Screening for Nonmedical Use and Misuse of Prescription Medication by Adolescents

Several screening tools have been developed to identify youth with alcohol, cannabis, and tobacco/nicotine use disorders, although less attention has been paid to other substances, including the nonmedical use of prescription medication or prescription medication misuse.

To evaluate the proportion of youth reporting the use of substances other than alcohol, cannabis, and nicotine on 3 screening tools that have been developed and validated for identifying alcohol, cannabis, and nicotine use disorders among adolescent primary care patients.

Adolescents (N = 757) from primary care pediatric practices were randomized to complete substance use screening tools (Screening to Brief Intervention [S2BI, N = 242], Brief Screener for Alcohol, Tobacco, and Other Drugs [BSTAD, N = 253], Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS, N = 262]) and then complete a brief electronic assessment battery and a structured diagnostic interview that assessed for past-year use of opioids and benzodiazepines. A total of 716 adolescents with complete data for each screening tool and the structured interview were analyzed for this report.

Rates of the nonmedical use of prescription medication or prescription medication misuse varied by tool: S2BI: 20 (8.5%), BSTAD: 4 (1.7%), and TAPS: 3 (1.3%). No participant endorsed benzodiazepine or opioid use on the World Mental Health Composite International Diagnostic Interview Substance Abuse Module.

Rates of reporting the nonmedical use of prescription medication or prescription medication misuse vary by screen, and some exceed national estimates. Nonmedical use of prescription medication or prescription medication misuse may be more common than previously reported, although some responses may be false positives. Refining questions could elucidate an especially concerning behavior given widespread fentanyl contamination.