Texas State University, San Marcos, Texas.
Massachusetts General Hospital, Boston, and Harvard Medical School, Cambridge, MA.
J Am Acad Child Adolesc Psychiatry. 2019 Jul;58(7):670-680.e4. doi: 10.1016/j.jaac.2018.09.438. Epub 2018 Oct 30.
Adolescent controlled prescription drug misuse (PDM) co-occurs with significant consequences, including lower educational achievement, substance use disorder (SUD) symptoms, and psychopathology. Nonetheless, adolescent PDM sources and the prevalence of other substance use, SUD, and mental health outcomes associated with sources remain poorly understood.
Data were from the 2009 to 2014 National Survey on Drug Use and Health, including 103,920 adolescents (12-17 years of age). Six mutually exclusive sources were used: physician source only, theft/fake prescription only, friend/relative for free only, purchases only, other source only, or multiple sources. Analyses occurred separately for prescription opioids, stimulants, and tranquilizer/sedatives. PDM source prevalence across adolescents and by sex and school enrollment/engagement were estimated. Adjusted odds of past-year DSM-IV substance-specific SUD, marijuana use, any SUD, major depressive disorder (MDD), anxiety diagnosis, mental health treatment, and past-month binge drinking were estimated by source.
Friends/relatives, for free, was the most common source (29.0%-33.2%), followed by physician sources for opioids (23.9%), purchases for stimulants (23.5%), and tranquilizer/sedatives (22.7%). Few school enrollment/engagement differences existed, but female adolescents were more likely to use multiple sources. Over 70% of adolescents using multiple sources had a past-year SUD. Multiple sources, purchases, and theft/fake prescription were more strongly associated with other substance use than physician source use, and multiple source use was linked with MDD.
Adolescents using multiple sources, purchases and theft/fake prescriptions have elevated rates of other substance use, SUD and MDD and particularly warrant intervention. Also, adolescents with other SUD and MDD should be screened for PDM and misuse sources.
青少年自控处方药物滥用（PDM）与许多严重后果同时发生，包括教育程度降低、物质使用障碍（SUD）症状和精神病理学。尽管如此，青少年 PDM 的来源以及与来源相关的其他物质使用、SUD 和心理健康结果的流行情况仍知之甚少。
数据来自 2009 年至 2014 年全国毒品使用和健康调查，包括 103920 名青少年（12-17 岁）。使用了六个互斥的来源：仅医生来源、仅盗窃/伪造处方、仅朋友/亲戚免费、仅购买、其他来源或多个来源。分别对处方类阿片类药物、兴奋剂和镇静剂/安定剂进行分析。估计了青少年中以及按性别和学校入学/参与情况的 PDM 来源流行率。根据来源，估计了过去一年 DSM-IV 物质特异性 SUD、大麻使用、任何 SUD、重度抑郁症（MDD）、焦虑症诊断、心理健康治疗以及过去一个月狂饮的过去年发生率。
朋友/亲戚免费是最常见的来源（29.0%-33.2%），其次是阿片类药物的医生来源（23.9%）、兴奋剂的购买来源（23.5%）和镇静剂/安定剂的购买来源（22.7%）。学校入学/参与情况差异不大，但女青少年更有可能使用多个来源。超过 70%的使用多个来源的青少年过去一年存在 SUD。与医生来源相比，多个来源、购买和盗窃/伪造处方与其他物质使用的关联更强，而多个来源的使用与 MDD 相关。
使用多个来源、购买和盗窃/伪造处方的青少年其他物质使用、SUD 和 MDD 的发生率较高，特别需要干预。此外，有其他 SUD 和 MDD 的青少年应接受 PDM 和滥用来源的筛查。
