An Exploratory Study of Prescription Pain Medication Misuse with and without Heroin Use Among Adolescents
Associations with Mental Health and Substance Use Measures
Abstract
Abstract:Aims: Opioid misuse is an epidemic in the United States and globally, with adolescents affected by negative consequences including overdoses and deaths. Understanding how mental health and substance use relate to specific types of opioid use is thus important. Methods: Data from the 2019 Connecticut Youth Risk Behavior Survey were analyzed. Chi squares and adjusted odds ratios were computed to relate demographic variables, mental health, and substance use measures to misuse of prescription pain medications with and without heroin use, as compared to neither. Results: Among 1,931 high-school respondents, 8.8 % (n=180) reported prescription pain medication misuse (PPMM+), and 1.4 % (n=28) also reported using heroin (PPMM/HU+). PPMM+ was associated with being female while PPMM/HU+ was associated with being non-White and male. Poorer mental health was associated with PPMM+, and suicidality measures were strongly related to PPMM/HU+. Use of other substances was reported with PPMM+ and PPMM/HU+, with use of vapor products, including on school grounds, particularly linked to the latter. Conclusions: PPMM+ and PPMM/HU+ are associated with suicidality and substance use among adolescents, with suicidality particularly related to PPMM/HU+. Having access to and using substances on school property suggests the need for school-based and other interventions.
Zusammenfassung:Ziele: Der Missbrauch von Opioiden stellt insbesondere in den Vereinigten Staaten sowie weltweit eine Epidemie dar, wobei Jugendliche von negativen Folgen wie Überdosierungen und Todesfällen betroffen sind. Daher ist es wichtig zu verstehen, wie psychische Gesundheit und Substanzkonsum mit bestimmten Arten des Opioidkonsums zusammenhängen. Methodik: Es wurden Daten aus dem Connecticut Youth Risk Behavior Survey (YRBS) von 2019 analysiert, der vom Center for Disease Control (CDC) entwickelt wurde. Im Rahmen dieses Projekts werden die Risikoverhaltensweisen von Oberschülern über einen längeren Zeitraum verfolgt und überwacht. Die Analysen der Studie basierten auf der Erhebung mittels des YRBS-Fragebogens für Connecticut des Jahres 2019. Der Opioidmissbrauch wurde anhand der folgenden zwei Fragen bewertet: „Wie oft hast du im Laufe deines Lebens verschreibungspflichtige Schmerzmittel ohne ärztliche Verschreibung oder anders als vom Arzt empfohlen eingenommen?“ und „Wie oft hast du im Laufe deines Lebens Heroin (auch Smack, Junk oder China White genannt) genommen?“. Die statistische Auswertung erfolgte mittels Chi-Quadrat-Analysen. Weiterhin wurden bereinigte Odds-Ratios berechnet, um demografische Variablen, psychische Gesundheit und Maßnahmen zum Substanzkonsum mit dem Missbrauch von verschreibungspflichtigen Schmerzmitteln mit und ohne Heroinkonsum in Beziehung zu setzen, und zwar jeweils im Vergleich zu der Gruppe ohne eines der beiden Konsummuster. Ergebnisse: Von den 1.931 befragten Schülern gaben 8,8 % (n=180) an, verschreibungspflichtige Schmerzmittel zu missbrauchen (Prescription Pain Medication Misuse; PPMM+), und 1,4 % (n=28) gaben an, auch Heroin zu konsumieren (Prescription Pain Medication Misuse plus Heroin Use; PPMM/HU+). PPMM+ wurde mit weiblichem Geschlecht in Verbindung gebracht, während PPMM/HU+ mit nicht-weißen und männlichen Personen im Zusammenhang stand. Eine schlechtere psychische Gesundheit wies eine Assoziation mit PPMM+ auf, und Suizidalitätsmaße standen in starkem Zusammenhang mit PPMM/HU+. Der Konsum anderer Substanzen wurde sowohl mit PPMM+ als auch mit PPMM/HU+ in Verbindung gebracht, wobei der Konsum von elektronischen Dampferzeugnissen auch auf dem Schulgelände besonders mit PPMM/HU+ zusammenhing. Schlussfolgerungen: Unseres Wissens ist dies die erste Studie, welche den Missbrauch von verschreibungspflichtigen Schmerzmitteln mit und ohne Heroinkonsum im Zusammenhang mit psychischer Gesundheit und Substanzkonsum bei Jugendlichen untersucht hat. Eine Stärke der aktuellen Studie ist die große, für den US-Staat Connecticut repräsentative Stichprobe. Die Ergebnisse weisen auf, dass PPMM+ und PPMM/HU+ mit Suizidalität und Substanzkonsum unter Jugendlichen in Verbindung gebracht werden, wobei Suizidalität besonders mit PPMM/HU+ zusammenhängt. Der Zugang zu und der Konsum von Substanzen auf dem Schulgelände legt den Bedarf an schulischen und anderen Interventionen nahe. Zusammengenommen deuten diese Ergebnisse darauf hin, dass mehrdimensionale Präventionsbemühungen auf dem Schulgelände und aus der Perspektive des öffentlichen Gesundheitswesens erforderlich sind. Weitere Forschung ist erforderlich, um wirksame Interventionen zu entwickeln.
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