Early-onset prescription drug misuse in Indiana youth

Concern surrounding prescription drug misuse (PDM) has traditionally focused on opioids and adult populations despite alarming rates of PDM among adolescents. In 2018, according to data from the National Survey on Drug Use and Health (NSDUH), the past-year prevalence of PDM (i.e., pain relievers, tranquilizers, stimulants, and sedatives) was 5 % for 12–17 year olds, with misuse as high as 21 % for those who used any prescription psychotherapeutic drugs in the past year (United States, 2019). Data from the Monitoring the Future (MTF) study indicates past-year PDM use at 10 % among 12th graders (Johnston et al., 2019). Moreover, PDM during adolescence is associated with numerous adverse health outcomes, including drug overdose, substance use disorders, suicidal ideation, delinquency and violence, sexual risk-taking behavior, and STDs (Clayton et al., 2019, Gaither et al., 2016). Thus, understanding risk factors associated with PDM among adolescents is critical.

Several models have been constructed to illuminate the multi-factorial nature of risk for adolescent substance use (e.g., Dodge et al., 2009, Petraitis et al., 1995, Schulenberg and Maggs, 2002). Common across all models, and consistent with the gateway drug theory (Kandel & Kandel, 2015), is the recognition that prior substance use is a risk factor for using other substances. A significant body of research has been conducted examining gateway models within the context of adolescent alcohol and cigarette use. Data from MTF (Kirby & Barry, 2012) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Nkansah-Amankra & Minelli, 2016) suggest increased likelihood of using other drugs in older adolescence as a function of earlier alcohol and cigarette use. There is also evidence consistent with gateway models of PDM (Griesler et al., 2019, Hermos et al., 2008, Osborne et al., 2017). Utilizing state-level data, alcohol, cigarette, and cannabis use were observed risk factors for PDM, specifically the later use of stimulants, central nervous system depressants, opioids, and over the counter (OTC) drugs (Jayawardene & YoussefAgha, 2014). In data drawn from the NSDUH, Yockey et al. (2020) found that youth who previously used cannabis, alcohol, and cigarettes were also more likely to engage in prescription opioid misuse.

Although important information has been gained through studies examining PDM based on prior substance use, they are limited in two ways. First, most studies examine the gateway hypothesis based on past year use or use by a certain age rather than age of onset. Age at first use is a significant predictor of future engagement in substance use, as well as related problems into adulthood (DeWit et al., 2000, Wagner and Anthony, 2002). Of note, early initiation of PDM is also associated with faster transition to substance use disorders (Parker & Anthony, 2015, Volkow et al., 2021).

A second limitation is that much research on adolescent PDM has been conducted with predominately White samples or with data pooled across racial/ethnic group and, thus, ignoring potential variation in risk based on racial/ethnic group membership. Among few studies to examine PDM by racial/ethnic group, differences have been observed. For example, analyzing NSDUH, Ford and Rigg (2014) found that prior cigarette use and binge drinking were associated with PDM only among White youth, with misuse of prescription stimulants increasing risk for both White and Hispanic youth, and the use of other illicit drugs increasing risk for both White and Black youth. Yet, cannabis use and the misuse of prescription sedatives/tranquilizers increased risk of PDM across all racial/ethnic groups. Although limited in the number of published studies, such findings suggest that risk for PDM may vary across racial/ethnic groups based on substance class or type, which is critical to understand given evidence of higher PDM among Black youth (Carmona et al., 2020), with some evidence of elevated risk also for Hispanic youth (Yockey et al., 2020).

To expand on this body of research, the current study aimed to examine both the prevalence of first PDM among three racial/ethnic groups of adolescents and the association of timing of first alcohol and cigarette use on the timing of first PDM.

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