Paula Ross-Durow

Medical Misuse of Controlled Medications Among Adolescents

OBJECTIVES To determine the past-year medical misuse prevalence for 4 controlled medication classes (pain, stimulant, sleeping, and antianxiety) among adolescents, and to assess substance use outcomes among adolescents who report medical misuse. DESIGN A Web-based survey was self-administered by 2744 secondary school students in 2009-2010. SETTING Two southeastern Michigan school districts. PARTICIPANTS The sample had a mean age of 14.8 years and was 51.1% female. The racial/ethnic distribution was 65.0% white, 29.5% African American, 3.7% Asian, 1.3% Hispanic, and 0.5% other. MAIN OUTCOME MEASURES Past-year medical use and misuse of 4 controlled medication classes. RESULTS Eighteen percent of the sample reported past-year medical use of at least 1 prescribed controlled medication. Among past-year medical users, 22.0% reported misuse of their controlled medications, including taking too much, intentionally getting high, or using to increase alcohol or other drug effects. Medical misusers were more likely than nonmisusers to divert their controlled medications and to abuse other substances. The odds of a positive screening result for drug abuse were substantially higher among medical misusers (adjusted odds ratio, 7.8; 95% confidence interval, 4.3-14.2) compared with medical users who used their controlled medications appropriately. The odds of drug abuse did not differ between medical users who used their controlled medications appropriately and nonusers. CONCLUSIONS Most adolescents who used controlled medications took their medications appropriately. Substance use and diversion of controlled medications were more prevalent among adolescents who misused their controlled medications. Careful therapeutic monitoring could reduce medical misuse and diversion of controlled medications among adolescents.

Characteristics associated with the diversion of controlled medications among adolescents.

BACKGROUND The objective of this study was to estimate the lifetime prevalence of diversion (i.e., trading, selling, giving away or loaning) of four classes of controlled medications (pain, stimulant, anti-anxiety, and sleeping) among adolescents, and to identify demographic and behavioral characteristics of adolescents who divert their own controlled medications. METHODS A web-based survey was self-administered by 2744 secondary school students from two southeastern Michigan school districts in 2009-2010. The sample consisted of 51% females, 65% Whites, 29% African-Americans, 4% Asians, 1% Hispanics and 1% from other racial categories. RESULTS Thirty-three percent of the students had ever been prescribed at least one controlled pain, stimulant, anti-anxiety, or sleeping medication. Approximately 13.8% (n=117) of lifetime prescribed users of controlled medications (n=848) had ever traded, sold, given away or loaned their medications. Multiple logistic regression analyses indicated that being approached to divert medications, nonmedical use of prescription medications, externalizing behaviors, and being non-White were significantly associated with the diversion of controlled medications. Multiple logistic regression analysis indicated that the odds of substance use and abuse for lifetime prescribed users who diverted their controlled medications were significantly greater than prescribed users who never diverted. CONCLUSIONS The findings indicate that approximately one in seven prescribed users had diverted their controlled medications in their lifetimes. Being approached to divert medications and substance use are more prevalent among adolescents who diverted their controlled medications. Careful assessments, diligent prescribing and monitoring of controlled medications, and continual patient education could be useful in reducing medication diversion.

Nonmedical Use of Prescription Opioids Among Adolescents: Subtypes Based on Motivation for Use

The purpose of this study was to advance our understanding of nonmedical use of prescription medications by identifying the distinguishing characteristics of 2 subtypes of adolescent nonmedical users of prescription opioids that have been previously described. A Web-based, self-administered survey was completed by 2,597 7th–12th grade students. Sensation-seeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self-treating users were best characterized by somatic complaints, anxiety and depressive symptoms, and history of sexual victimization.

Adolescent nonmedical users of prescription opioids: Brief screening and substance use disorders

OBJECTIVES The objectives of this study are to examine the associations among a positive score on the CRAFFT (a substance use brief screening test for adolescents) and demographic characteristics, diversion sources, routes of administration, substance use behaviors and motivations associated with the use of prescription opioids without a legal prescription. METHODS In 2009-2010, a sample of 2744 middle and high school students from two Midwestern school districts in the United States self-administered a Web-based survey. RESULTS Approximately 5.6% (n=148) of respondents reported past-year nonmedical use of prescription opioids (NMUPO). Of those reporting NMUPO, approximately 35.1% (n=52) screened positive for substance use disorders based on the CRAFFT. Multiple logistic regression analyses indicated that the odds of buying prescription opioids, obtaining opioids from multiple diversion sources, administering opioids intranasally, and using opioids to get high were greater for nonmedical users with a positive CRAFFT screen as compared to NMUPO with a negative CRAFFT screen. NMUPO with a positive screen was motivated primarily for recreational purposes, while NMUPO with a negative screen was motivated almost exclusively by pain relief. CONCLUSIONS The CRAFFT brief screening test for adolescents can be used to identify a subgroup of NMUPO at the highest risk for a substance use disorder as well as a subgroup of NMUPO who would benefit from appropriate pain management.

Painfully obvious: A longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants

PURPOSE The objective of this longitudinal study was to assess the prevalence of medical use, medical misuse, and non-medical use of opioid medication among adolescents who participate in organized sports. METHODS Data for this study were taken from the Secondary Student Life Survey. A total of 1,540 adolescents participated in three waves of data collection occurring between the 2009-2010 and 2011-2012 school years, with 82% of the baseline sample completing all three waves. RESULTS Using generalized estimating equation models to analyze the longitudinal data, it was found that male adolescents who participated in organized sports during each wave of the Secondary Student Life Survey had higher odds of being prescribed an opioid medication (i.e., medical use) during the past year (adjusted odds ratio [AOR], 1.86; 95% confidence interval [CI], 1.23-2.82), higher odds of past-year medical misuse of opioid medication as a result of taking too much (AOR, 10.5; 95% CI, 2.42-45.5), and higher odds of past-year medical misuse of opioid medication to get high (AOR, 4.01; 95% CI, 1.13-14.2) compared with males who did not participate in organized sports during the study period. Among females, no association was found between participation in organized sports and medical use, medical misuse, and non-medical use of opioid medication. CONCLUSIONS The results of this study indicate that adolescent males who participate in sports may have greater access to opioid medication, which puts them at greater risk to misuse these controlled substances.

Designing Assignments to Establish a Foundation for Evidence‐Based Practice in an Undergraduate Clinical Nursing Course

Nursing faculty play a central role in facilitating students’ use of best scientific evidence in their clinical practice (Callister, Matsumura, Lookinland, Mangum, & Loucks, 2005; Ciliska, 2005; Winters & Echeverri, 2012). Burns and Foley (2005) documented how they built a foundation for evidence-based practice (EBP) in their freshman seminar course. However, it has not been well-explicated in the literature how to stimulate clinical inquiry through incorporating EBP in a junior-level clinical course. EBP is a key component of baccalaureate nursing curricula and is often threaded across all levels of a program to meet the standard mandated by national organizations (American Association of Colleges of Nursing, 2008; American Nurses Association, 2004). In the baccalaureate nursing program at a large Midwestern public university, EBP was established as one of seven critical domains of focus in all clinical courses. Our four-member faculty team discussed how best to meet the EBP criterion in our mental health clinical course. Because students were new to the specialty and had limited experience locating literature in this area, the most appropriate step of the EBP process was to focus on “Step Zero: Cultivate a spirit of inquiry” (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010, p. 51). It was premature to expect students to write a PICOT (Population, Intervention or area of Interest, Comparison intervention or group, Outcome, Time) statement or locate the best evidence. Seven assignments were designed to promote clinical inquiry and to increase students’ knowledge of mental health nursing. The aims of this paper are to: (a) describe ways in which a foundation was laid for clinical inquiry through assignments and (b) evaluate whether students searched for and cited recent literature in their clinical assignments.