ED 'Ideal Setting' to Screen Youth for Prescription Drug Abuse

Caroline Cassels

October 31, 2013

About 10% of adolescents and young adults who present to the emergency department (ED) report nonmedical use of prescription opioids or sedatives during the past year, new research shows.

A retrospective study conducted by investigators at Washington University in Seattle showed that 10.4% of ED patients aged 14 to 20 years reported nonmedical use of prescription opioids or sedatives during the past year, with 8.7% reporting nonmedical prescription opioid use (NPOU) and 5.4% reporting nonmedical sedative use (NPSU).

"These results suggest the ED is an ideal location for both screening and intervention," the authors, led by Lauren K. Whiteside, MD, write.

The study is published in the November issue of Pediatrics.

An Epidemic

With 1 million ED visits related to prescription drug overdoses, abuse, and misuse in 2008, the Centers for Disease Control and Prevention (CDC) has described abuse of prescription drugs as an epidemic.

The investigators note that for every 1 prescription opioid overdose, there are 35 ED visits and more than 400 reports of nonmedical use, defined as use without a prescription or taking more than was prescribed or using to get high.

The peak age for initiating NPOU is 16 years, and there is a sharp rise in the number of ED visits involving NPOU and NPSU in late adolescence.

The investigators also point out that pain is a common complaint among ED patients and that "many patients leave the ED with an opioid prescription."

"Given that the emergency medicine providers are a source of prescription opioids and sedatives, a more thorough understanding of patient and ED visit characteristics associated with NPOU and NPSU is needed to inform screening and intervention initiatives," they write.

The researchers examined past-year prevalence of NPOU and NPSU among a sample of 2135 adolescents and young adults aged 14 to 20 who attended an ED at a single center between September 2010 and September 2011.

They also looked at ED visit characteristics and other correlates associated with past-year NPOU and NPSU in the study sample.

Future Directions

Of the total study sample, 222 (10.4%) reported either NPOU or NPSU.

Among the 185 (8.7%) participants who reported NPOU, 14.6% had a current home prescription for an opioid, and among the 115 (5.4%) with NPSU, 12.3% had a current home prescription for a sedative.

The researchers found that correlates of NPOU or NPSU included other substance use, drinking and driving, or riding with a drinking driver. Other correlates of NPOU included receiving an intravenous opioid in the ED.

Additional correlates of NPSU included dating violence, presenting to the ED for a noninjury complaint, and a previous ED visit in the past year.

According to investigators, the results point to the ED as an "ideal location" for screening and intervention for both NPOU and NPSU.

Future directions, the investigators note, include developing screening and intervention protocols to help identify patients at risk for nonmedical use of prescription drugs, regardless of their reason for presenting to the ED.

The authors report no relevant financial relationships.

Pediatrics. 2013;132:825-832. Full article

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