title: Prescription pain reliever abuse and dependence among adolescents: a nationally representative study.
abstract: OBJECTIVE
  We examined the prevalence, patterns, and correlates of adolescents' abuse, subthreshold dependence ("diagnostic orphans"), and dependence on prescription pain relievers (PPRs) such as opioids in a representative national sample (N = 36,992).
  
  
  METHODS
  Data were from the 2005-2006 National Surveys of Drug Use and Health. DSM-IV criteria for abuse and dependence were examined.
  
  
  RESULTS
  Of all adolescents ages 12 to 17, 7% (n = 2,675) reported nonprescribed PPR use in the past year, and 1% (n = 400) met criteria for past-year PPR abuse or dependence. Among the 2,675 adolescents who reported nonprescribed PPR use, more than one in three reported symptoms of abuse or dependence: 7% abuse, 20% subthreshold dependence, and 9% dependence. Regular PPR use, major depressive episodes, and alcohol use disorders were associated with each diagnostic category. Compared with asymptomatic nonprescribed PPR users, increased odds of abuse were noted among nonstudents (adjusted odds ratio [AOR] 2.6), users of mental health services (AOR 1.8), and those reporting poor or fair health (AOR 2.4); and increased odds of dependence were observed among females (AOR 1.6), those who were involved in selling illicit drugs (AOR 1.7), and users of multiple drugs (AOR 2.9). Subthreshold dependent users resembled dependent users in major depressive episodes (AOR 1.5), alcohol use disorders (AOR 1.8), and use of multiple drugs (AOR 1.7).
  
  
  CONCLUSIONS
  Dependence on PPRs can occur without abuse, and subthreshold dependence deserves to be investigated further for consideration in major diagnostic classification systems.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC 27710, USA. litzy.wu@duke.edu
authors.forename: Li-Tzy
authors.initials: LT
authors.lastname: Wu
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Ringwalt
authors.forename: Paolo
authors.initials: P
authors.lastname: Mannelli
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000453:epidemiology; D000701:Analgesics, Opioid / Q000506:poisoning; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D004366:Nonprescription Drugs / Q000506:poisoning; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D055553:Prescription Drugs / Q000506:poisoning; D011446:Prospective Studies; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D013287:Illicit Drugs; D004366:Nonprescription Drugs; D055553:Prescription Drugs