Queen’s University Kingston, ON May 28 2014

1. Nonmedical use of prescription opioids and injury risk among Canadian youthAriel Pulver, Colleen Davison, Alyssa Parpia, Eva Purkey, Will Pickett Queen’s University Kingston, ON May 28 2014

2. Background • Multifactorial etiologies adolescent injury • Substance use both precedes and follows injury Emergence of risk behaviour in teen years Drug/alcohol related injuries may fare worse

3. Recreational prescription drug use: • 3 to 6% from 2003-2008 (YSS, 2008) • CNS stimulants, sedatives/tranquilizers and opioid pain relievers • Limited studies of opioid use and injury risk in this population

4. Objective • To examine the relationship between recreational use of opioid pain relievers and occurrence of serious injury among Canadian young people • Activities where injuries occur • Proportion of injury by frequency of drug use • Risk estimate adjusted for other key factors

5. Data source • 2009/2010 Cycle 6 Canada • N=10,429 • Two-stage cluster sample design • 14-16 years

6. Recreational use of pain reliever medications • How many times have you used prescription pain relievers “to get high” in the past 12 months? • E.g. Percodan, Demerol, Oxycontin, and Codeine • Never; 1-2 times; 3-6 times; 7-9 times; 10-19 times; 20-39 times; 40 times or more • ‘no use’ and ‘ever use’.

7. Injury • Serious injury: • Have you been injured in the past year? • Medical attention • Missed ≥5 days from activities • Activities in which injury occurred

8. Covariates • Age • Gender • SES • Urban/rural status • Binge drinking • Cannabis use • Peer drug use • Quality of home life • Perceived school environment • Number of adults at home

9. Analytic strategy • Cross-tabulations for proportions • Prescription opioid use • Injury • Activity in which injury occurred • Multilevel, multi-variable Poisson regression • Adjusted relative risks (RR) and 95% CI

10. Description

11. Occurrence of Serious Injury

12. Activities in which injuries occurred by drug use

13. Frequency of use • 5% used prescription pain relievers ≥once/ past year • females, older teens, low SES and some rural • Among users • 43.5% (95% CI: 39.1, 47.8) have used 3+ times/ past year

14. Proportions of serious injury by frequency of pain reliever use

15. Regression analysis *adjusted for age, SES and gender

16. Discussion • Physiologic effects of opioids • Motor deficits, attention problems, hand-eye coordination impairments • Risk taking tendencies • Multiple risk-taking • Sensation-seeking • Did drug use precede the injury or did the injury precede the drug use? • Shift from medical to nonmedical use

17. Strengths: • Large, nationally representative sample • Multilevel modeling • Validated items • Novel, contemporary importance • Limitations: • Self report • Exclusion of youth who were homeschooled; living on reserves; incarcerated; absent; didn’t receive consent; private schools

18. Implications • Because of the surge in Rx misuse, related harms must be studied • Prescriptions for youth should be given with caution • Secure storage of Rx • Targeting multiple risk-taking behaviours

19. Thank you Acknowledgements: