Prevalence and Etiology of the Non-Medical Use of Prescription - PowerPoint PPT Presentation

Prevalence and Etiology of the Non-Medical Use of Prescription Medications among College Students Amelia M. Arria, Ph.D. Associate Professor Department of Behavioral and Community Health Director, Center on Young Adult Health and Development University of Maryland School of Public Health For more information, email: aarria@umd.edu Illinois Higher Education Center for Alcohol, Other Drug and Violence Prevention Eastern Illinois University April 4, 2017 Funded by NIH/NIDA R01-DA014845

Overview 1. National Estimates of Prevalence 2. Background on the College Life Study 3. What we know 4. What we suspect 5. What we can do

National Estimates of Prevalence

Past-Year Nonmedical Use of Prescription Drugs among 12- to 17-year-olds, 2002-2014 (SAMHSA, 2015) Any Psychotherapeutics Pain Relievers Stimulants Sedatives Tranquilizers 10.0 9.2 9.2 8.8 9.0 8.6 8.3 8.1 8.0 7.7 7.7 7.7 7.6 7.4 7.4 7.2 7.0 6.9 6.7 7.0 6.6 6.6 6.5 6.3 6.2 5.9 5.8 6.0 5.3 4.7 5.0 % 4.6 4.0 2.7 3.0 2.3 2.1 2.2 2.0 2.0 1.9 1.9 1.9 1.9 1.8 2.3 2.0 1.7 2.3 2.0 2.0 1.4 1.9 1.6 1.5 1.5 1.4 1.3 1.3 1.1 1.0 1.2 0.6 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.3 0.4 0.4 0.3 0.3 0.0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Past-Year Nonmedical Use of Prescription Drugs among 18- to 25-year-olds, 2002-2014 (SAMHSA, 2015) Any Psychotherapeutics Pain Relievers Stimulants Sedatives Tranquilizers 15.7 16.0 15.1 15.1 15.0 14.9 14.9 14.6 14.4 14.3 13.7 14.0 12.7 12.5 12.4 12.2 12.2 12.0 12.0 12.0 11.9 11.8 12.0 11.4 11.1 10.1 9.8 10.0 8.8 7.8 8.0 % 6.0 5.5 5.5 5.4 5.4 5.3 5.3 5.2 5.2 5.0 4.9 4.5 4.5 4.2 4.1 4.0 4.0 3.9 3.9 3.8 3.8 3.7 3.7 3.6 4.0 3.5 3.4 3.1 2.0 0.6 0.6 0.6 0.5 0.5 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.3 0.0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Prescription stimulants are the only class of prescription drugs that are nonmedically used more by full-time college students than part-time college and non-college peers (during the past month; ages 18-22; SAMHSA, 2015) 5.0 4.7 4.3 4.0 3.3 Full-time college students 3.0 Part-time college students % and non-college peers 2.3 2.0 1.5 1.4 1.0 1.0 1.0 0.2 0.1 0.0 Any Psychotherapeutics Pain Relievers Stimulants Tranquilizers Sedatives

Past-Year Nonmedical Use of Prescription Drugs, among 12- to 17-year-olds, by Gender (SAMHSA, 2013) 8.0 7.1 7.0 Males Females 6.1 6.0 5.6 5.1 5.0 % 4.0 3.0 2.2 2.0 1.5 1.4 1.2 1.0 0.4 0.2 0.0 Any Psychotherapeutics Pain Relievers Stimulants Tranquilizers Sedatives

Summer First Sophomore Junior Senior Post College Post College Post College Post College Orientation Year Year Year Year Year 1 Year 2 Year 3 Year 4 Baseline 24 Months: 48 Months: 72 Months: Interview Interview Interview Interview (n=1,253) ( n =1,101) 88% ( n =1,019) 81% ( n =982) 78% Screening ( n =3,401) 60 Months: 84 Months: 36 Months: 12 Months: Interview Interview Interview Interview ( n =1,001) 80% ( n =951) 76% ( n =1,097) 88% ( n =1,142) 91%

Weighted lifetime prevalence of drug use in the first four years of college, by year 70.0 Weighted percent of students who used drug at least once in lifetime 63% Year 4 60.0 Year 3 Year 2 50.0 Year 1 40.0 Pre- College 30% 30.0 23% 20.0 16% 13% 13% 8% 7% 10.0 3% 1% 0.0 Cocaine Heroin Marijuana Prescription Prescription Hallucinogens Inhalants Prescription Ecstasy Amphetamines Analgesics Stimulants Tranquilizers Data weighted to adjust for both sampling bias and attrition. Source: College Life Study. Not to be shown or redistributed without written permission from Amelia M. Arria, PI

Figure 1. Trends in past-year nonmedical use of prescription medications: 2003-2013 16.0 14.0 12.0 Estimated % with Past-Year Use 10.0 Sleeping Meds Sedatives 8.0 Stimulants Opioids 6.0 Any Meds 4.0 2.0 0.0 2003 2005 2007 2009 2011 2013 Year McCabe, S. E., West, B. T., Teter, C. J., & Boyd, C. J. (2014). Trends in Medical Use, Diversion, and Nonmedical Use of Prescription Medications among College Students from 2003 to 2013: Connecting the Dots. Addictive Behaviors , 39 (7), 1176-1182.

What We Know • Different drug classes = different harms • Definition of nonmedical use • Motives • Research Studies of College Students • Sources of obtaining drugs for nonmedical use • Access and availability

What We Know, continued • Diversion is prevalent and fuels nonmedical use • Overestimation of others use • Positive and Negative Expectancies • High-risk Groups for use and diversion • Strong association with other drug use

Motives Curiosity • Improve concentration • Stay awake longer to study • Stay awake longer to party, drink more • Get high • Relieve depression symptoms? • But remember, motives are not the same as risk factors

How often do users take prescription stimulants nonmedically? 30 Average number of times in the past year 25 20 15.3 13.8 15 11.3 10 5 0 Year 2 Year 3 Year 4 Source: College Life Study. Not to be shown or redistributed without written permission from Amelia M. Arria, P

What about students with ADHD who have their own prescribed ADHD medications? Among 45 first-year college students with ADHD: • 27% overused their own meds • 16% nonmedically used someone else’s ADHD meds In another sample of 55 males (mean age 21) with ADHD: • 22% misused or took too much of their meds • 10% got high on their meds • 8% grinding/sniffing • Nearly all of the misusers (83%) met criteria for CD and/or SUD, and all were using immediate-release formulations. Sources: Arria, A.M., Caldeira, K.M., O’Grady, K.E., Vincent, K.B., Johnson, E.P., Wish, E.D. (2008). Nonmedical use of prescription stimulants among college students: Associations with attention-deficit-hyperactivity disorder and polydrug use. Pharmacotherapy, 28 (2) 156-169. Wilens, T.E., Gignac, M., Swezey, A., Monuteaux, M.C., Biederman, J. (2006). Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. J Am Acad Child Adolesc Psychiatry, 45( 4), 408-14.

Sources Among college students, friends and peers are the most common sources to obtain prescription medications used nonmedically References: McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use and diversion of prescription stimulant medication. J Psychoactive Drugs 2006;38(1):43-56. McCabe SE, Boyd CJ. Sources of prescription drugs for illicit use. Addict Behav 2005;30(7):1342-1350. McCabe SE, Cranford JA, Boyd CJ, Teter CJ. Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav 2007;32(3):562-575. Barrett SP, Darredeau C, Bordy LE, Pihl RO. Characteristics of methylphenidate misuse in a university student sample. Can J Psychiatry 2005;50(8):457- 461.

How are ADHD meds obtained for nonmedical use? Year 1 Year 2 Year 3 Year 4 90 80 70 Percent of users 60 50 40 30 20 * ** 10 0 Friend w/ Friend Other Self Internet $0 $1-4 $5+ Rx w/o Rx Cost Sources of Medication **Denotes significant difference from years *Denotes significant difference from years 1 and 2 ( p <.05). 3 and 4 ( p <.05). Garnier-Dykstra, L.M., Caldeira, K.M., Vincent, K.B., O’Grady, K.E., Arria, A.M. (2012). Nonmedical use of prescription stimulants during college: Four-year trends in exposure opportunity, use, motives, and sources. Journal of American College Health, 60 (3), 226-234.

DIVERSION 60.2% of one sample of college students with ADHD shared or sold their prescription stimulants; 35.4% of students with prescription analgesics diverted their medications. Source: Garnier, L.M., Arria, A.M., Caldeira, K.M., Vincent, K.B., O'Grady, K.E., Wish, E.D. (2010). Sharing and selling of prescription medications in a college student sample. Journal of Clinical Psychiatry. 71(3), 262-269.

Students overestimate how many others use Students who reported their Students who used stimulants peers used stimulants nonmedically nonmedically Source: Carroll, B. C., McLaughlin, T. J., & Blake, D. R. (2006). Patterns and knowledge of nonmedical use of stimulants among college students. Archives of Pediatrics and Adolescent Medicine, 160(5), 481-485.

Nonmedical Use is also associated with: High levels of Low levels of positive negative expectancies expectancies about the about the purported benefit purported benefit on performance on performance “It will work” “I won’t get in trouble” Source: Bavarian N, Flay BR, Ketcham PL, Smit E, Illicit Use of Prescription Stimulants in a College Student Sample: A Theory-Guided Analysis. Drug and Alcohol Dependence 2013; 132:665-673.

High Risk Groups Students attending competitive colleges • Students involved with Greek organizations • High-risk drinkers and other drug users • Students who are academically struggling • Students who are not risk-aversive • Students who have misperceptions of prevalence and what is normative • Students who perceive drugs as benign, safe to use •

Nonmedical prescription drug use is strongly associated with alcohol and other drug use • Numerous studies report past-year prevalence estimates for marijuana use of 85%+ • Cocaine: 35-60% • Ecstasy: 52% • Prescription Analgesics: 44%