The prevalence of nonmedical use of prescription opioids among adolescents and young adults in the United States is now at its highest level in 15 years and represents a public health concern.2-5
The present study found a wide range of motives for nonmedical use of prescription opioids and 45% of nonmedical users were motivated to relieve physical pain. The prevalence of nonmedical use to relieve pain is similar to the only other study to examine motives for nonmedical use of prescription opioids based on nationally representative samples of American high school seniors between 1976 and 1984 which found that 50% of nonmedical users were motivated to relieve physical pain.13
Notably, lifetime and annual prevalence rates of nonmedical use of prescription opioids in the earlier study13
(10% and 6%, respectively) were lower than this study (12% and 8%, respectively). Furthermore, the present study found that nonmedical users of prescription opioids who reported relieve physical pain as their sole motivation had significantly lower rates of substance use behaviors than other nonmedical users.
Recent studies have identified several important characteristics of nonmedical use of prescription drugs that can influence drug abuse potential, including co-ingestion with other drugs and route of administration.11,14-18
The findings of the present study provide evidence that motives were significantly associated with frequency of past-year nonmedical prescription opioid use, non-oral routes of administration, co-ingestion of prescription opioids and other drugs, and substance use behaviors. Nonmedical users of prescription opioids motivated only to relieve physical pain had considerably lower odds than nonmedical users reporting other motives to co-ingest prescription opioids with other drugs or use prescription opioids via non-oral routes. Notably, nonmedical users who reported to relieve physical pain and other motives generally resembled nonmedical users who reported only non-pain relief motives in regards to substance use behaviors. These results reinforce previous studies that have shown adolescents and young adults who engage in nonmedical use of prescription opioids for motives other than “to relieve pain” are at increased risk for drug use and drug related problems.10-11
Future clinical and research efforts should attempt to differentiate between motives for nonmedical use of prescription opioids because the present study identified subtypes that were significantly associated with medical use of prescription opioids and substance use behaviors. Interestingly, we found few gender differences in the motives for nonmedical use of prescription opioids which resembles findings from earlier work within secondary school students.10,13
Notably, we found that over 7 in every 10 nonmedical users of prescription opioids motivated by pain relief reported a lifetime history of medical use of prescription opioids. Recent work indicates nearly 40% of high school seniors who reported nonmedical use of prescription opioids in the past 12 months obtained these medications from their own previous prescription.21
These results suggest that appropriate pain management and careful therapeutic monitoring could contribute to reductions in the nonmedical use of prescription opioids among adolescents. In addition, the elevated rates of substance use behaviors found among nonmedical users reporting any motives other than “to relieve physical pain” indicate such behaviors are part of a pattern of “multi-problem” behavior.22
Taken together, these findings suggest screening efforts should be employed to identify nonmedical users of prescription opioids who may require appropriate pain management and/or those who need more comprehensive assessment for substance use disorders.
Based on the elevated risk for substance abuse among nonmedical users who reported any motives other than “to relieve physical pain”, future work should identify subgroups of nonmedical users who endorse combinations of motives because most nonmedical users have multiple motives underlying their behavior. Further, nonmedical users of prescription opioids motivated only by pain relief had greater odds of over 33% of the substance use outcomes relative to their high school peers who did not use prescription opioids nonmedically. Future research is needed to determine the extent to which increased rates of substance use among such individuals could be related to untreated pain. Although the risk for substance abuse appears to be lower among nonmedical users of prescription opioids motivated by pain relief relative to nonmedical users with other motives, it is important to note that there are health risks to those who use prescription opioids on their own, without a doctor's orders, regardless of motive. For example, nonmedical users of prescription opioids do not benefit from clinical assessments and monitoring nor do they receive important medical information that accompanies appropriate pain management. Thus, nonmedical users are likely unaware of the medication's proper use, contraindications or potential for interaction with other drugs.
The present study had some limitations that need to be taken into account while considering the implications of the findings. First, the results may not be generalized to other adolescent populations because our sample was drawn from high school seniors and did not include individuals who had dropped out or who were absent from school on the day of the survey administration. Future research should examine motives for nonmedical use of prescription opioids in adolescents not attending high school to assess whether findings in the present study can be replicated in other populations. Second, nonresponse may have introduced potential bias in the present study and the data are subject to the potential bias introduced when collecting substance use behaviors via self-reports surveys. The present study attempted to minimize potential biases by implementing conditions that previous research has shown minimizes biases such as informing potential respondents that participation was voluntary, assuring potential respondents that data would remain confidential.23-25
It is worth noting that the prevalence rates of nonmedical use of prescription opioids in the present study were comparable to rates reported from national studies of adolescents and young adults.5,8
Finally, the cross-sectional design of the study presented limitations and longitudinal studies are needed to examine subtypes of nonmedical users of prescription opioids over time.
Despite these limitations, the findings of the present study provide further evidence that a variety of motives are currently subsumed under the estimates of nonmedical use of prescription opioids commonly reported in national drug use studies such as the NSDUH, MTF, and NESARC
Efforts to reduce consequences associated with nonmedical use of prescription opioids must be based on knowledge of the motives associated with this behavior because treatment implications can differ based on subtypes of nonmedical users. In this regard, identifying motivations associated with nonmedical use of prescription opioids at an early stage can help distinguish individuals in need of an evaluation for pain management and/or those who need more comprehensive assessment and may require substance abuse treatment. The findings of the present study suggest it is essential to move away from combining multiple subtypes into the same measure of nonmedical use of prescription opioids.