Adolescents who misuse controlled medications (e.g., pain, stimulant, sleeping and antianxiety medications) for which they have a legitimate prescription may be more likely to abuse other substances and to sell, give or trade their controlled medications to other individuals, according to a report in the August issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.
According to background information in the article, U.S. children and teens have increasingly received prescriptions for controlled medications. "Despite the importance of controlled medications in treating childhood and adolescent disorders, a consequence of this increase in prescribing may be a concomitant rise in medical misuse, diversion of controlled medications, and nonmedical use of controlled medications among adolescents," write the authors. They define "medical misuse" as "the use of a controlled psychotherapeutic medication by a patient in a manner not intended by the prescribing health care professional, including (but not limited to) not following the prescribed dosage, using intentionally to get high, not taking the medication within a prescribed interval, or co-ingesting with alcohol or other drugs."
Sean Esteban McCabe, Ph.D., from the University of Michigan, Ann Arbor, and colleagues conducted a Web-based survey from December 2009 to April 2010. The 2,597 respondents who completed the survey were students at middle schools and high schools in two southeastern Michigan school districts. The average age was 14.8 years, 65 percent of respondents were white and 51.1 percent of participants were female. The survey included standard measures of substance use (cigarette smoking in the past month, binge drinking in the past two weeks, nonmedical use of prescription medication and marijuana and other illicit drug use in the past year); questions about medical use, misuse and diversion (selling, giving away or trading) of controlled medications; and two drug-screening tests.
Of the 18 percent of respondents who said that during the past year they had used, for medical purposes, one of the controlled medications mentioned, 22 percent also said they had misused these medications, mostly by taking too much. Those defined as frequent users of controlled medications (at least 10 instances) were more likely than less-frequent users to engage in misuse. Prevalence of misuse was greater among frequent users of pain, sleeping and antianxiety medications. Adolescents who misused their controlled medications were also more likely to use alcohol and other drugs, and to divert these medications to others.
"Despite the importance of controlled medications for the treatment of pediatric disorders, our results suggest that a consequence of the greater availability of these medications may be an increase in their nonmedical use," write the authors. "Clinicians must balance the risks and benefits of controlled medication use with the abuse potential when assessing, treating, and monitoring their patients." The researchers also urge clinicians to "consider prescribing controlled medications with less potential for substance abuse and diversion."
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