Mental Health and Pain Medication Prescriptions for Young People Have Declined in the Past 20 Years

Rutgers researchers analyze trends in the prescribing of drugs at risk for misuse, known as controlled medications

The number of controlled medications - those classified to have the potential for misuse or dependency - prescribed to young people is declining, according to Rutgers Health researchers.

Their study, published in Drug and Alcohol Dependence,examined prescription trends over the past two decades of U.S. adolescents and young adults ages 10 to 29 enrolled in Medicaid, with an annual sample of 9 million to 18 million.

Researchers analyzed prescriptions for six medications commonly used to treat mental health or pain conditions that are involved in overdoses. While researchers observed an overall decline in the proportion of youth prescribed a controlled medication, the trends varied across specific substances and age groups.

Multiple factors could contribute to the changes in prescribing trends, such as changes in state and federal policies, changes in diagnostic practices, increased recognition of safety concerns, and shifts in patient and clinician preferences.

Greta Bushnell

Core Member, Rutgers Center for Pharmacoepidemiology and Treatment Science

Declines may be attributed to a range of factors, including increased awareness of the risks of opioid misuse and policy changes, researchers said.

"As young people are a vulnerable age group with a heightened risk for drug misuse and overdose, it is important to monitor trends in the prescribing of controlled medications," said Greta Bushnell, a core member of the Rutgers Center for Pharmacoepidemiology and Treatment Science at the Institute for Health, Health Care Policy and Aging Researchand lead author of the study.

The U.S. Drug Enforcement Administration and individual state laws classify drugs with the potential for misuse or dependency as "controlled medications." The medications examined in the Rutgers Health study included opioids, stimulants, benzodiazepines, Z-hypnotics, barbiturates and gabapentin, which are a controlled substance in certain states.

In 2021, the National Survey on Drug Use and Healthreported that 14 million people older than 12 misused a prescription psychotherapeutic drug in the past year, with the highest prevalence in young adults. The use and misuse of controlled medications can create a risk for substance use disorders and overdoses, Rutgers researchers said.

From 2001 to 2019, researchers observed an overall decline in the proportion of young people with a prescription for a controlled medication, with variation by age group and a larger decline in females than males.

While opioids, benzodiazepines, Z-hypnotics and barbiturates prescriptions decreased, prescriptions for stimulants increased. Researchers said this finding could align with the increasing prevalence of attention-deficit/hyperactivity disorder (ADHD) diagnoses, as stimulants are the most common medication for addressing ADHD symptoms. Prescriptions for gabapentin, which are prescribed for a variety of conditions including epilepsy and pain, increased in young adults.

"Multiple factors could contribute to the changes in prescribing trends, such as changes in state and federal policies, changes in diagnostic practices, increased recognition of safety concerns, and shifts in patient and clinician preferences," said Bushnell, who also is an assistant professor of epidemiology at the Rutgers School of Public Health.

Coauthors of the study include Kristen Lloyd, Tobias Gerhard and Hillary Samples of Rutgers Institute for Health and Stephanie Shiau of Rutgers School of Public Health.

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