Prescription Drug Misuse: Taking a Lifespan Perspective

Abstract

Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.

Early Life Stress and Risks for Opioid Misuse: Review of Data Supporting Neurobiological Underpinnings

“…Internalizing and externalizing symptoms have been shown to partially mediate the association between ELS and prescription opioid misuse [ 24 , 106 ]. These findings suggest that self-medication may play a role in generating and maintaining both recreational and prescription opioid misuse in ELS-exposed individuals [ 124 , 125 ]. In addition to their euphoric and analgesic effects, opioids relieve stress through their inhibitory actions on the hypothalamic-pituitary-adrenal (HPA) axis [ 120 , 126 , 127 ], which can be highly negatively reinforcing [ 128 ] to individuals with such affective vulnerabilities.…”

Medicine misuse: A systematic review and proposed hierarchical terminology

“…Of the remaining 172 full texts that were assessed for eligibility, 121 were excluded (see Figure 1 for details of selection process, and Table S2 for details of excluded references). Finally, 51 references were included 3,5–11,13–55 …”

“…For 27 (38.0%), misuse occurs when medicines are not used as prescribed (or medical misuse), 9,10,[15][16][17]21,23,26,27,33,34,38,43,55 when prescription-only medicines are used without prescription (or nonmedical misuse) 5,23,33,55 or both. 23,25,29,32,35,39,[50][51][52] In 14 definitions (19.7%), misuse occurs when initiators do not follow summary of product characteristics (SmPCs, i.e. off-label), medical guidelines or either.…”

Why Parents Misuse Prescription Drugs to Enhance the Cognitive Performance of Healthy Children: The Influence of Peers and Social Media

“…While students’ motive to use prescription stimulants nonmedically for better performance while studying has been frequently reported in student samples of different ages (Faraone et al, 2020; Garnier-Dykstra et al, 2012; Rabiner et al, 2009; Schepis et al, 2020; Teter et al, 2020), parents’ willingness to initiate such behavior and the etiology behind their decision-making have rarely been studied. To the best of our knowledge, this is the first set of theory-driven research experiments investigating parents’ willingness to give CE to healthy children and the question of the drivers that lead parents to do so.…”

“…A recent study among U.S. high school students found that 2.5% self-reported CE for study purposes (Teter et al, 2020). Among the several hundred thousand adolescents (aged 12–17) in the United States who misused prescription stimulants (Substance Abuse and Mental Health Services Administration, 2019), cognitive performance enhancement is one key motive (Schepis et al, 2020). The prevalence rates of CE that have been assessed in different populations (e.g., students or employed people) vary greatly (Maier & Schaub, 2015; Sattler, 2016; Smith & Farah, 2011).…”