Abstract
OBJECTIVE: We examined the prevalence, patterns, and correlates of adolescents' abuse, subthreshold dependence ("diagnostic orphans"), and dependence on prescription pain relievers (PPRs) such as opioids in a representative national sample (N = 36,992). METHOD: Data were from the 2005-2006 National Surveys of Drug Use and Health. DSM-IV criteria for abuse and dependence were examined. RESULTS: Of all adolescents ages 12 to 17, 7% (n = 2,675) reported nonprescribed PPR use in the past year, and 1% (n = 400) met criteria for past-year PPR abuse or dependence. Among the 2,675 adolescents who reported nonprescribed PPR use, more than one in three reported symptoms of abuse or dependence: 7% abuse, 20% subthreshold dependence, and 9% dependence. Regular PPR use, major depressive episodes, and alcohol use disorders were associated with each diagnostic category. Compared with asymptomatic nonprescribed PPR users, increased odds of abuse were noted among nonstudents (adjusted odds ratio [AOR] 2.6), users of mental health services (AOR 1.8), and those reporting poor or fair health (AOR 2.4); and increased odds of dependence were observed among females (AOR 1.6), those who were involved in selling illicit drugs (AOR 1.7), and users of multiple drugs (AOR 2.9). Subthreshold dependent users resembled dependent users in major depressive episodes (AOR 1.5), alcohol use disorders (AOR 1.8), and use of multiple drugs (AOR 1.7). CONCLUSIONS: Dependence on PPRs can occur without abuse, and subthreshold dependence deserves to be investigated further for consideration in major diagnostic classification systems.