Longitudinal Changes in Prescription Drug Misuse and Polysubstance Use in Adolescents and Young Adults - PROJECT SUMMARY/ABSTRACT Prescription drug misuse (PDM) – controlled medication use in ways not intended by the prescriber or use without a prescription – is an important public health issue in adolescents and young adults (AYAs). Relative to other age groups, older adolescents and young adults have the highest rates of PDM and high rates of PDM-related overdose. Also, PDM initiation by age 18 is associated with poorer outcomes at 35 years. Research on AYA PDM has established prevalence and processes in adolescents or young adults, but little research has investigated age-period-cohort (APC) differences and longitudinal change in PDM among AYAs. Furthermore, poly-PDM (i.e., PDM from multiple medication classes) and PDM-involved polysubstance use are underinvestigated in AYAs, despite evidence that single medication class PDM without other substance use is rare. Thus, the long-term goal of the research team is to understand PDM, poly-PDM, and PDM-involved polysubstance use in AYAs to influence policy and facilitate the development of screening and intervention to target AYAs most at-risk. Using data from the nationally representative longitudinal Monitoring the Future (MTF) and cross-sectional National Survey on Drug Use and Health (NSDUH) datasets, our aims in 12-30 year-old AYAs are to: (1) establish age/period/cohort (APC) and longitudinal differences in PDM prevalence and characteristics (i.e., SUD symptoms, motives, source, type, age of initiation, and co-ingestion); (2) quantify APC and longitudinal patterns of poly-PDM, the PDM (e.g., motives) and policy features linked to longitudinal poly- PDM change, and the effects of age of initiation on poly-PDM in AYAs; (3) evaluate longitudinal differences in PDM-involved polysubstance use (e.g., opioids and heroin; psychostimulants), and factors (e.g., state-level PDMP features) influencing course of PDM-involved polysubstance use; and (4) investigate the effects of life course factors (i.e., marriage, education, social bonds, employment, and household) on the course of PDM, poly- PDM and PDM-involved polysubstance use. Variable selection and analyses were guided by life course theories of deviant behavior and substance use. The contribution of this project will be significant because of its focus on identifying the most vulnerable AYAs in terms of PDM, poly-PDM and PDM-involved polysubstance use, all ongoing and significant public health issues. The project is innovative because of the use of PDM-relevant policy features (e.g., PDMP characteristics), use of life course theory and variables, and underutilized analyses (e.g., APC and mixture modeling). Finally, scientific rigor is maximized by the broad and complimentary expertise of the research team, a history of publication with both datasets, use of validated measures, accepted analytic techniques, and strong power for analyses. Rapid dissemination of the findings of this project can influence policy and inform the development of maximally valid screening, prevention, and intervention for PDM and its consequences in high-risk AYAs, all of which is consistent with the mission of NIDA.
