely to use methamphetamine than were males or individuals who did not report these attitudes or behaviors. Additionally, black adolescents were less likely than white adolescents to use methamphetamine. Alternatively, adolescents who reported high family conflict and sensation-seeking were more likely than their counterparts to use prescription stimulants nonmedically, and Hispanic adolescents were less likely to use prescription stimulants nonmedically than white adolescents. CONCLUSIONS: Risk for illicit use of stimulants varies by demographic, psychosocial, and behavioral factors. Different intervention mechanisms, populations, and settings should be targeted to prevent nonmedical use of prescription stimulants versus methamphetamine among adolescents.

Nonmedical use of prescription stimulants in the United States.

OBJECTIVE: This study estimated prevalences and correlates of stimulant diversion in the United States and examined relationships between diversion and measures of abuse or dependence. METHODS: We conducted descriptive and multivariate analysis of data from the National Survey on Drug Use and Health. Key measures were nonmedical use (misuse) of any prescription stimulant, any stimulant other than methamphetamine, and stimulants indicated for attention-deficit/hyperactivity disorder (ADHD). RESULTS: Lifetime stimulant misuse included some misuse of longer-acting ADHD drugs. The majority of past-year misuse involved drugs other than methamphetamine, particularly for youth aged 12-17. Past year misuse was more prevalent among persons aged 12-25, compared with older adults, and among Whites, compared with other groups. Prevalences in large metropolitan areas were lower than or similar to those in less populated areas. About 13% of past-year stimulant misusers met the survey criteria for dependence or abuse, as did about 10% of persons aged 12-25 who misused only nonmethamphetamine stimulants. CONCLUSIONS: Most stimulant misuse in the United States (particularly among youth) involved prescription drugs other than methamphetamine. The problem is not limited to metropolitan areas.