1. CIHR Team in CHILD & YOUTH INJURY 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 University Kingston, ON May 28 2014

2. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Slide 2 of (19) Background  Multifactorial etiologies adolescent injury  Substance use both precedes and follows injury Emergence of risk behaviour in teen years Drug/alcohol related injuries may fare worse

3. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

4. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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 occur 2. Proportion of injury by frequency of drug use 3. Risk estimate adjusted for other key factors Slide 4 of (19)

5. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Data source  2009/2010 Cycle 6 Canada  N=10,429  Two-stage cluster sample design  14-16 years Slide 5 of (19)

6. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

7. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

8. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

9. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

10. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Description Non-users [Frequency (%)] n=9471 (94.96) Prescription Opioid Users [Frequency (%)] n=503 (5.04) P (Rao-scott chi-square test) Injury1760 (20.04)183 (40.44)<.0001 Females4973 (52.51)291 (57.85)0.1280 Low SES786 (8.44)88 (17.90)<.0001 Dislike school environment 3347 (36.89)252 (53.59)<.0001 Frequent peer drug 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 home829 (8.95)141 (28.93)<.0001 <2 adults at home1973 (20.93)157 (31.33)<.0001 Slide 10 of (19)

11. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Occurrence of Serious Injury Slide 11 of (19)

12. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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 0.59210.01470.14310.1346<.00010.0002 Slide 12 of (19)

13. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

14. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Proportions of serious injury by frequency of pain reliever use Slide 14 of (19)

15. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION Regression analysis Slide 15 of (19) Relative Risk [95% Confidence Interval] P value Recreational Use of Prescription Pain Relievers No1.00 Yes1.64 [1.39-1.93]<0.0001 Peers never/rarely use drugs1.00 Peers sometimes use drugs1.22 [1.08-1.38]0.0016 Peers often use drugs1.19 [1.02-1.41]0.0322 No drinking or never binge drink 1.00 ≤1 time/month1.46 [1.30-1.64]<0.0001 2-4 times/month1.68 [1.44-1.94]<0.0001 ≥2 times/week1.68 [1.30-2.17]<0.0001 No cannabis1.0 1-5 times1.20 [1.04-1.38]0.0130 6 or more times1.03 [0.88-1.21]0.7008 *adjusted for age, SES and gender

16. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

17. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY PREVENTION  Strengths:  Large, nationally representative sample  Multilevel modeling  Validated items  Novel, contemporary importance  Limitations:  Self report  Exclusion of youth who were homeschooled; living on reserves; incarcerated; absent; didn’t receive consent; private schools Slide 17 of (19)

18. © (Pulver / May 2014) CIHR Team in Child and Youth Injury Prevention CIHR Team in CHILD & YOUTH INJURY 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)

19. CIHR Team in CHILD & YOUTH INJURY PREVENTION © (Pulver/ May 2014) CIHR Team in Child and Youth Injury Prevention Slide 19 of (19) Thank you Acknowledgements: