title: Opioid misuse among adolescents: new evidence from a misclassification analysis.
abstract: BACKGROUND
  Non-medical prescription-opioid (NMPO) use has been declared a national epidemic in the US. Opioid misuse is associated with substantial physiological, psychological, and concomitant economic implications. NMPO use among adolescents warrants special attention given its prevalence and the high risk of addiction.
  
  
  OBJECTIVE
  Our objectives were to: (a) identify factors associated with adolescent NMPO use after controlling for misclassification, while simultaneously identifying characteristics that affected the likelihood of misreporting use; and (b) identify factors associated with an individual misusing their own versus a diverted prescription, and the likelihood that the prescription source was misreported.
  
  
  METHODS
  Data come from the Washington State Healthy Youth Survey. A maximum likelihood estimation technique for systematically misclassified binary-dependent variables was utilized. Covariates were chosen to represent influential factors identified in the theoretical adolescent development literature.
  
  
  RESULTS
  An estimated 35 % of respondents who stated that they had never misused prescription opioids most likely had. An estimated 17 % of those who admitted to NMPO use claimed to have misused a diverted prescription, but most likely misused their own. Various demographic, school, neighborhood, family, substance-use, personality/attitude, and social factors were identified as potential predictors of adolescent NMPO use, opioid-prescription source, and misclassification of responses to each outcome.
  
  
  CONCLUSIONS
  The finding that a self-reported survey failed to identify over one-third of individuals at risk for NMPO use is concerning, as is the finding that approximately 17 % of those who admitted to NMPO use may have misstated their prescription-opioid source. The findings presented here are critical to focus prevention efforts, especially for identifying at-risk youths who may misrepresent their use.
authors.affiliation: Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA, sean.murphy@wsu.edu.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Friesner
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenman
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology