Majority of adolescents with prescriptions for pain, stimulant, sleeping and antianxiety medications take them appropriately, study finds

ScienceDaily (Aug. 1, 2011) — Adolescents who misuse controlled medications (e.g., pain, stimulant, sleeping and antianxiety medications) for which they have a legitimate prescription may be more likely to abuse other substances and to sell, give or trade their controlled medications to other individuals, according to a report in the August issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

According to background information in the article, U.S. children and teens have increasingly received prescriptions for controlled medications. "Despite the importance of controlled medications in treating childhood and adolescent disorders, a consequence of this increase in prescribing may be a concomitant rise in medical misuse, diversion of controlled medications, and nonmedical use of controlled medications among adolescents," write the authors. They define "medical misuse" as "the use of a controlled psychotherapeutic medication by a patient in a manner not intended by the prescribing health care professional, including (but not limited to) not following the prescribed dosage, using intentionally to get high, not taking the medication within a prescribed interval, or co-ingesting with alcohol or other drugs."

Sean Esteban McCabe, Ph.D., from the University of Michigan, Ann Arbor, and colleagues conducted a Web-based survey from December 2009 to April 2010. The 2,597 respondents who completed the survey were students at middle schools and high schools in two southeastern Michigan school districts. The average age was 14.8 years, 65 percent of respondents were white and 51.1 percent of participants were female. The survey included standard measures of substance use (cigarette smoking in the past month, binge drinking in the past two weeks, nonmedical use of prescription medication and marijuana and other illicit drug use in the past year); questions about medical use, misuse and diversion (selling, giving away or trading) of controlled medications; and two drug-screening tests.

Of the 18 percent of respondents who said that during the past year they had used, for medical purposes, one of the controlled medications mentioned, 22 percent also said they had misused these medications, mostly by taking too much. Those defined as frequent users of controlled medications (at least 10 instances) were more likely than less-frequent users to engage in misuse. Prevalence of misuse was greater among frequent users of pain, sleeping and antianxiety medications. Adolescents who misused their controlled medications were also more likely to use alcohol and other drugs, and to divert these medications to others.

"Despite the importance of controlled medications for the treatment of pediatric disorders, our results suggest that a consequence of the greater availability of these medications may be an increase in their nonmedical use," write the authors. "Clinicians must balance the risks and benefits of controlled medication use with the abuse potential when assessing, treating, and monitoring their patients." The researchers also urge clinicians to "consider prescribing controlled medications with less potential for substance abuse and diversion."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

S. E. McCabe, B. T. West, J. A. Cranford, P. Ross-Durow, A. Young, C. J. Teter, C. J. Boyd. Medical Misuse of Controlled Medications Among Adolescents. Archives of Pediatrics and Adolescent Medicine, 2011; 165 (8): 729 DOI: 10.1001/archpediatrics.2011.114

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Inpatient hospitalization rates appear to have increased among children and adolescents with psychiatric disorders, but decreased among elderly

ScienceDaily (Aug. 1, 2011) — Over a 10-year period, rates of short-stay inpatient hospitalizations increased for children and adolescents but decreased for elderly who had a primary psychiatric diagnosis, according to a report published Online First today by Archives of General Psychiatry, one of the JAMA/Archives journals. The article also finds the proportion of inpatient days paid for by private health insurance appeared to decline among children, adolescents and adults.

According to background information in the article, inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, payers have reduced expenditures in these acute care settings and mental health policy makers and advocates have emphasized treatment alternatives with less restrictiveness and less negative stigma. Between 1990 and 2000, admissions to U.S. inpatient psychiatric services declined, but various data have suggested an increase in more recent years.

Joseph C. Blader, Ph.D., from the Stony Brook University School of Medicine, State University of New York, Stony Brook, evaluated trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007, segmented by patient-level variables. He used demographic, clinical and payment data from the National Hospital Discharge Survey on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were classified as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment).

The study found increases in discharges for children and adolescents, as well as more moderate increases for adults, while discharge rates for elderly patients declined. However, the total inpatient days increased from 1,845 days per 100,000 in 1996 to 4,370 days in 2007 for children and from 5,882 days per 100,000 in 1996 to 8,247 days in 2007 for adolescents; again, a decrease was seen among elderly individuals, from 10,348 days per 100,000 in 1996 to 6,517 in 2007. Also, during the years studied, the proportion of inpatient days covered by private payers decreased among children, adolescents, and adults. Through the period surveyed, primary diagnoses of bipolar disorder increased and primary diagnoses of anxiety decreased.

"In conclusion, a substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Joseph C. Blader. Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.84

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com