The Genetic and Environmental Etiology of Non-Medical Use of Prescription Drugs

项目摘要 处方物质的非医疗使用（NMUPS）是指在没有处方的情况下使用药物， 除规定的方式外，或为引起的经验或感受。NMUPS在年轻人中的形象 成年人是暗淡的。每年估计有240万北美人，或每天约6，600名同修， 首次使用非医疗处方药的妇女超过一半。NMUPS是最高的 18至25岁的年轻人，5.3%的人报告目前的NMUPS。NMUPS与大学辍学有关， 更糟糕的就业结果，性受害，危害健康的行为，如驾驶下， 影响，和高风险的性行为，和精神症状，包括自杀。在青少年中，美国 大学生和年轻人，它也与多种物质的使用有关，包括可卡因，摇头丸， 和安非他明类物质在美国，超过一半的与毒品有关的急诊室就诊可以 现在已经连接到NMUPS。NMUPS对公众健康构成明显威胁。意外吸毒致死 阿片类药物和止痛药过量超过可卡因和海洛因，并继续增加。此外，委员会认为， 所有年龄组的NMUPS死亡人数超过了所有其他非法物质。 推动NMUPS的因素包括但不限于对安全性的误解，增加药物 可用性，沿着个人风险因素和动机。尽管NMUPS的患病率很高， 伴随死亡率和并发症，NMUPS在遗传和 环境风险仍然未知。如果没有对这些风险因素的彻底的、经验性的理解， 预防和干预方案将继续受到限制。了解这些风险因素及其 与其他物质的关系也将决定是否资助开发特定的NMUPS 诊断评估也是值得的。 我们建议使用两个大的基于人群的样本进行二次数据分析，这些样本按性别、年龄和 以民族为中心，实现三个目标。第一个是描述两种NMUP镇痛药和兴奋剂的模式 以年轻人和大学生为基础的人口样本。然后我们将使用基本的基因 流行病学方法估计NMUP镇痛药中遗传和环境风险的贡献 和兴奋剂。下一步，先进的遗传流行病学将用于估计遗传和 NMUP镇痛剂和兴奋剂与其他合法和非法物质使用之间的环境重叠。 最后，我们确定酒精、尼古丁、大麻、可卡因和海洛因使用的多基因风险， 物质使用预测NMUP镇痛药和兴奋剂，同时检查性别，年龄和种族差异。 这些知识将大大提高我们对遗传和环境风险的理解， 新出现的危险趋势。

Project summary Non-medical use of prescription substances (NMUPS) is the use of a medication without a prescription, in ways other than prescribed, or for the experience or feelings elicited. The picture of NMUPS among young adults is bleak. Each year an estimated 2.4 million North Americans, or ~6,600 initiates per day, use prescription drugs non-medically for the first time, more than one-half are females. NMUPS is highest among young adults aged 18 to 25, with 5.3% reporting current NMUPS. NMUPS is associated with college drop out, worse employment outcomes, sexual victimization, health-jeopardizing behaviors such as driving under the influence, and high-risk sexual behavior, and psychiatric symptoms including suicide. Among adolescents, U.S. college students and young adults, it is also associated with poly-substance use including cocaine, ecstasy, and amphetamine-like substances. More than half of all drug-related emergency room visits in the U.S. can now be linked to NMUPS. NMUPS is a clear threat to public health. Deaths attributable to unintentional drug overdose of opioids and analgesic exceed those for cocaine and heroin, and continue to increase. Moreover, the death toll across all age groups from NMUPS exceeds those for all other illicit substances. Factors driving NMUPS include, but are not limited to, misperceptions about safety, increasing drug availability, along with individual risk factors and motivations. Despite the high prevalence of NMUPS, concomitant death rates, and comorbidity, the basic genetic epidemiology of NMUPS in terms of genetic and environmental risks remains unknown. Without a thorough, empirical understanding of these risk factors, prevention and intervention programs will continue to remain limited. Knowledge of these risks factors and their relation to other substances will also determine whether funding the development of NMUPS-specific diagnostic assessments is also merited. We propose secondary data analyses using two large population-based samples varying by sex, age and ethnicity to address three aims. The first is to describe the patterns of NMUP analgesics and stimulants in two population-based samples of young adults and college-aged students. We will then use basic genetic epidemiological methods to estimate the contribution of genetic and environmental risks in NMUP analgesics and stimulants. Next, advanced genetic epidemiological will be used to estimate the degree of genetic and environmental overlap between NMUP analgesics and stimulants and other licit and illicit substance use. Finally, we determine whether polygenic risk for alcohol, nicotine, cannabis, cocaine, and heroin use and substance use predicts NMUP analgesics and stimulants while examining sex, age and ethnic differences. This knowledge will significantly improve our understanding of the genetic and environmental risks behind the emerging, dangerous trends in NMUPS.