Forgotten Youth
After marijuana, prescriptions painkillers are America’s most popular recreational drug, and they’re far more deadly. According to the Centers for Disease Control and Prevention, non-prescription use of prescription opioids like Oxycontin were responsible for the deaths of 16,000 Americans in 2012, twice the number of a decade earlier.
While the latest data hint that the painkiller epidemic may be abating slightly, Mailman School epidemiologist Silvia Martins warns that prevention efforts geared towards young people have been too narrowly focused on college campuses, neglecting millions of young people who aren’t in school.
“There’s been a large effort to educate college students about the risks of prescription opioids,” Martins says. “But what about the other 60 percent of young people who aren’t in college? What are we doing for them?”
It turns out that it’s these young people who need help the most.
A study she just published with colleagues in the journal Social Psychiatry and Psychiatric Epidemiology found that young people ages 18 to 22 who didn’t go on to college used prescription painkillers recreationally at significantly higher rates than their counterparts on campus.
They were also more likely to develop problems. Nearly 20 percent of those who didn’t complete high school had a problem that met the clinical definition of prescription opioid abuse or dependence—double the rate of college students.
It’s not just prevention programs that give college students a leg up. Student support services can get them help when they need it. Broadly speaking, Martins says, college students have relatively strong social networks and self-efficacy. “The better educated you are, the more power you have to make the right choices. You also feel more empowered to seek help.”
Occupational Hazard
Being in the workforce has its own risks for prescription painkillers, particularly if you’re doing manual labor—professions more common for those not pursing a college degree. “If you’re in a job where you’re prone to have back pain or other physical injury, you’re more likely be prescribed a month’s worth of medication,” explains Martins. “Extra pills sitting in your medicine cabinet may remind you of how good they made you feel.”
Non-prescription painkillers used to soothe more than physical aches and pains. According to Martins, Americans of all ages self-medicate with these pills for untreated mood and anxiety disorders that are more prevalent among those with less schooling. Taking pills can be easier than dealing with the stigma and expense of seeking professional help.
But college doesn’t protect young people from all drugs. Martins’ study reports that a greater portion of college students used stimulants than their counterparts with less schooling. Why? College students may have better access to simulants—and a rationale to use them. “They may take drugs prescribed to a friend with ADHD to help them study for a test,” she explains.
Custom-Fit Prevention
Deaths related to prescription opioids may be on their way down, but the problem, Martins says, is still very serious. New rules have made “doctor shopping” for prescriptions more difficult, and drugs like Oxycontin have been reformulated to make them harder to sniff or inject. The unintended result has been a rise in deaths from heroin; research by Martins and others indicates that many are substituting one drug for another. “Once you’re addicted, you’re going to try to get something else, and heroin is out on the streets and it’s cheaper.”
But the scourge of painkillers is far from over. “We can’t ignore prescription drugs,” says Martins. “Even with changes to formulations, it’s not impossible to abuse them. We have to deal with both problems.”
What’s needed, Martin believes is a greater focus on young people who are developing patterns that stay with them for life. Prevention efforts, she says, must go beyond campus to the workplace, where they will need to be tailored to young workers, even to specific workplaces. Says Martins: “There is no one-size-fits-all approach.”