MedicalResearch.com Interview with:
Shannon M. Monnat, PhD
Assistant Professor of Rural Sociology, Demography, and Sociology
Department of Agricultural Economics, Sociology, and Education
The Pennsylvania State University
University Park, PA 16802
Medical Research: What is the background for this study? What are the main findings?
Dr. Monnat: Given concurrent rapid increases in opioid prescribing and adolescent prescription opioid misuse since the 1990s and historical problems with opioid abuse in rural areas, we were interested in whether adolescents in rural areas were more likely to abuse prescription opioids than their peers in urban areas. Adolescence is a really crucial time to study substance abuse disorders because most abuse begins during adolescence, and individuals who begin use before age 18 are more likely to develop a long-term disorder as an adult compared to those who first try a substance later in life. The active ingredient in prescription opioids and heroin is the same. Prescription opioids are highly addictive and can be dangerous if utilized incorrectly. Prescription opioid abuse is currently responsible for over 16,000 deaths in the US annually and has an estimated annual cost of nearly $56 billion dollars. Therefore, it is correctly viewed as a major public health problem.
We found that teens living in rural areas are more likely to abuse prescription opioids compared to teens living in large urban areas. Several important factors increased rural teens’ risk of abusing prescription opioids, including that they are more likely to rely on emergency department treatment than their urban peers, they have less risky attitudes and perceptions about substance abuse than their urban peers, and they are less likely to be exposed to drug/alcohol prevention messages outside of the school environment than their urban peers. Rural teens are also buffered by several factors that help to reduce opioid abuse, including stronger religious beliefs, less depression, less peer substance abuse, and less access to illicit drugs. If not for these protective factors, the current epidemic we see in rural areas could be even worse.
We also found that both rural and urban adolescents were most likely to report obtaining the prescriptions they abused from friends or family. However, rural adolescents were less likely than urban adolescents to obtain the pills this way. Rural adolescents were more likely than urban adolescents to report getting the pills they abuse directly from physicians.
Medical Research: What should clinicians and patients take away from your report?
Dr. Monnat: Preventing initiation of opioids is the key to preventing addiction. Adolescents who are not terminally ill or seriously injured should avoid ever taking a prescription opioid. We encourage parents to discuss alternative pain management with physicians when an opioid prescription is presented at the time of treatment. Parents must be pro-active with the health of their children and not be fearful to ask doctors about the risks involved with prescription painkillers.
Physicians in rural areas should be mindful that rural adolescents are at especially high risk of prescription painkiller misuse. The prescribing of painkillers should be avoided for minor injuries because of the high risk of addiction. Physicians who do prescribe painkillers to adolescents should require regular follow-up visits throughout the course of the prescription and should emphasize the risks involved with taking prescription painkillers with adolescents and their parents. Physicians should encourage parents to hold onto the bottle of pills for their children and administer the pills at the recommended timing and dosage. Any unused prescriptions should be returned to the pharmacy rather than thrown away or saved in the family medicine cabinet.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Monnat: Future research should explore the circumstances surrounding the first time an adolescent consumes a prescription painkiller:
- Was the first time related to an injury?
- Was it social in nature?
- Did it include the use of other substances?Moreover, researchers should investigate transitions from prescription painkillers into heroin.
- What are the characteristics of people and the places where they live that can help us better understand when and where transitions into heroin are most likely?
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Shannon M. Monnat, PhD (2015). Rural Teens More Likely To Abuse Prescription Opioids