Prescription Drug Misuse Among Antisocial Youth

Background and Purpose: Whereas use of most illicit drugs has plateaued or decreased since the early 1990s, prescription drug misuse (PDM) has increased markedly. Adolescents and young adults are among the largest demographic subpopulations of prescription drug misusers (PDMs). Most epidemiological research examining adolescent PDM has been conducted in schools, or to a lesser degree, in homes. These studies omit institutionalized youth, an adolescent subpopulation at presumably high risk for PDM. This study is the first, to our knowledge, to investigate the prevalence and correlates of PDM among youth in institutional care. Specific aims of the study were to describe the prevalence and correlates of PDM and to distinguish low- and high-frequency PDMs in a state population of youth in residential care for antisocial behavior.

Methods: Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 incarcerated Missouri youth. Participants were predominantly male (87.0%), averaged 15.5 (SD = 1.2) years of age, were ethnically diverse (33% African American, 55.4% White, 3.9% Latino, and 7.7% Other), and constituted 97.7% of the service population sampled. The client population is representative of incarcerated youth nationally with regard to age, gender and number of state youth incarcerated per 100,000 adolescents.

Results: Overall, 314 youths (43.4%) reported lifetime PDM; 33.7%, 32.0%, and 11.2% had misused prescription opioids, anxiolytics, and sedatives, respectively. PDMs were significantly older and larger proportions were girls, White, and resided in small towns compared to non-PDMs. PDMs evidenced significantly more varied, frequent, and problematic psychoactive drug use, higher levels of distressing psychiatric symptoms, and were nearly twice as likely to have been diagnosed with a psychiatric disorder compared to non-PDMs. Traumatic life events, experiences of criminal victimization, and suicidal ideation were significantly more prevalent in the histories of PDMs compared to non-PDMs. In multiple logistic regression models, older age, White racial status, prior inhalant, marijuana, and LSD use, residence in a small town, and temperamental impulsivity were associated with significantly increased risk for PDM. In comparison with low-frequency PDMs, high-frequency PDMs committed more property and violent crimes, initiated criminal careers at an earlier average age, and were more likely to report a history of head injury, criminal victimization, traumatic life events, psychiatric disorder, and distressing psychiatric symptoms. In logistic regression models predicting frequency of PDM, greater impulsivity and more lifetime substance-related problems were characteristic of high-frequency PDMs.

Conclusions: Adolescents in residential care for antisocial behavior have high rates of PDM and comorbid psychiatric and behavioral problems. Prevalence estimates for lifetime prescription opioid and anxiolytic misuse in this sample were nearly three times the lifetime use prevalence rates reported for adolescents in the Monitoring the Future study. Youth served in institutional settings, who number more than 1 million annually in the U.S., should be routinely screened and treated for PDM and co-occurring disorders.