Prescription Drug Misuse Among American Indian and White High School Students

Introduction.  Prescription (Rx) drug misuse among youth is an increasingly public health problem.  According to the Youth Risk Behavior Surveillance System, Rx drug misuse impacts American Indian/Alaska Native (AI/AN) communities at a higher rate than any other racial group.  Approximately, one quarter of AI/AN high school students report taking an Rx drug without a doctor’s prescription (lifetime).  The goal of the current study is to identify the role of risk and protective factors related to Rx drug misuse among AI youth.

Methods. Participants included 1889 youth (ages 15-19) who completed surveys in 2011 and 2012, as part of a longitudinal randomized control trial of an alcohol preventative intervention for rural, non-reservation communities (Komro, et al, 2014; Komro, et al., 2015).  Youth were in 9-12^th grade, 50% were female, and American Indian (24%), American Indian Mixed (21.5%) or Non AI (54.5%). We assessed the past 30-day prevalence of prescription misuse by using a binary outcome (0=never; 1= response of “1 or more times” to the question: “during the past 30 days, how many times did you take a prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, Xanax, or sleeping pills) without a doctor’s prescription?”).  We used logit regression models to examine the role of demographic variables (e.g. age, gender, race/ethnicity, SES), alcohol and mental health risk at wave 1 (e.g. feeling tired, trouble sleeping, feeling sad, hopeless, nervous, or worrying too much) on the prevalence of Rx drug misuse at wave 3.

Results. Among youth ages 15-19, the prevalence of Rx misuse ranged between 6.8 and 7.7 percent; and no age, race/ethnicity or gender differences were observed.  Among youth who did not report Rx misuse at wave 1 (n=1509), 4.8% reported initiation by wave 2 (n=72) and 4.0% by wave 3 (n=59).  After controlling for race and ethnicity (e.g. AI only, AI mixed), gender, age, and SES, youth who reported Rx misuse (OR=3.37, 95% CI=1.99-5.69; p<.001), early alcohol risk (OR=1.12; 95% CI=1.07-1.18; p=<.01) and higher depression symptoms (OR=1.12; 95% CI=1.03-1.3; p=<.01) at wave 1, reported higher prevalence of Rx drug misuse at wave 3.

Conclusion. Among youth ages 15 to 19, an average of 7 to 8 percent reported Rx misuse in the last 30 days.  No gender, race/ethnicity or age differences were observed.  Prior misuse of Rx drugs, early alcohol risks and higher depressive symptoms were predictive of future Rx misuse.  Findings highlight the need to address early alcohol use, polysubstance use and depression as factors associated with youth Rx drug misuse.