Prescription Drug Misuse, Illicit Substance Use and Mental Health Symptoms Among Homeless Youth

Background: Prescription drug misuse (PDM) is an emerging epidemic in the U.S., and is associated with serious health consequences including addiction, seizures, respiratory depression, and death.  Homeless populations experience higher risks for substance misuse and associated health problems and as a result may be particularly vulnerable to PDM and its negative health consequences. However, little research has been done to investigate PDM prevalence among homeless youth and possible correlates of PDM. This study examines the relationship between PDM and other substance use, and the association between PDM and symptoms of mental health problems among homeless youth.

Methods: As part of a longitudinal study, we collected baseline data from 652 homeless youth between October 2011 and August 2012. Youth were recruited from three Los Angeles drop-in agencies serving youth 13-25 years of age. Baseline interviews assessed demographics, mental health status, and substance use. Bivariate associations were examined using Pearson’s chi-squared test for dichotomous predictors, and two-sample t-tests with equal variances for continuous predictors.

Results: Almost half (46.6%) of the youth reported any lifetime PDM, and 19.4% reported PDM in the past 30 days. Past month PDM was statistically significantly associated at the bivariate level with past month binge drinking (Chi2=36.48; Pr<0.001) and past 30-day use of other illicit substances, including marijuana (Chi2=22.37; Pr<0.001), methamphetamine (Chi2=53.07; Pr<0.001), heroin (Chi2=107.76; Pr<0.001), and crack/cocaine (Chi2=47.08; Pr<0.001). PDM was also associated with increased lifetime experiences of trauma (t=-3.48; Pr<0.001), symptoms of PTSD (Chi2=7.56; Pr=0.01), symptoms of psychological distress/depression (t=-2.57; Pr=0.01), and having attempted suicide in the past year (Chi2=17.79; Pr<0.001).

Conclusions: The prevalence of lifetime and past month prescription drug misuse is high in this population. PDM was strongly associated with the use of “hard drugs” (e.g., meth, heroin, and crack/cocaine), as well as with marijuana use and binge drinking, suggesting a profile of very high risk substance use among homeless youth. Symptoms of mental health problems and attempted suicide were also associated with PDM, but further research is needed to understand the directionality of this relationship (i.e.. self-medication versus substance-induced mental health symptomology). Regardless, this vulnerable population should be targeted for harm-reduction and substance use prevention programs, with an emphasis on associations with mental health problems.