Non-Medical Rx Use More Common Among 'Rural' than 'City' Teens

Teens who reside in rural communities appear more likely than their peers who live in more urban areas to use prescription drugs for non-medical purposes, according to a report posted online that will appear in the March 2011 print issue of Archives of Pediatrics & Adolescent Medicine, one of the journals of the American Medical Association.

The non-medical use of prescription drugs is common among U.S. adolescents, with about one in eight reporting lifetime non-medical use of prescription opioids, according to background information in the article.
"During adolescence, non-medical prescription drug use is particularly problematic given its association with use of other illicit drugs such as cocaine and heroin, as well as engagement in problem behaviors such as gambling, increased sexual activity and impulsivity," the authors write. "Moreover, individuals who use prescription drugs earlier in life have a greater chance of later developing prescription drug dependence."

Previous studies have examined substance abuse among urban teens, but their conclusions may not apply to those from rural areas, the authors note. Jennifer R. Havens, Ph.D., M.P.H., of University of Kentucky College of Medicine, Lexington, and colleagues analyzed data from 17,872 12- to 17-year-olds participating in the 2008 National Survey on Drug Use and Health. Of these, 53.2 percent lived in urban areas, 51 percent were male and 59 percent were white.

There were no differences between urban and rural youth in rates of any illicit drug use, including marijuana, cocaine, heroin and hallucinogens. However, 13 percent of rural teens reported ever having used prescription drugs for non-medical purposes, compared with 10 percent of urban teens. When the researchers assessed specific medication types, they found rural teens were also more likely to have used pain relievers (11.5 percent vs. 10.3 percent) or tranquilizers (3.5 percent vs. 2.5 percent) non-medically.

After adjusting for sociodemographic factors, health status and the use of other substances, rural teens remained 26 percent more likely than urban adolescents to say they had used prescription drugs for non-medical purposes.

"Data support that one reason for the higher prevalence of non-medical prescription drug use in rural areas may be the lack of availability of drugs such as heroin that are easily accessed in urban areas," the authors write.

This data jives with what Cheryl Guthier’s coalition, the Community Prevention Partnership of Berks County, has observed in her duties as a coalition executive director and as a CADCA personal coach. The executive director says their coalition, based in Reading, Penn., is located just outside of Philadelphia and is mostly urban, but serves a rural part of their county, too.

“Anecdotally, yes, we are seeing the same thing, but I think it’s a changing trend,” says Seth Kuranz, Racine County Youth Coalition coordinator. Kuranz’ Wisconsin coalition has similar demographics to Guthier’s, with a close proximity to major cities Milwaukee and Chicago.

Both coalitions are proactively educating their rural and urban communities in Rx prevention. In Racine County, the coalition has even started a new prescription drug task force to address the problem, adding the drug to their underage drinking and marijuana initiatives.

According to the Center for Disease Control's 2009 Youth Risk Behavior Survey, conducted September 2008 to December 2009, about 20 percent of high school students have taken a prescription drug without a doctor's supervision.

That's 1 in 5 — more than the percent of students who had tried cocaine, ecstacy, heroin and methamphetamines combined.

Guthier thinks prescription drug abuse could be more of a problem in rural communities because of access, both to different kinds of drugs and to medical care for mental health and substance abuse treatment.

Study authors noted that "While we were able to identify potential targets for intervention such as increased access to health, mental health and substance abuse treatment, this may be difficult for rural areas where such resources are in short supply or non-existent. Research into the causal mechanisms surrounding initiation of non-medical prescription drug use in rural adolescents is necessary to develop tailored interventions for this population."