Trajectories of Nonmedical Prescription Drug Misuse

描述(申请人提供)：非医疗处方药滥用(非医疗处方药滥用)涉及预定(控制)药物(即阿片类止痛剂、兴奋剂、镇静剂)在过去20年中在美国显著增加，并在18岁的个人中最为普遍。尽管在对NPDM的了解方面取得了进展，但由于测量和研究设计的限制，知识仍然存在相当大的差距，而且还没有全国性的研究考察NPDM在青少年中的纵向轨迹，而且现有的大多数研究都未能解释NPDM的重要特征，如动机、给药途径和与其他药物的共同摄取。我们的两个小型探索性横断面项目(R03DA018239和R03DA0187272)的研究结果表明，目前用于评估NPDM的方法至少包括两种行为亚型(自我治疗和娱乐)，这些行为亚型似乎在不良后果方面有所不同。然而，关于美国青少年中与NPDM相关的滥用和不良后果的长期模式的公开信息很少。来自监测未来(MTF)研究的现有横断面和纵向小组数据提供了一个前所未有的机会来解决研究问题，这些问题将使青少年更全面地了解非传染性疾病及其后果。这项拟议研究的目的是利用MTF研究中的12个独立的、具有全国代表性的队列，从1997年到2008年大约18万名高中生，来推进我们对NPDM纵向轨迹的了解。MTF面板样本包括大约28,800名高中生(18岁)的12个不同的队列，他们在1-2年(19-20岁)和3-4年(21-22岁)之后被跟踪，产生了三波数据。这项拟议研究的目的是：1)利用横断面数据和专家小组数据，评估与三类处方药(阿片类镇痛剂、兴奋剂、镇静剂)相关的NPDM及其特征(例如，动机、给药途径、与其他药物的共同摄入)，并确定NPDM、NPDM的特征、心理社会风险因素和不良后果(例如，健康、法律和社会)之间的关系；2)使用小组数据(即，18-22岁)确定三类处方药(阿片类镇痛剂、兴奋剂、镇静剂)在NPDM相关不良后果风险最大的发展转型期间的NPDM纵向轨迹，并按人口因素、心理社会风险和保护因素以及NPDM特征检查这些轨迹的变化；以及3)使用小组数据检查三类处方药(阿片类止痛剂、兴奋剂、镇静剂)、重要的发展转型(例如，上大学、就业)和成年初期不良后果(例如，健康、法律和社会)之间的关系。该项目的研究结果将极大地促进美国青少年对非处方药物的了解，并为改善处方药滥用的筛查、评估、预防和治疗提供信息。 公共卫生相关性：尽管最近美国非医疗处方药滥用(NPDM)有所增加，但对青少年中NPDM的纵向模式知之甚少。拟议的研究将通过使用具有全国代表性的样本检查非传染性疾病的轨迹，为减少非传染性疾病的预防工作的发展提供信息。研究结果将有助于指导临床实践和未来的研究，通过检查与NPDM发展过程相关的新研究问题。这项研究对确定与非丙二醛相关的不良后果风险最大的个人和最需要治疗服务的人具有重要意义。

DESCRIPTION (provided by applicant): Nonmedical prescription drug misuse (NPDM) involving scheduled (controlled) medications (i.e., opioid analgesics, stimulants, tranquilizers) has significantly increased over the past two decades in the United States and is most prevalent among individuals 18 years of age. While there have been advances in understanding NPDM, considerable gaps in knowledge remain due to limitations in measurement and study designs and no national studies have examined longitudinal trajectories of NPDM among adolescents and most existing studies fail to account for important characteristics of NPDM such as motives, route of administration, and co- ingestion with other drugs. Findings from our two small exploratory cross-sectional projects (R03DA018239 and R03DA0187272) indicate that there are at least two behavioral subtypes of NPDM (self-treatment and recreational) subsumed under current measures used to assess NPDM, and these behavioral subtypes appear to differ in terms of adverse consequences. However, there is little published information regarding the long- term patterns of misuse and adverse outcomes associated with NPDM among adolescents in the United States. Existing cross-sectional and longitudinal panel data from the Monitoring the Future (MTF) study provide an unprecedented opportunity to address research questions that will lead to a more comprehensive understanding of NPDM and its consequences among adolescents. The objective of the proposed study is to advance our knowledge regarding longitudinal trajectories of NPDM using twelve independent, nationally representative cohorts of approximately 180,000 high school seniors between 1997 and 2008 from the MTF study. The MTF panel sample features twelve separate cohorts of approximately 28,800 high school seniors (modal age 18) who were followed 1-2 years (modal ages 19-20) and 3-4 years (modal ages 21-22) later, resulting in three waves of data. The proposed study aims to 1) assess NPDM and characteristics of NPDM (e.g., motives, route of administration, co-ingestion with other drugs) associated with three prescription drug classes (opioid analgesics, stimulants, tranquilizers), and determine the associations among NPDM, characteristics of NPDM, psychosocial risk factors, and adverse outcomes (e.g., health, legal and social) using cross-sectional and panel data; 2) identify longitudinal trajectories of NPDM of three prescription drug classes (opioid analgesics, stimulants, tranquilizers) across the developmental transition of greatest risk for NPDM- related adverse outcomes using panel data (i.e., ages 18-22), and examine variations in these trajectories by demographic factors, psychosocial risk and protective factors, and NPDM characteristics; and 3) examine the associations among longitudinal trajectories of NPDM of three prescription drug classes (opioid analgesics, stimulants, tranquilizers), important developmental transitions (e.g., college attendance, employment) and adverse outcomes (e.g., health, legal and social) during emerging adulthood using panel data. Findings from this project will substantially advance the current understanding of NPDM among adolescents in the United States, and provide information that will improve the screening, assessment, prevention, and treatment of prescription drug abuse. PUBLIC HEALTH RELEVANCE: Despite a recent increase in nonmedical prescription drug misuse (NPDM) in the United States, relatively little is known about the longitudinal patterns of NPDM among adolescents. The proposed study will inform the development of prevention efforts to reduce NPDM by examining trajectories of NPDM using a nationally representative sample. Findings will help guide clinical practice and future research by examining new research questions related to the developmental course of NPDM. This study has important implications for the identification of individuals at greatest risk for adverse consequences associated with NPDM and those in greatest need of treatment services.