Prescription Pain Relievers for Extramedical Reasons

The risk of beginning prescription pain relievers for extramedical purposes peaks before the final year of high school, around the age of 16, and not during the college years as is commonly believed, according to results of a recent study [Arch Pediatr Adolesc Med. doi:10.1001/archpediatrics.2012.209]. Risk estimates were lowest for youth at age 12 to 14 years and at age 19 to 21 years.

Extramedical use of prescription pain relievers refers to the use of these agents for the purpose of getting high or other unapproved indications. Media coverage and government reports on the issue have given attention mainly to high school seniors and college students. Using data from the 2004-2008 National Survey on Drug Use and Health (NSDUH), researchers conducted a study to identify the age at which youth are most likely to begin taking prescription pain relievers for extramedical reasons.

A total of 138,729 participants in the NSDUH ages of 12 to 21 years were interviewed once in a cross-sectional manner by means of a standardized audio-enhanced computer-assisted self-interview. They were asked questions about the use of prescription pain relievers for the “experience or feelings” they caused, or if “not prescribed for you,” the reasons they took them (eg, getting high or other unapproved indications). Based on their self-report, participants had never used prescription pain relievers for extramedical reasons prior to the year in which they were assessed.

Results showed risk estimates varied from 0.4% to 0.9% for participants 12 and 13 years of age, rising as participants reached age 14, with a range of 1.4% to 1.9%. As participants reached age 15, risk estimates rose again and varied from 1.6% to 3.0%. The highest risk estimates were seen in participants 16 years of age, beginning at 2.5% and peaking at 3.1%, which meant about 1 in 30 to 40 adolescents began extramedical use of prescription pain relievers.

The researchers found a range of risk estimates from 2.4% to 2.7% for 17-year-olds, and 1.6% to 2.7% for 18-year-olds. Decreasing risk estimates began at age 19, ranging from 1.8% to 2.1%; for 20-year-olds, 1.2% to 1.9%; and for 21-year-olds, 0.6% to 1.6%.

The greatest proportion of newly incident users across the 10 age groups of 12 to 21 years was observed in 2008. The researchers found 6 of the 10 age groups reached their peak risk or second-highest peak risk in that year (peak risk for ages 13, 14, and 18 years; and second-highest peak risk for ages 17, 19, and 21 years).

Some limitations of the study included the self-reporting character of national sample survey data, and possible survey nonparticipation by adolescents using prescription pain relievers for extramedical purposes who were not willing to participate in a survey of this kind.