Ann Arbor, MI—Medical use, misuse, and availability of prescribed controlled substances have steeply declined among U.S. high school seniors in the last decade or so, according to a new study.

That is according to University of Michigan (U-M) researchers who compared use trends, sources, and perceived availability of opioids, stimulants, and benzodiazepines from 2009 to 2022.

“To put these findings in context, the reduction over the past decade was like going from 1 in every 9 high school students using prescription drugs nonmedically down to 1 in every 40 high school students,” explained lead author Sean Esteban McCabe, PhD, U-M professor of nursing and director of the Center for the Study of Drugs, Alcohol, Smoking and Health. “While this decrease is encouraging, we need to be vigilant because any amount of nonmedical use poses risks, especially with the danger posed by counterfeit pills.”

The research letter was recently published in the Journal of the American Medical Association.

The study team noted that prescription stimulants, opioids, and benzodiazepines are three of the most commonly prescribed and nonmedically used controlled substances among U.S. adolescents, adding, “Trends in prescribing have occurred and adolescent overdose deaths have increased, partially due to proliferation of counterfeit pills.”

This study used data collected in 2009 through 2022 from 12th-grade students responding to the Monitoring the Future survey, which is an annual self-administered survey conducted with nationally representative samples of high school students. The mean response rate was 80.20%, and 51,84% of the 29,220 adolescents included were female.

On the topic of prescription stimulants, opioids, and benzodiazepines, respondents were asked about the following:

• Lifetime medical use (any vs. none)
• Past-year NMU (nonmedical use; use without a prescription or other than prescribed, categorized as any vs. none)
• Past-year diversion sources (where medications were obtained for NMU; 10 options, including bought on the internet, obtained or bought from a friend or relative, and used from one’s own prescription)
• Perceived difficulty of obtaining prescription medications for NMU (probably impossible vs. other).

The results indicated that between 2009 and 2022, reported lifetime medical use significantly decreased (23.66%-16.00%; linear trend, adjusted odds ratio [aOR], 0.93; 95% CI, 0.91-0.95), as did past-year NMU (11.49%-2.38%; linear trend, aOR = 0.82; 95% CI, 0.80-0.85).

“Trends in 2 diversion sources significantly declined. In 2009-2010, 57.96% reported being given prescription medications by a friend, which decreased to 26.87% in 2021-2022 (linear trend, aOR = 0.87 [95% CI, 0.81-0.93]); and 44.35% reported buying medications from a friend in 2009–2010, decreasing to 19.42% in 2021–2022 (linear trend, aOR = 0.91 [95% CI, 0.85-0.98]),” the researchers pointed out.

For adolescents reporting past-year NMU, the most prevalent diversion source in 2021–2022 was one’s own prescription (37.37%). In addition, the prevalence of adolescents reporting multiple diversion sources decreased from 56.27% in 2009–2010 to 29.33% in 2021–2022 (linear trend, aOR = 0.88; 95% CI, 0.82-0.94).

At the same time, the authors noted that the prevalence of adolescents who reported it would be probably impossible for them to obtain prescription medications for NMU increased from 35.56% in 2009–2010 to 48.96% in 2021–2022 (linear trend, aOR = 1.08; 95% CI, 1.06-1.10).

“Prevalence of adolescents reporting multiple diversion sources significantly decreased for opioids (47.83% to 36.71%; linear trend, aOR = 0.90 [95% CI, 0.82-1.00]) and benzodiazepines (53.09% to 24.30%; linear trend, aOR = 0.86 [95% CI, 0.76-0.98]), but not stimulants,” the authors explained. “Perceived difficulty of obtaining prescription medications for NMU significantly increased for each prescription medication class.”

The study expands previous findings by showing declines in peer-to-peer and multiple sources of diversion and increased perceived difficulty of obtaining prescription medications for NMU. “These changes may be partially attributed to prescribing guideline changes and COVID-related school closures, which limited social interaction with peers,” the authors suggested.

The authors suggested, “Efforts to further reduce NMU and diversion are needed, particularly given the role of counterfeit pills in the adolescent overdose crisis. Furthermore, monitoring, storage, and disposal of prescription medications and education regarding them are important.”

“Prescribing practices have changed dramatically because we had an opioid epidemic, which turned into a heroin epidemic, and we’re still reeling from that, especially with fentanyl,” coauthor Philip Veliz, PhD, posited. “A lot of this also has to do with parents having better knowledge and oversight of these medications.”

Dr. Veliz said that the researchers found the results somewhat surprising.

“That’s a massive decline. It used to be 1 in 9 kids, now it’s an incredibly rare event at this point,” Dr. Veliz noted. “The second surprise was that ... nearly half of kids say it’s probably impossible to get these drugs if they want to use them nonmedically right now. That’s a big chunk of the adolescent population, and this is just off the table.”

Dr. McCabe added that the situation has not returned to what it looked like before the COVID-19 pandemic, which also is surprising.

“Adolescents have found it more difficult to obtain prescription stimulants for nonmedical use in recent years, which is a positive sign,” Dr. McCabe said. “There needs to be more attention on stimulant use and diversion, and our team is currently working on such studies to help inform clinical guidelines for ADHD [attention-deficit/hyperactivity disorder] and stimulant use disorder.”

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