Trajectories of Nonmedical Prescription Drug Misuse

描述（由申请人提供）：涉及计划（受控）药物的非医疗处方药误用（NPDM）（即，阿片类镇痛剂、兴奋剂、镇静剂）在过去二十年中在美国显著增加，并且在18岁的个体中最普遍。虽然在理解NPDM方面取得了进展，但由于测量和研究设计的局限性，知识仍存在相当大的差距，并且没有国家研究检查青少年NPDM的纵向轨迹，大多数现有研究未能解释NPDM的重要特征，如动机，给药途径以及与其他药物的共同摄入。我们的两个小型探索性横断面项目（R 03 DA 018239和R 03 DA 0187272）的结果表明，在目前用于评估NPDM的措施下，至少有两种NPDM行为亚型（自我治疗和娱乐），这些行为亚型在不良后果方面似乎有所不同。然而，关于美国青少年中NPDM的长期误用模式和不良结局的已发表信息很少。监测未来（MTF）研究的现有横截面和纵向面板数据提供了一个前所未有的机会来解决研究问题，这将导致更全面地了解NPDM及其在青少年中的后果。拟议的研究的目的是推进我们的知识纵向轨迹NPDM使用12个独立的，全国代表性的队列约180，000高中毕业生在1997年和2008年之间的MTF研究。MTF小组样本包括1 - 2个独立的队列，约28，800名高中毕业生（模态年龄18岁），他们在1-2年（模态年龄19-20岁）和3-4年（模态年龄21-22岁）后被跟踪，产生三波数据。拟议的研究旨在1）评估NPDM和NPDM的特征（例如，动机、给药途径、与其他药物共同摄入），并确定NPDM、NPDM特征、心理社会风险因素和不良结局（例如，健康、法律的和社会）; 2）使用面板数据（即，年龄18-22岁），并通过人口统计学因素，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）检查三种处方药类别（阿片类镇痛药，兴奋剂，镇静剂）的NPDM纵向轨迹之间的关联，重要的发育转变（例如，大学出勤率，就业）和不利的结果（例如，健康，法律的和社会）在新兴的成年期使用面板数据。该项目的研究结果将大大提高美国青少年对NPDM的认识，并提供信息，改善处方药滥用的筛查、评估、预防和治疗。 公共卫生相关性：尽管最近在美国的非医疗处方药滥用（NPDM）的增加，相对较少的是知道青少年NPDM的纵向模式。拟议的研究将通过使用全国代表性样本检查NPDM的轨迹，为减少NPDM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，通过检查新的研究问题相关的NPDM的发展历程。这项研究对于识别与NPDM相关的不良后果风险最大的个体和最需要治疗服务的个体具有重要意义。

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.