Recreational Use of Prescription Painkillers Linked to Other Drug Problems in Teens

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Nearly 1 in 4 high school seniors has ever taken a prescription opioid pain reliever either medically or recreationally, according to a new study. Nonmedical use of these drugs was associated with a higher risk of smoking, illegal drug use and binge drinking, but proper medical use was not.

Researchers analyzed survey data on more than 7,000 high-school seniors, taken from the national Monitoring the Future study between 2007 and 2009. They found that 18% of 12th graders reporting having ever used opioid painkillers — which include medications like codeine, Oxycontin and Vicodin — for medical reasons. Thirteen percent of seniors reported taking the drugs recreationally.

Of the teens who reported recreational use of painkillers, one-third had previously been prescribed the drugs for a legitimate medical reason. The majority, two-thirds, said their first experience with painkillers had been recreational use (before subsequently being prescribed the drugs legitimately) or they had never received a legitimate prescription at all.

As previous studies have found, most people who misuse prescription pain relievers do not do so as a consequence of standard pain treatment, but because they started taking the drugs on the street to get high or in an attempt to self-medicate. The researchers write: “These findings, along with results from three earlier smaller studies, should provide some reassurance to clinicians that prescription opioids can be safely prescribed to adolescents.”

(MORE: Can Addictive Behaviors Be Predicted in Preschool?)

There is an important caveat, however. Of the teens who did have prior medical exposure and chose to misuse the drugs, 80% used leftover medications from a legitimate prescription. That means, the authors suggest, “that the quantity of prescription opioids and/or limiting refills [for teens] should be carefully considered by prescribers.”

Overall, the results mirror other research showing that the characteristics of the user and his or her relationship to the drug matters more than mere exposure.

For example, teens who had medical exposure to prescription painkillers before they misused their drugs were 60% more likely to smoke, 80% more likely to binge drink, 220% more likely to try marijuana and more than four times more likely to misuse other types of prescription drugs like stimulants or sedatives, compared with teens who never used prescription painkillers

However, the risks for those who had tried opioids recreationally first — before receiving a prescription for medical use — were far greater: they were eight times more likely to binge drinking or smoke, 12 more likely to use marijuana, and a whopping 28 times more likely to misuse other prescription drugs, compared with their peers who had no exposure to painkillers.

Teens who had only ever used the drugs recreationally had similar risks as those who used them nonmedically before receiving a legitimate prescription. Further, teens who reported only ever using prescription painkillers as directed by the doctor had no higher substance-use risks than those who never used them at all.

(MORE: What’s Really Behind the Opioid Epidemic?)

It’s likely that initial recreational use seems riskiest because of the age of teens who start experimenting with drugs that way. The older someone gets, the greater the odds are that they will receive at least one legitimate prescription for painkillers. But the younger a teen is when he or she tries drugs deliberately, the more it tends to reflect pre-existing psychological or family problems. So, the kids who use recreationally first are like any kids who take drugs at a young age: already troubled.

The study also found some disturbing racial differences: while 23% of white students had been medically prescribed opioids at some point, only 6.9% of African American teens and 6.7% of Hispanics reported medical use. Rates of recreational use were lower among the minority groups as well, possibly reflecting the fact that since most nonmedical users get their drugs from friends and family, those whose social group is less likely to have the drugs are obviously less likely to get them.

The authors cite research showing that pharmacies in neighborhoods with high minority populations — regardless of income — are more than 50 times less likely to carry sufficient supplies of opioid medications, compared with white-dominated areas (many refuse to stock the drugs at all). They note that this could indicate either a lack of adequate pain treatment for minorities or overprescribing to whites.

(MORE: Government Considers Overdose Antidote, Naloxone, to Fight Prescription Drug Misuse)

The research was led by Sean McCabe of the University of Michigan and published in the Archives of Pediatric & Adolescent Medicine.

Maia Szalavitz is a health writer for Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.