Initiation of Non-Medical Prescription Use among High-Risk Youth

Background: Despite emerging public health problems associated with prescription drug misuse, limited research has examined patterns of initiation into non-medical use of prescription drugs among high-risk youth. Methods: A sample of 57 youth aged 18 to 25 reporting current prescription drug misuse were recruited in Los Angeles and New York in 2008-09. Three subgroups of high-risk youth were targeted: polydrug users; homeless youth; and injection drug users. Both qualitative and quantitative data were collected on several aspects of initiation events: drug type; mode of administration; drug source; rationale; and history of prescribed use. Findings: The average age of initiation into non-medical use of prescription drugs for three primary categories were as follows: stimulants (14.7); opioids (14.9); and tranquilizers (16.1). Transitioning from oral administration to sniffing was common across drug classes: stimulants (64.9%); opioids (64.3%); and tranquilizers (51%), while injection was less typical (2.7%, 33.9% and 9.8% respectively). Among youth who had been prescribed opioids for pain, or drugs such as Adderall for psychological problems, 72.2% and 50% respectively reported misusing those prescriptions. Frequently, youth reported misusing legitimate prescriptions belonging to family members, particularly parents (61.1%) and siblings (34.8%). Rationales for initiation included experimentation, self-medication, and intoxication due to other drugs. Conclusions: Initiation into non-medical prescription drug use occurred at an early age and was often facilitated by drug availability within households. Transitioning into higher-risk modes of administration, such as sniffing, was common. Prevention efforts should focus on reducing or restricting availability of a wide range of prescription drugs within households.