Sources of Nonmedical Prescription Drug Misuse Among US High School Seniors: Differences in Motives and Substance Use Behaviors

Objective: To examine whether sources of nonmedical use of prescription drugs (NMUPD) involving anxiolytics, opioids, and stimulants were associated with sociodemographic characteristics, NMUPD characteristics (eg, frequency), and other substance use. Method: Nationally representative samples of US high school seniors (N = 18,549) were surveyed by self-administered questionnaires (2009-2016). Design-based latent class analysis and Rao-Scott chi(2) tests were used to test associations among sociodemographic characteristics, NMUPD characteristics, other substance use behaviors (eg, binge drinking, cigarette smoking, marijuana use), and NMUPD sources. Results: Approximately 11.0% of high school seniors reported past-year NMUPD (n = 1,917). A substantial proportion of nonmedical users obtained the prescription drugs from multiple sources (44.2%). Latent class analysis identified 5 subgroups of NMUPD sources (friend/relative sources, friend/purchased sources, own leftover prescription, multiple sources, and other sources). Nonmedical users who obtained prescription drugs from friend/purchased sources were more likely to be adolescent boys, whereas those who used their own leftover prescriptions were more likely to be adolescent girls. Nonmedical users who obtained prescription drugs from multiple sources were more involved in substance use. In contrast, adolescent nonmedical users who used their own leftover prescriptions were less involved in substance use. Conclusion: Growing evidence indicates that different NMUPD sources are associated with different substance use behaviors. All NMUPD sources should be discouraged, because they place individuals, families, and communities at risk. Patients and their families should receive education on how to manage and properly dispose of controlled medications to avoid diversion into the community. Prescribers are encouraged to check prescription monitoring programs and screen adolescents for substance use/misuse when prescribing controlled medications.