Psychological and Drug Abuse Symptoms Associated With Nonmedical Use of Opioid Analgesics Among Adolescents

Subst Abus. 2014;35(3):284-9. doi: 10.1080/08897077.2014.928660.


Background: Approximately 18% of US adolescents engaged in prescription opioid abuse in 2013. However, this estimate may be misleading because it includes both medical misusers and nonmedical users, and there is evidence that these are 2 groups that differ relative to substance abuse and criminal risk. Thus, this study does not combine medical and nonmedical users; rather, it seeks to better understand the characteristics of nonmedical users.

Methods: This was a school-based, cross-sectional study that was conducted during 2009-2010 in southeastern Michigan with a sample of 2627 adolescents using a Web-based survey. Three mutually exclusive groups were created based on responses regarding medical and nonmedical use of opioid analgesics. Group 1 had never used an opioid analgesic, Group 2 used an opioid analgesic only as prescribed, and Group 3 nonmedically used an opioid analgesic. In addition, Group 3 was divided into 2 mutually exclusive subgroups (self-treaters and sensation-seekers) based on reasons for nonmedical use. A series of multinomial logistic regressions were conducted to determine if the groups differed on the presence of pain, psychological symptoms (e.g., affective disorder, conduct disorder, attention-deficit/hyperactivity disorder [ADHD]), and drug abuse.

Results: Sixty-five percent (65.0%) of the sample was white/Caucasian and 29.5% was African American. The average age was 14.8 years (SD = 1.9). Seventy percent (70.4%; n = 1850) reported no lifetime opioid use, 24.5% (n = 644) were medical users, 3.5% (n = 92) were nonmedical users who used for pain relief only, and 1.6% (n = 41) were classified as nonmedical users for reasons other than for pain relief (e.g., to get high). Both medical users and nonmedical users reported more pain and substance abuse symptoms compared with never users. Those nonmedical users who used opioids for sensation-seeking motivations had greater odds of having psychological symptoms.

Conclusions: These data support the need to further consider subgroups of nonmedical users of opioid analgesics.

Keywords: Prescription medication abuse; opioid drug abuse; prescription drug abuse.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Analgesics, Opioid / adverse effects*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / psychology*
  • Pain / psychology*
  • Prescription Drugs / adverse effects*
  • Self Medication / psychology*
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / psychology*


  • Analgesics, Opioid
  • Prescription Drugs