, et al
Nonmedical prescription opioid and sedative use among adolescents in the emergency department
; doi:

Investigators from the University of Michigan conducted a study to estimate the prevalence and correlates of nonmedical prescription opiate (NPOU) and sedative use (NPSU) in adolescents and young adults using the emergency department (ED). Patients aged 14 to 20 years who presented to the University of Michigan ED for any reason were systematically recruited as part of a randomized controlled trial. Participants completed a self-administered computerized screening questionnaire that included items about past-year nonmedical prescription drug use and use of any prescription opioids or sedatives to get high, that were prescribed to someone else, or were taken at a higher dose than prescribed. Additional questions addressed demographic factors, dating violence, alcohol misuse, driving after drinking, and marijuana use. A retrospective chart review was used to abstract current and past ED visit characteristics and active outpatient sedative or opioid prescriptions. Regression analyses were done to identify participant characteristics statistically associated with NPOU and/or NPSU.

Data from 2,135 patients were analyzed. The mean age of study participants was 17.5 years, 56% were female, 72% were white, and 29% received public assistance. A total of 222 (10.4%) patients reported NPOU or NPSU. Of those who reported NPOU, 27 (14.6%) had a current home prescription for an opioid. Of those who reported NPSU, 14 (12.3%) had a current home prescription for a sedative. After controlling for demographic characteristics, correlates of either NPOU or NPSU included drinking and driving or riding with a drinking driver as well as other past-year substance use. NPOU alone was statistically associated with receipt of an intravenous opioid in the ED, while NPSU alone was associated with past-year dating violence, presenting to the ED for injury, or a previous ED visit in the past year.

The investigators conclude that approximately 1 in 10 adolescents or young adults visiting the ED endorse NPOU or NPSU in the past year. The investigators suggest that the ED is an ideal location for both opioid and sedative misuse screening and intervention.

Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

National surveys have demonstrated an increasing trend in the misuse of prescription opioids among adolescents (see AAP Grand Rounds, August 2005;14[29]:29–30) and a subsequent rise in unintentional prescription drug overdoses.2,3  There is growing public awareness of prescription medication misuse. Policy makers at the federal and state levels have tightened restrictions in an attempt to curb this epidemic.2,4  Other interventions that balance reducing misuse with protecting legitimate access to these medications are urgently needed. Approaches to consider include more systematic provider education, routine monitoring of insurance claims for inappropriate use, and universal provider use of state prescription...

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