Non-medical prescription drug use more common among rural teens than city dwellers

November 1, 2010, JAMA and Archives Journals

Rural teens appear more likely than their urban peers to use prescription drugs for non-medical purposes, according to a report posted online today that will appear in the March 2011 print issue of Archives of Pediatrics & Adolescent Medicine.

The non-medical use of prescription drugs is common among U.S. adolescents, with about one in eight reporting lifetime non-medical use of prescription opioids, according to background information in the article. "During adolescence, non-medical prescription drug use is particularly problematic given its association with use of other illicit drugs such as cocaine and heroin, as well as engagement in problem behaviors such as gambling, increased sexual activity and impulsivity," the authors write. "Moreover, individuals who use prescription drugs earlier in life have a greater chance of later developing prescription drug dependence."

Previous studies have examined substance abuse among urban teens, but their conclusions may not apply to those from rural areas, the authors note. Jennifer R. Havens, Ph.D., M.P.H., of University of Kentucky College of Medicine, Lexington, and colleagues analyzed data from 17,872 12- to 17-year-olds participating in the 2008 National Survey on Drug Use and Health. Of these, 53.2 percent lived in urban areas, 51 percent were male and 59 percent were white.

There were no differences between urban and rural youth in rates of any illicit drug use, including marijuana, cocaine, heroin and hallucinogens. However, 13 percent of rural teens reported ever having used prescription drugs for non-medical purposes, compared with 10 percent of urban teens. When the researchers assessed specific medication types, they found rural teens were also more likely to have used pain relievers (11.5 percent vs. 10.3 percent) or tranquilizers (3.5 percent vs. 2.5 percent) non-medically.

After adjusting for sociodemographic factors, health status and the use of other substances, rural teens remained 26 percent more likely than urban adolescents to say they had used prescription drugs for non-medical purposes. "Data support that one reason for the higher prevalence of non-medical prescription drug use in rural areas may be the lack of availability of drugs such as heroin that are easily accessed in urban areas," the authors write.

Rural teens were more likely to misuse if they reported poorer health, episodes of depression or other substance abuse. "Residing in a household with two parents was associated with a 32 percent reduction in the odds of non-medical prescription drug use," the authors write. "These results suggest that interventions aimed at family involvement may be beneficial in preventing or reducing non-medical prescription drug use." Enrollment in school was also a protective factor.

"The cultural, structural and social realities of rural life can not only affect the prevalence of drug use but also exacerbate its consequences. The isolation and self-reliance of rural communities can negatively affect careseeking behavior, particularly regarding mental health and substance abuse services," the authors write. "While we were able to identify potential targets for intervention such as increased access to health, mental health and treatment, this may be difficult for rural areas where such resources are in short supply or non-existent. Research into the causal mechanisms surrounding initiation of non-medical prescription drug use in rural adolescents is necessary to develop tailored interventions for this population."

More information: Arch Pediatr Adolesc Med. Published online November 1, 2010. doi:10.1001/archpediatrics.2010.217

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