queen’s university kingston, on may 28 2014

CIHR Team inCHILD & YOUTHINJURY PREVENTION

© (Pulver/ May 2014)CIHR Team in Child and Youth Injury Prevention

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Nonmedical use of prescription opioids and injury risk among

Canadian youth

Ariel Pulver, Colleen Davison, Alyssa Parpia,

Eva Purkey, Will Pickett Queen’s UniversityKingston, ONMay 28 2014

© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention


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Background

Multifactorial etiologies adolescent injury

Substance use both precedes and follows injury

Emergence of risk behaviour in teen yearsDrug/alcohol related injuries may fare worse



Recreational prescription drug use: 3 to 6% from 2003-2008 (YSS, 2008)

CNS stimulants, sedatives/tranquilizers and opioid pain relievers

Limited studies of opioid use and injury risk in this population

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Objective

To examine the relationship between recreational use of opioid pain relievers and occurrence of serious injury among Canadian young people

1. Activities where injuries occur2. Proportion of injury by frequency of drug use 3. Risk estimate adjusted for other key factors

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Data source

2009/2010 Cycle 6 Canada N=10,429 Two-stage cluster sample design 14-16 years

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Recreational use of pain reliever medications

How many times have you used prescription pain relievers “to get high” in the past 12 months? E.g. Percodan, Demerol, Oxycontin, and Codeine Never; 1-2 times; 3-6 times; 7-9 times; 10-19 times;

20-39 times; 40 times or more ‘no use’ and ‘ever use’.

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Injury

Serious injury: Have you been injured in the past year? Medical attention Missed ≥5 days from activities

Activities in which injury occurred

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Covariates

Age Gender SES Urban/rural status Binge drinking Cannabis use

Peer drug use Quality of home life Perceived school

environment Number of adults at

home

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Analytic strategy

Cross-tabulations for proportions Prescription opioid use Injury Activity in which injury occurred

Multilevel, multi-variable Poisson regression Adjusted relative risks (RR) and 95% CI

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Description

Non-users [Frequency (%)]n=9471 (94.96)

Prescription Opioid Users [Frequency (%)]n=503 (5.04)

P (Rao-scott chi-square test)

Injury 1760 (20.04) 183 (40.44) <.0001

Females 4973 (52.51) 291 (57.85) 0.1280

Low SES 786 (8.44) 88 (17.90) <.0001

Dislike school environment 3347 (36.89) 252 (53.59) <.0001

Frequent peerdrug use 1152 (12.28) 192 (39.21) <.0001

Frequent binge drinking 200 (2.17) 27 (11.72) <.0001

Frequent cannabis use 1252 (13.32) 238 (48.28) <.0001

Unhappy home 829 (8.95) 141 (28.93) <.0001<2 adults at home 1973 (20.93) 157 (31.33) <.0001

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Occurrence of Serious Injury

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Activities in which injuries occurred by drug use

Prescription opioid use

Cycling n (%)

Sports and Recreational Activities n (%)

Walking or Running n (%)

Riding in or Driving a Motor Vehicle n (%)

Fighting n (%)

Other Activity n (%)

Never 156 (8.47) 895 (48.61)

153 (8.31) 76 (4.13) 102 (5.54)

458 (24.88)

At least once

11 (6.01) 70 (38.25)

15 (8.20) 9 (4.92) 26 (14.21)

53 (28.96)

P Rao-scott chi square

0.5921 0.0147 0.1431 0.1346 <.0001 0.0002

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Frequency of use

5% used prescription pain relievers ≥once/ past year females, older teens, low SES and some rural

Among users 43.5% (95% CI: 39.1, 47.8) have used 3+ times/ past

year

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Proportions of serious injury by frequency of

pain reliever use

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Never 1-2 times 3-5 times 6-9 times 10-19 times

20-39 times

40 times or more

0

10

20

30

40

50

60

70

80

90

%



Regression analysis

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Relative Risk [95% Confidence

Interval]

P value

Recreational Use of Prescription Pain Relievers No 1.00 Yes 1.64 [1.39-1.93] <0.0001

Peers never/rarely use drugs

1.00

Peers sometimes use drugs

1.22 [1.08-1.38] 0.0016

Peers often use drugs 1.19 [1.02-1.41] 0.0322No drinking or never

binge drink1.00

≤1 time/month 1.46 [1.30-1.64] <0.00012-4 times/month 1.68 [1.44-1.94] <0.0001≥2 times/week 1.68 [1.30-2.17] <0.0001

No cannabis 1.0 1-5 times 1.20 [1.04-1.38] 0.0130

6 or more times 1.03 [0.88-1.21] 0.7008*adjusted for age, SES and gender



Discussion

Physiologic effects of opioids Motor deficits, attention

problems, hand-eye coordination impairments

Risk taking tendencies Multiple risk-taking Sensation-seeking

Did drug use precede the injury or did the injury precede the drug use? Shift from medical to nonmedical

use

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Strengths:Large, nationally representative sampleMultilevel modeling Validated itemsNovel, contemporary importance

Limitations:Self reportExclusion of youth who were homeschooled; living on reserves; incarcerated; absent; didn’t receive consent; private schools

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Implications

Because of the surge in Rx misuse, related harms must be studied

Prescriptions for youth should be given with caution

Secure storage of Rx

Targeting multiple risk-taking behaviours

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queen’s university kingston, on may 28 2014

Documents

injury risk

injury events

youth injury prevention

alcohol use

frequent of opioid use

recreational use of

occurrence of serious

canadian youth ariel