Public Release:  Skipping college makes young people more likely to abuse pain pills

Columbia University's Mailman School of Public Health

December 1, 2014 -- A study just released by Columbia University's Mailman School of Public Health compared the use of prescription opioids and stimulants among high school graduates, non-graduates, and their college-attending peers, and found that young adults who do not attend college are at particularly high risk for nonmedical prescription opioid use and disorder. In contrast, the nonmedical use of prescription stimulants is higher among college-educated young adults. Results of the study are published online in the journal Social Psychiatry and Psychiatric Epidemiology.

Non-medical use of prescription opioids is any self-reported use of prescription pain relievers that were not prescribed or that the respondent took only to experience the feeling they provided.

Among non-college-attending young adults with at least a high school degree, 13.1 percent reported using prescription opioids for non-medical reasons. The figure rose slightly to 13.2 percent for those who did not graduate from high school, and declined to 11.3 percent among college attendees.

The relationship between educational attainment and prescription drug use disorder was seen to a greater extent in women: young women who completed high school but were not enrolled in college were at a significantly greater risk of opioid disorder than their college-attending counterparts, while the difference between male college students and males with a high school diploma/GED for past-year opioid disorder was negligible.

Until this study, little was known about nonmedical use of prescription drugs among non-college-attending young adults in the United States. Approximately 70 percent of all U.S. young adults enroll in some form of college education, but around 30% do not.

"Our findings clearly show there is a need for young adult prevention and intervention programs to target nonmedical prescription drug use beyond college campuses," said Silvia S. Martins, MD, PhD, Mailman School of Public Health associate professor of Epidemiology.

While a large proportion of young adults, ages 18 to 22, are prescribed opiates, non-medical use of opioids is second only to marijuana as the most prevalent form of illegal drug use among young adults.

"This age group is particularly vulnerable to the development of adverse substance using patterns, due in part to the process of identity formation that emerges at this developmental stage," noted Martins, first author of the study.

The researchers analyzed public data for 36,781 young adults between the ages of 18 and 22 over a 12-month period in 2008 through 2010 from the National Survey on Drug Use and Health, an annual cross-sectional survey of the Substance Abuse and Mental Health Administration. Using the Kessler 6 screening instrument, the researchers also measured past-year serious psychological distress as self-reported by the respondents.

Non-Hispanic Blacks and Asians were less likely to use prescription opioids non-medically in the past-year compared to non-Hispanic Whites. Those who reported experiencing psychological distress most recently were more likely than those without distress to be non-medical users of the drugs.

The researchers also looked at non-medical use of prescription stimulants. The result was the opposite of what they found with opioids: Those without a high school degree and those who completed high school or equivalency were less likely to have used nonmedical stimulants compared to their college-attending peers. Asian users of the stimulants for non-medical purposes were more likely than whites to develop a stimulant use disorder. Living in a large metropolitan area was associated with a greater use of stimulants that were not prescribed compared to those living in less urban areas. Hometown size also had a bearing on whether this led to a stimulant-use disorder.

"More than 40 percent of the nonmedical prescription opioid and stimulant users identified in our data who initiated use of these drugs at 18 years of age or younger went on to develop prescription opioid and stimulant disorders," said Martins. "Therefore, prevention messages targeting young adult users of these drugs without a prescription are crucial to prevent escalation to either of these syndromes."

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Dr. Martins is currently a consultant for Purdue Pharma. All other authors have no conflict of interest. The study was supported by the National Institute of Drug Abuse-National Institutes of Health (DA023434, K01DA030449, T32DA031099); the Eunice Kennedy Shriver National Institute of Child and Human Development (HD060072); and the National Institute on Alcohol and Alcoholism (K01AA021511).

About Columbia University's Mailman School of Public Health

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu

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