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Age and Cohort Patterns of Medical and Nonmedical Use of Controlled Medication Among Adolescents

Austic, Elizabeth PhD; McCabe, Sean Esteban PhD; Stoddard, Sarah A. PhD; Ngo, Quyen Epstein PhD; Boyd, Carol PhD

doi: 10.1097/ADM.0000000000000142
Original Research

Objectives: We identified peak annual incidence rates for medical and nonmedical use of prescription opioid analgesics, stimulants, sedatives, and anxiolytics (controlled medication), and explored cohort effects on age of initiation.

Methods: Data were gathered retrospectively between 2009 and 2012 from Detroit area students (n = 5185). Modal age at the last assessment was 17 years. A meta-analytic approach produced age-, year-, and cohort-specific risk estimates of first-time use of controlled medication. Cox regression models examined cohort patterns in age of initiation for medical and nonmedical use with any of 4 classes of controlled medication (opioid analgesics, stimulants, sedatives, or anxiolytics).

Results: Peak annual incidence rates were observed at age 16 years, when 11.3% started medical use, and 3.4% started using another person's prescription for a controlled medication (ie, engaged in nonmedical use). In the more recent birth cohort group (1996–2000), 82% of medical users and 76% of nonmedical users reported initiating such use by age 12 years. In contrast, in the less recent birth cohort group (1991–1995), 42% of medical users and 35% of nonmedical users initiated such use by age 12 years. Time to initiation was 2.6 times less in the more recent birth cohort group (medical use: adjusted hazard ratio [aHR] = 2.57 [95% confidence interval {CI} = 2.32–2.85]; nonmedical use: aHR = 2.57 [95% CI = 2.17–3.03]).

Conclusions: Peak annual incidence rates were observed at age 16 years for medical and nonmedical use. More recent cohorts reported initiating both types of use at younger ages. Earlier interventions may be needed to prevent adolescent nonmedical use of controlled medication.

Department of Emergency Medicine (EA), University of Michigan, Ann Arbor, MI; Institute for Research on Women and Gender (SEM, QEN, CB), University of Michigan, Ann Arbor, MI; School of Nursing (SAS, CB), University of Michigan, Ann Arbor, MI; Injury Research Center and Michigan Institute for Clinical and Health Research (QEN), University of Michigan, Ann Arbor, MI; and Addiction Research Center (CB), University of Michigan, Ann Arbor, MI.

Send correspondence and reprint requests to Elizabeth Austic, PhD, 2800 Plymouth Rd, Ste B10-G080, Ann Arbor, MI 48109. E-mail:

Received 29 September, 2014

Accepted 3 May, 2015

Supported by research grants R01DA024678, R01DA031160, and T32DA007267 from the National Institute on Drug Abuse, and U49/CE002099 from the Centers for Disease Control.

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Health or National Institute on Drug Abuse.

E. Austic had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. E. Austic and S. McCabe conceptualized and designed the study. C. Boyd (Principal Investigator) and S. McCabe acquired the data. E. Austic and S. McCabe analyzed and interpreted the data. E. Austic drafted the article. S. McCabe, S. Stoddard, Q. Epstein Ngo, and C. Boyd wrote the critical revision of the article for important intellectual content. E. Austic performed the statistical analysis. S. McCabe supervised the study.

The University of Michigan Institutional Review Board approved the study, and a Certificate of Confidentiality was obtained from the National Institutes of Health.

The authors declare no conflicts of interest.

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© 2015 American Society of Addiction Medicine