Medical and nonmedical use of prescription sedatives and anxiolytics: Adolescents' use and substance use disorder symptoms in adulthood

Abstract

Objectives This study assessed the longitudinal associations between medical and nonmedical use of prescription sedatives/anxiolytics (NMPSA) during adolescence (age 18) and substance use disorder (SUD) symptoms during adulthood (age 35). Methods Multiple cohorts of nationally representative samples of U.S. high school seniors (n = 8,373) were surveyed via self-administered questionnaires and followed longitudinally from adolescence (age 18, 1976–1996) to adulthood (age 35, 1993–2013). Results An estimated 20.1% of adolescents reported lifetime medical or nonmedical use of prescription sedatives/anxiolytics. Among adolescents who reported medical use of prescription sedatives/anxiolytics, 44.9% also reported NMPSA by age 18. Based on multivariate analyses that included age 18 sociodemographic and other substance use controls, medical use of prescription sedatives/anxiolytics without any history of NMPSA during adolescence was not associated with SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use. In contrast, adolescents with a history of both medical and nonmedical use of prescription sedatives/anxiolytics and adolescents who reported only NMPSA had between two to three times greater odds of SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use and those who reported only medical use of prescription sedatives/anxiolytics. Conclusions One in every five U.S. high school seniors report ever using prescription sedatives/anxiolytics either medically or nonmedically. This study provides compelling evidence that the medical use of prescription sedatives/anxiolytics (without any NMPSA) during adolescence is not associated with increased risk of SUD symptoms in adulthood while any NMPSA during adolescence serves as a signal for SUDs in adulthood.

Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US

“…Past-year tranquilizer/sedative misuse was most likely in young adults, at 5.8%; 42.8% of all young adults engaged in past-year use also engaged in past-year misuse. Similar results were found in 18 year-old participants in the nationally-representative Monitoring the Future survey, with 44.9% of those with lifetime medical tranquilizer/sedative use also engaged in nonmedical misuse (McCabe, Veliz, Boyd, & Schulenberg, 2017). Young adults also had the highest rates of past-month misuse.…”

Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults

“…Schepis and Krishnan-Sarin (2009) found that adolescent nonmedical misusers had higher rates of other substance use and frequent PDM than medical misusers. Adolescent nonmedical opioid and stimulant misusers also have higher rates of SUD symptoms in adulthood (McCabe et al, 2017; McCabe et al, 2016). However, medical misuse is associated with poorer outcomes than nonmedical misuse, depending on underlying motives (McCabe et al, 2013), and even medical use can impart risk, as adolescent opioid users have higher follow-up opioid-PDM rates than non-users (McCabe et al, 2016; Miech et al, 2015).…”

Prescription Drug Misuse: Sources of Controlled Medications in Adolescents

“…Significant cross-sectional evidence links PDM and psychopathology in adults 5,6 and adolescents, 7 with prospective evidence associating adult PDM with incidence and recurrence of major depression (MDD), generalized anxiety and panic disorder at a three-year follow-up. 8 Adolescent PDM also co-occurs with substance use disorder (SUD) development in adulthood, 9 poorer adult educational outcomes 10 and other poor psychosocial outcomes (e.g., aggressive behavior). 11 The most commonly misused medication class was opioids (3.5%), with roughly half as many adolescents (1.7% each) engaged in prescription stimulant or tranquilizer (a term capturing primarily benzodiazepine medication) misuse.…”

“…13 Longitudinal evidence links PDM initiation during adolescence with greater risk of PDMrelated SUD symptoms and lower educational attainment in adulthood. 9,10,14 Given the consequences of adolescent PDM, limiting it is a worthy public health goal.…”