Our Nations Students: Prescription Medication Abuse

1
Our Nations StudentsPrescription Medication
Abuse

• Carol J. Boyd, PhD, MSN, FAAN
• Professor and Director
• Institute for Research on Women and Gender
• University of Michigan - Ann Arbor
• February 23, 2006

2
Acknowledgements

• National Institutes of Health National Institute
  on Drug Abuse (NIDA)
• R03DA018271 (PI Boyd)
• T32DA07267 (PI Boyd)
• McCabe, Teter Young,
• previous T32 post-doctoral fellows
• R03DA019492 (PI McCabe)
• R03AA014601 (PI Young funding from NIAAA)

3
Purpose

• Draw attention to prescription medication use and
  abuse by secondary college students
• Psychostimulants (e.g. Ritalin, Adderall,
  Concerta, etc.)
• Opioid analgesics (e.g.Vicodin, OxyContin,
  Tylenol 3, etc.)
• We will focus on diversion behaviors
• How do students get their drugs?
• We will focus on motivations to misuse and abuse
  prescription medications
• Why do students abuse prescription medications?
• We will examine poly-substance abuse in relation
  to the nonmedical abuse of prescription
  medications.

4
Schedule for Prescription Medications

• 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

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Nonmedical Abuse (Illegal Use) Focus on
Schedule II Drugs
6
Definitions

• Medical misuse of prescription medications
  (drugs)
• use of a prescribed medication by the person (and
  for the purpose) intended by the prescribing
  clinician however, the medication is
• NOT used in the prescribed dose or not taken
  within a prescribed time interval.
• Nonmedical abuse or illegal use of prescription
  medications (drugs)
• use of prescription medication to get
  high/create an altered state
• use for reasons other than what the prescribing
  clinician intended.
• Diversion of prescription medications (drugs)
• exchange of prescription medications that leads
  to the use of these drugs
• by people other than whom the prescribing
  clinician intended or
• under conditions associated with doctor
  shopping.
• (Note Every study uses somewhat different
  operational definitions 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)

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Nonmedical Abuse of Prescription Medications

• Studies indicate that the nonmedical use of
  prescription medications is increasing in the
  U.S. among adolescents and young adults (See
  Johnston et al., 2004, 2005 Olfson et al., 2003
  NSDUH, 2004 Robinson et al., 1999 2002 Zito et
  al., 2003)
• The nonmedical use of pain medication had largest
  number of new initiates in 2004
• 2.4 million new initiates (average age 23 years)
• 2.1 million new initiates to marijuana (average
  age 18 years)
• Nine percent of adolescents (12 to 17 years) used
  prescription drugs for nonmedical purposes in the
  past year
• 7.4 for pain medication and 2.0 for stimulant
  medication.
• (NSDUH, 2004)

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Past Year Medical Use

reporting medical use

• p chi-square tests Student Life Survey 2005

9
Secondary Students

• Are students who abuse prescription drugs more
  likely to abuse other substances?

10
Secondary Students who abuse prescription pain
medications are

• 8 times more likely to use other illegal drugs
• 7 times more likely to smoke cigarettes
• 6 times more likely to smoke marijuana
• 5 times more likely to drink alcohol.

students who did NOT have a prescription
excludes marijuana SSLS, 2003 Source
Boyd, McCabe, Teter (2006).
11
College Students who Abuse Prescription
medications

• 58 of students got diverted pain medications
  from their peers (12 from family members)
• These students were 8 times as likely to smoke
  marijuana and 4 times as likely to binge drink
• 68 of students got diverted stimulant
  medications from their peers (3 from family
  members)
• 24 times more likely smoke marijuana and 7 times
  more likely to binge drink.

SLS, 2003 Source McCabe, Boyd (2005)
12
College Students

• Are students who abuse prescription drugs more
  likely to abuse other substances?

13
College Students

• Are there Gender and Race Differences?

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Gender Nonmedical Use of Prescription Drugs


pN10,904 Sources McCabe et al, Addiction 2005
100 96-106 and McCabe et al Addictive Behav.
2005 30789-805
15
Race/Ethnicity Nonmedical Use of Prescription
Drugs





pN10,904 Sources McCabe et al, Addiction 2005
100 96-106 and McCabe et al Addictive Behav.
2005 30789-805
16
College Students

• Where do students get the stimulants and pain
  pills?

17
Sources Prescription Stimulant Medications


Lifetime use reported in 2005 SLS, pThe following sources were less than 1
aunt/uncle, other family, abroad, and internet.
Source Teter, McCabe et al, under review
18
WOMEN
MEN
I snorted my friend's Ritalin before finals last
semester. (White, junior)
Getting Adderall and Ritalin are probably easier
than getting alcohol on this campus. I could find
500 pills in 20 minutes. (White, senior)
I was given them by a friend at a party.
(White, freshmen)
From friends with prescriptions, or from those
who have bought large quantities from people with
prescriptions. (White, junior)

• My friends need these drugs for ADD/ADHD and
  they give them out to myself and other friends.
• (Hispanic, senior)

• a friend has a prescription and sells the pills
  to me.
• (White, senior)

Source Scientific American. The Quest for a
Smart Pill, Sept. 2003
Source McCabe, Teter Boyd, J Psychoactive
Drugs, in press
19
Sources Prescription Pain Medications



Lifetime use reported in 2005 SLS, pThe following sources were 2 or less aunt/uncle
(2), abroad (1), and internet (0.2).
Source McCabe et al, under review
20
WOMEN
MEN
I was having back pain and my mom game me one of
her T3s, she is a nurse, and I knew they would
give me the same meds if I went to see a doc.
(junior)
A roommate had leftover Vicodin that I used.
(senior)
It (pain medication) was prescribed to a friend
and he gave me a couple before we started
drinking... (junior)
My father is a virtual pharmacy from all his
surgeries. If I'm in pain, he is going to give
me pain medication. (junior)
I tried one pill (Tylenol 3) and had 4 beers
because my friend said it gives you a really nice
buzz. (junior)
Source McCabe, Teter Boyd, Drug Alcohol Depend
2005 7737-47
21
Diversion of Prescription Drugs, (Medical users
approached to divert their medication)
approached to divert their medication

W97 M59
W84 M52
W59 M76
W517 M450
pSurvey, 2005
22
Secondary Students

• Where do students get the stimulants and pain
  pills?

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Pain Medications From Family

• I had a headache so my mom gave me one
  (referring to hydrocodone).
• I burned my hand real bad and on the way to the
  hospital, my mom gave me a 3.
• I borrow it (OxyContin) from my grandmother

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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!

25
Secondary Students Percentage Approached to
sell, trade or give away their medications
Lifetime in 2005 Stimulant14/62 Pain104/460
Sleeping25/145 Anxiety14/64
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Motives to Abuse College Students
27
Motives of Nonmedical Use Prescription Pain
Medication




pStudent Life Survey
Source McCabe et al, under review
28
Motives of Nonmedical Use Prescription
Stimulant Medications





pStudent Life Survey
Source Teter et al, under review
29
Gender differences Self-treatment among
illegal users

p 30
Motives to Abuse Secondary Students
31
Secondary Students

• Students responded about motivations to abuse
  opioid analgesics
• 80 for the purpose of relieving pain
• 16 for the purpose of helping to sleep
• 20 of adolescents reported to get high
• 3 because they are safer than street drugs.
• (2005 SSLS Data Check all that apply
  Girls127 Boys58)

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Secondary Students

• Students responded about motivations to abuse
  stimulant medications
• 52 for the purpose of getting high
• 40 for the purpose of increasing alertness
• 36 for the purpose of helping to concentrate
• 28 for the purpose of weight control
• 3 because they are safer than street drugs.
• (2005 SSLS Data Check all that apply
  n25)

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Summary

• Students who abuse prescription medications are
  significantly more likely to smoke cigarettes,
  use marijuana and use other illegal drugs.
  (Boyd, McCabe, Teter, 2006 Boyd, McCabe Teter,
  2005)
• Approximately 25 of secondary school students
  and 50 of college students prescribed stimulants
  for ADHD are approached to divert their
  medication. (Boyd, McCabe, Teter, 2006 McCabe,
  Teter Boyd, 2004)
• Self-treatment appears to be one motivation for
  nonmedical abuse.
• College men are more likely than women to obtain
  prescription opioid medications from peer
  sources, while women from family. (McCabe,
  Teter Boyd, 2005)
• Adolescent boys are less likely than girls to get
  prescription opioid medications from family
  members. (Boyd, 2005)
• Our samples are NOT obtaining prescription drugs
  directly via the internet. (Boyd, McCabe, Teter,
  2006 McCabe Boyd, 2005)

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On Balance Risks and Benefits

• The need to control and reduce abuse and
  diversion of scheduled medications must be
  balanced against patients needs physicians and
  patients must have access to legal medications
  that are used for legitimate medical purposes.
  

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Preventing Medication Abuse

• Educational implications
• We need prevention programs aimed at teaching
  adolescents the safe and legal use of
  medications
• Clinical implications
• Physicians and nurses must talk with their
  patients and their families
• Research Implications
• Epidemiological studies should further examine
  motives and diversion practices.

Source U.S. Food and Drug Administration, FDA
Consumer magazine, September-October 2001,
Prescription Drug Use and Abuse
36
References

• Available on request
• (caroboyd_at_umich.edu or 734-764-9537)
• Boyd, McCabe Teter, 2004 2005 2006
• McCabe, Boyd Teter, 2005
• McCabe Boyd, 2005
• Teter, McCabe, Boyd Guthrie, 2003
• Teter, McCabe, Cranford, Boyd, Guthrie, 2005