Prescription Drug Abuse Raises Suicide Risk in Teens

Megan Brooks

December 14, 2015

Adolescents may abuse prescription drugs, including pain relievers, depressants, and stimulants, to ease psychological distress, and doing so could increase their risk for suicide, especially in both boys and girls who use antidepressants and in girls who use stimulants alone, a new study suggests.

"Despite the management of emotions being an important motivation for nonmedical use of prescription drugs [NMUPD], research is just beginning to investigate the influence of psychology," first author Keith J. Zullig, PhD, MSPH, of West Virginia University School of Public Health, in Morgantown, told Medscape Medical News.

"Thus, our findings are important in that we demonstrated an association between depression, suicide ideation, and suicide attempts not just for general NMUPD but also for the individual drug classes of prescription pain relievers, stimulants, and depressants," he said.

The study was published online November 17 in Substance Use and Misuse.

Prevalent Problem

NMUPD now ranks second to marijuana as the most prevalent drug problem in the United States, and adolescents appear to be disproportionately affected, with 1 in 4 reporting lifetime NMUPD use, the authors note in their article. NMUPD has also been linked to multiple psychopathologies, including depression and suicidal behavior.

Dr Zullig, with Amanda L. Divin, PhD, from the Department of Health Sciences, Western Illinois University, in Macomb, and colleagues explored ties between NMUPD and suicide risk among 4148 adolescents in grades 9 to 12 from five public high schools.

About 21% of the adolescents reported using at least one prescription pain reliever, sedative, or stimulant nonmedically in their lifetime, most commonly, pain relievers, such as oxycodone.

Compared with nonusers, adolescent boys and girls who reported any lifetime NMUPD were significantly more likely to report feeling sad or hopeless every day for at least 2 weeks and to report considering suicide and making a plan about committing suicide (P < .0001 for all comparisons).

Table. Adjusted Odds Ratios (95% Confidence Interval) for Reporting Suicidal Risk in Past 12 Months for Any NMUPD

Variable Males Females
Sad/hopeless daily for 2+ weeks 1.72 (1.30 - 2.28) 2.04 (1.61 - 2.58)
Seriously considered suicide 2.28 (1.64 - 3.17) 1.94 (1.49 - 2.51)
Made suicide plan 2.01 (1.42 - 2.85) 2.11 (1.60 - 2.79)
Attempted suicide 1.30 (0.93 - 1.81) 1.34 (0.98 - 1.82)


By drug class, adjusted models revealed a significant association between adolescent nonmedical use of prescription pain relievers, stimulants, and depressants and suicidal ideation and between the nonmedical use of stimulants and depressants and suicide attempts.

Abusing depressants was associated with a far greater likelihood of suicide attempts for both males and females (odds ratio [OR], 1.61 and 2.25, respectively), and the same was true among females who abused stimulants (OR = 2.06; P < .01).

Action Needed

"NMUPD and suicide risk are stronger for females than males (especially for stimulant and depressant use and suicide attempts), even after adjusting for multiple key demographic and behavioral variables, such as age, self-reported grades, gun carrying, and the use of alcohol, marijuana, and cigarette smoking," Dr Zullig told Medscape Medical News.

He said their findings have several implications for healthcare providers and educators. "There appears to be a need to increase adolescent knowledge of available low-cost or free and confidential mental health services. In addition, we should encourage mental health outreach and periodic screenings in schools. Finally, educational efforts, particularly those targeted at parents, may help decrease the stigma of mental illness, and perhaps even the perceived social acceptance of NMUPD," Dr Zullig said.

Reached for outside comment on the findings, Steven Klee, PhD, chief psychologist, Brookdale Hospital, New York City, said, "The admitted numbers of both NMUPD and depression/suicide are high and therefore interesting. The fact that these adolescents may not have the knowledge of resources to treat their affective symptoms is worth noting. I would think that the best recommendations from this study would be for clinicians to do a better job screening for NMUPD and for depression/suicidal behaviors in all adolescents referred for treatment and to somehow increase screenings in schools to try and catch those students who are troubled but not yet referred for treatment," Dr Klee said.

He also noted that the study does not address the reasons for NMUPD among adolescents. "The correlations seem to suggest that the adolescents are self-medicating their depression, but they could also be taking these as part of the culture scene, where such drugs are available at gatherings and parties," Dr Klee said.

In his view, the "major drawback" of the study is that drug use was assessed as "lifetime," whereas depression and suicide were assessed for the past year. "Therefore, someone reporting feeling depressed today many have only tried a single medication 5 years earlier," Dr Klee said.

"We also have to remember that these are self-report measures," he said. "It may be that those adolescents who were willing to admit to prior drug use may also be willing to admit to depression and suicidal feelings. In contrast, there may have been adolescents who were reluctant to admit to either drug use or depression while one or both existed. Thus, we could have had a host of depressed adolescents who did not experiment with drugs but would not acknowledge feeling depressed or suicidal," Dr Klee commented.

Jonathan Jackson, PhD, director of psychological services at Adelphi University, Garden City, New York, who was not involved in the study, noted that "improvements in predicting of suicidal behavior are always valuable, and since clinicians may neglect to assess the role of nonmedical use of prescription meds in suicide, this study is a notable contribution."

The study was supported by Purdue Pharma LP. The authors have disclosed no relevant financial relationships.

Subst Use Misuse. Published online November 17, 2015. Abstract


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