Nonmedical Use of Controlled Medications by Adolescents and Young Adults

Publication Date: November 18, 2024
Last Updated: November 21, 2024

Summary of Recommendations

Nonmedical prescription drug use carries several acute and long-term risks and remains common among adolescents and young adults in the United States. There are several ways in which pediatricians can contribute to reducing the burden of nonmedical prescription drug use:
  • Because controlled medications can be prescribed by prescribers from a variety of medical and surgical disciplines, pediatricians should ask patients and caregivers about all controlled medication prescriptions, regardless of prescriber source, and provide appropriate education.
  • Pediatricians should be aware of nonmedical prescription drug use and provide universal anticipatory guidance for all families about the threats of nonmedical prescription drug use and how to protect their children, which includes:
    • Securing medications at home.
    • Supervised access and administration of controlled medications.
    • Proper disposal of unused prescription medications.
    • Anticipatory guidance around sharing, trading, or selling medications at home and at school, including college, and about the role of naloxone in opioid overdose death prevention.
  • When prescribing controlled medications for adolescents and young adults, clinicians should:
    • Stay up-to-date on practice guidelines for the treatment of conditions such as ADHD, chronic pain, and mental illness for which controlled medications could be indicated to reduce the rates of nonmedical prescription drug use. Controlled medications should be prescribed after consideration of other therapeutic options and with careful weighing of potential risks and benefits. Shorter prescription lengths with more frequent renewals as well as regular follow-up visits can help reduce risk of nonmedical prescription drug use.
    • Screen for substance use.
    • Be familiar with their state’s legal and practice requirements regarding prescription monitoring databases and make appropriate use of such programs. Any unusual prescription pattern (eg, early and/or frequent refills, prescriptions from several different prescribers) should be discussed and addressed with the patient and/or family while respecting confidentiality (when possible).
    • Explain the risks of nonmedical prescription drug use to adolescents and young adults and families.
    • Prescribe naloxone for overdose death prevention (applicable to opioids only).
  • When nonmedical prescription drug use has been identified, pediatricians should:
    • Consider using validated tools to screen for and address common mental health comorbidities, such as anxiety and depression as well as other risk factors, such as trauma, uncontrolled pain, insomnia, and untreated ADHD.
    • Prescribe and recommend naloxone for overdose death prevention and teach patients and families how and when to use naloxone, regardless of the type of medication being used nonmedically.
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Nonmedical Use of Controlled Medications by Adolescents and Young Adults

Authoring Organization

American Academy of Pediatrics

Publication Month/Year

November 18, 2024

Last Updated Month/Year

November 21, 2024

Document Type

Consensus

Country of Publication

US

Document Objectives

Nonmedical prescription drug use (NMPDU), the use of controlled prescription medications for purposes other than initially intended by the prescriber, is common among adolescents and young adults (AYAs). Prescription stimulants, sedatives, and opioid medications are the 3 main categories of controlled medications nonmedically used by AYAs. The intent of this clinical report is to provide an overview of the epidemiology, motives, sources, and risk factors of NMPDU among AYAs. This report also describes acute and long-term morbidity and mortality associated with NMPDU and discusses the importance of primary and secondary prevention to reduce the burden of NMPDU among AYAs. This report concludes with a series of recommendations on how pediatricians can address NMPDU with patients and their families.

Inclusion Criteria

Male, Female, Adolescent

Health Care Settings

Ambulatory, Outpatient, School

Intended Users

Addiction treatment specialist, counselor, nurse, nurse practitioner, physician, physician assistant, psychologist

Scope

Counseling, Diagnosis, Assessment and screening, Management, Prevention

Diseases/Conditions (MeSH)

D019966 - Substance-Related Disorders, D015813 - Substance Abuse Detection, D061891 - Controlled Substances

Keywords

opioids, Substance use disorders, prescription drug

Source Citation

Nicholas Chadi, Leslie Walker-Harding, COMMITTEE ON SUBSTANCE USE AND PREVENTION; Nonmedical Use of Controlled Medications by Adolescents and Young Adults: Clinical Report. Pediatrics 2024; e2024069298. 10.1542/peds.2024-069298