Correlates of Prescription Drug Misuse (PDM) Among Young Adults Experiencing Homelessness in 7 Cities across the United States

Background: Prescription Drug Misuse (PDM) among young adults aged 18-25 is an urgent public health concern facing the United States. Young adults experiencing homelessness are at a higher likelihood of experiencing a wide array of negative health outcomes including high substance use. However, community prevalence estimates of PDM engagement among young adults who experience homelessness are sparse. Extant data from smaller studies of homeless or street-involved youth in the United States have reported that approximately 25% of homeless youth engage in PDM (Al-Tayyib, Rice, Rhoades, & Riggs, 2014; Rhoades, Winetrobe, & Rice, 2014; Barman-Adhikari, Al-Tayyib, Begun, Bowen & Rice, 2017), which is several times the rate reported in the general population of young adults. Even though these studies provide us with important data regarding PDM engagement among this group of young people, they were all conducted in one geographical region (i.e. Los Angeles) and used data collected in 2013. It is important that we expand on this research and continue to document more recent patterns of PDM engagement across a more geographically diverse sample so that appropriate interventions can continue to be developed and tailored to reduce PDM engagement among this particularly vulnerable group of youth.

 

Methods: This study used data from the Homeless Youth Risk and Resilience Survey (HYRRS), a survey administered to approximately 200 young adults (ages 18-26) in each of 7 cities (Houston, LA, Denver, Phoenix, NYC, St. Louis, San Jose; N=1424) from June 2016-July 2017. Participants provided information on substance use, mental health, trauma and sexual risk behaviors. Multivariate logistic regression was utilized to assess demographic, psychological and behavioral correlates of PDM engagement (categorized into stimulant, sedative and opioids).

Results: Approximately 20% of participants reported past month PDM. 45.88% reported using opioids only, 43.37 % used sedatives only and 30.11 % used stimulants only. Youth reported that that they obtained prescriptions most commonly from friends or relatives for free (38.49%). Approximately 23% of youth said that they obtained it from a doctor. Multivariate logistic regressions revealed that perceived unmet mental health needs were associated with sedative (OR=2.88, CI=1.30-2.99) and stimulant use (OR=3.84; CI=1.62-4.27) but not with opioid use. Having suicidal thoughts was however associated with opioid use (OR=1.74; CI=1.08-2.79) but not with sedative or stimulant use. Hard drug use, pot use and injection drug use significantly correlated with all three types of PDM. While there no geographical differences for stimulant and sedative use, youth who were interviewed in Phoenix (OR=2.59; CI=1.29-6.54), Houston (OR=2.56; CI=1.28-6.38) and NYC (OR=2.25; CI=1.13-5.99) were more likely to engage in opioid use relative to youth interviewed in Los Angeles.

 

Implications: These results provide significant information on a growing public health concern. These findings indicate that interventions designed to address PDM needs to be multifaceted and designed to address a range of other risk behaviors that are correlated with PDM. This could include acknowledging the clustering of substance use behaviors, unmet mental health needs, access to prescription drugs and geographical differences that contribute to disparate rates and types of PDM engagement.