Nonmedical Use of Controlled Medications by Adolescents and Young Adults

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.