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Nonmedical use of prescription opioids and injury risk among Canadian youth Ariel Pulver, Colleen Davison, Alyssa Parpia , Eva Purkey , Will Pickett. Queen’s University Kingston, ON May 28 2014. Background. M ultifactorial etiologies a dolescent injury - PowerPoint PPT Presentation
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CIHR Team inCHILD & YOUTHINJURY PREVENTION
© (Pulver/ May 2014)CIHR Team in Child and Youth Injury Prevention
Slide 1 of (19)
Nonmedical use of prescription opioids and injury risk among
Canadian youth
Ariel Pulver, Colleen Davison, Alyssa Parpia,
Eva Purkey, Will Pickett Queen’s UniversityKingston, ONMay 28 2014
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Slide 2 of (19)
Background
Multifactorial etiologies adolescent injury
Substance use both precedes and follows injury
Emergence of risk behaviour in teen yearsDrug/alcohol related injuries may fare worse
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 3 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Objective
To examine the relationship between recreational use of opioid pain relievers and occurrence of serious injury among Canadian young people
1. Activities where injuries occur2. Proportion of injury by frequency of drug use 3. Risk estimate adjusted for other key factors
Slide 4 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Data source
2009/2010 Cycle 6 Canada N=10,429 Two-stage cluster sample design 14-16 years
Slide 5 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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’.
Slide 6 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Injury
Serious injury: Have you been injured in the past year? Medical attention Missed ≥5 days from activities
Activities in which injury occurred
Slide 7 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 8 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 9 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Description
Non-users [Frequency (%)]n=9471 (94.96)
Prescription Opioid Users [Frequency (%)]n=503 (5.04)
P (Rao-scott chi-square test)
Injury 1760 (20.04) 183 (40.44) <.0001
Females 4973 (52.51) 291 (57.85) 0.1280
Low SES 786 (8.44) 88 (17.90) <.0001
Dislike school environment 3347 (36.89) 252 (53.59) <.0001
Frequent peerdrug use 1152 (12.28) 192 (39.21) <.0001
Frequent binge drinking 200 (2.17) 27 (11.72) <.0001
Frequent cannabis use 1252 (13.32) 238 (48.28) <.0001
Unhappy home 829 (8.95) 141 (28.93) <.0001<2 adults at home 1973 (20.93) 157 (31.33) <.0001
Slide 10 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Occurrence of Serious Injury
Slide 11 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Activities in which injuries occurred by drug use
Prescription opioid use
Cycling n (%)
Sports and Recreational Activities n (%)
Walking or Running n (%)
Riding in or Driving a Motor Vehicle n (%)
Fighting n (%)
Other Activity n (%)
Never 156 (8.47) 895 (48.61)
153 (8.31) 76 (4.13) 102 (5.54)
458 (24.88)
At least once
11 (6.01) 70 (38.25)
15 (8.20) 9 (4.92) 26 (14.21)
53 (28.96)
P Rao-scott chi square
0.5921 0.0147 0.1431 0.1346 <.0001 0.0002
Slide 12 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 13 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Proportions of serious injury by frequency of
pain reliever use
Slide 14 of (19)
Never 1-2 times 3-5 times 6-9 times 10-19 times
20-39 times
40 times or more
0
10
20
30
40
50
60
70
80
90
%
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Regression analysis
Slide 15 of (19)
Relative Risk [95% Confidence
Interval]
P value
Recreational Use of Prescription Pain Relievers No 1.00 Yes 1.64 [1.39-1.93] <0.0001
Peers never/rarely use drugs
1.00
Peers sometimes use drugs
1.22 [1.08-1.38] 0.0016
Peers often use drugs 1.19 [1.02-1.41] 0.0322No drinking or never
binge drink1.00
≤1 time/month 1.46 [1.30-1.64] <0.00012-4 times/month 1.68 [1.44-1.94] <0.0001≥2 times/week 1.68 [1.30-2.17] <0.0001
No cannabis 1.0 1-5 times 1.20 [1.04-1.38] 0.0130
6 or more times 1.03 [0.88-1.21] 0.7008*adjusted for age, SES and gender
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 16 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
Strengths:Large, nationally representative sampleMultilevel modeling Validated itemsNovel, contemporary importance
Limitations:Self reportExclusion of youth who were homeschooled; living on reserves; incarcerated; absent; didn’t receive consent; private schools
Slide 17 of (19)
© (Pulver / May 2014)CIHR Team in Child and Youth Injury Prevention
CIHR Team inCHILD & YOUTHINJURY PREVENTION
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
Slide 18 of (19)
CIHR Team inCHILD & YOUTHINJURY PREVENTION
© (Pulver/ May 2014)CIHR Team in Child and Youth Injury Prevention
Slide 19 of (19)
Thank you
Acknowledgements: