Trajectories of Nonmedical Prescription Drug Misuse

描述（由申请人提供）：涉及计划（受控）药物（即阿片类镇痛药，兴奋剂，镇静剂）的非医疗处方药滥用（NPDM）在过去二十年中在美国显着增加，并且在18岁的个体中最为普遍。虽然在了解NPDM方面取得了进展，但由于测量和研究设计的限制，知识方面仍然存在相当大的差距，并且没有全国性的研究检查青少年NPDM的纵向轨迹，并且大多数现有研究未能解释NPDM的重要特征，如动机，给药途径和与其他药物的共同摄入。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的措施至少包含两种行为亚型（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，在美国青少年中，很少有关于NPDM的长期滥用模式和不良后果的公开信息。来自监测未来（MTF）研究的现有横断面和纵向面板数据为解决研究问题提供了前所未有的机会，这些研究问题将导致对青少年NPDM及其后果的更全面了解。本研究的目的是利用1997年至2008年MTF研究中12个独立的、具有全国代表性的约18万名高中毕业生的队列来提高我们对NPDM纵向轨迹的认识。MTF面板样本有12个独立的队列，大约有28,800名高中高年级学生（模态年龄18岁），他们被跟踪了1-2年（模态年龄19-20岁）和3-4年（模态年龄21-22岁），产生了三波数据。本研究旨在1)评估与三种处方药类别（阿片类镇痛药、兴奋剂、镇静剂）相关的NPDM和NPDM的特征（如动机、给药途径、与其他药物的共同摄入），并利用横断面和面板数据确定NPDM、NPDM特征、社会心理风险因素和不良后果（如健康、法律和社会）之间的关联；2)利用面板数据（即18-22岁）确定三种处方药类别（阿片类镇痛药、兴奋剂、镇静剂）在NPDM相关不良后果风险最大的发育过渡期间的纵向轨迹，并通过人口统计学因素、社会心理风险和保护因素以及NPDM特征来检查这些轨迹的变化；3)利用面板数据研究三种处方药（阿片类镇痛药、兴奋剂、镇静剂）、重要发展转变（如大学入学率、就业）和不良后果（如健康、法律和社会）在成年初期NPDM的纵向轨迹之间的关联。该项目的研究结果将大大提高目前对美国青少年NPDM的了解，并提供信息，以改善处方药滥用的筛查、评估、预防和治疗。

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.