Research suggests that non-medical prescription drug (NMPD) use is becoming increasingly prevalent, particularly among adolescents. A critical step towards developing effective intervention efforts requires identifying adolescents who are at risk for NMPD use. An extensive literature suggests that both adolescents and adults with elevated anxiety sensitivity (AS) are at greater risk for problematic substance use, and a small body of work has identified similar links with NMPD use specifically among adults. However, most of this literature combines all prescription drugs into a single category, and no work has evaluated the relation between AS and NMPD use among adolescents. The current study endeavors to further this area of research by examining the relation between AS (overall and subscales) and NMPD use among adolescents. The project evaluated 276 adolescents (age 9-19 years) enrolled in a residential treatment program on level of AS, including sub-dimensions (i.e., cognitive, physical, and social), and NMPD use across three categories of drugs: analgesic (e.g., Vicodin®), anxiolytic (e.g., Xanax®), and stimulant (e.g., Adderall®). A series of logistic regression models indicated that overall AS predicted nonmedical analgesic use, but not anxiolytic/sedative or stimulant use. A closer investigation of the AS subscales demonstrated that only the AS social subscale significantly predicted nonmedical analgesic and anxiolytic/sedative use. These results suggest that AS is related to NMPD use among adolescents, highlighting the need for future work to disaggregate the assessment of NMPD use into specific drug classes and explore the subscale dimensions of AS.

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This study examines student's nonmedical prescription drug (NMPD) and marijuana use and whether anxiety, depression, ADD or ADHD symptoms are associated with their use and if students are self-medicating to alleviate symptoms. The method of obtaining this information was provided by a total of 278 college students who voluntarily and anonymously completed a Web-based survey. This study fills in the gaps of previous research and reveals the most frequent NMPD's used by students and their overall perceptions of their intended effects of the drug and answers why students do not seek professional help for their anxiety, depression and impulsivity symptoms. Results from the survey indicate that students who report NMPD use self- reported higher symptoms of anxiety, depression and impulsivity. NMPD users reported higher percentages of other substance abuse compared to nonusers. The most prominent NMPD's used by students are Adderall and Vicoden or Codeine. Data also indicates student's primary reasons for their NMPD use are related to academic purposes; as opposed to nonacademic. This analysis is further supported by the fact that the majority of NMPD users did not use before they began college and do not use while classes are not is session. Furthermore, students perceive their overall intended effects of their NMPD use to be beneficial, despite the known risks associated with their drug use. By examining college student's current NMPD use we can provide alternative solutions to students who are self-medicating as a coping mechanism for underlying issues or mental health disorders. Also, we can provide them with the necessary services in order to address their problems professionally.

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The non-medical use of prescription drugs is an important public health concern. Non-medical use of prescription stimulants (NMUPS), specifically medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), is particularly concerning. One timely concern regarding NMUPS, especially among young adults, is their role in appetite suppression/weight loss. Indeed, some individuals are motivated to misuse such drugs for the purpose of losing weight. Engaging in NMUPS for weight loss has been examined only minimally in the research literature. However, extant data demonstrate that this behavior is associated with other unhealthy behaviors and poor psychosocial health. Limitations of prior research include the exclusive use of college student samples and little attention to relevant health behavior theory. The current study investigated NMUPS for weight loss in a national, young adult sample (n = 1526), ages 18-25 years, utilizing Amazon’s Mechanical Turk. Motivations and attitudes about NMUPS were evaluated, within the framework of the Theory of Planned Behavior (TPB). A structural equation model (SEM) was analyzed, which included attitudes; social norms; and perceived behavioral control (PBC) to lose weight without stimulants, as predictors of engaging in past year NMUPS for weight loss. Approximately 12.0% of participants reported lifetime NMUPS for weight loss, and of these, 48.4% reported past year use. Findings demonstrate that use is related to disordered eating and unhealthy weight loss behaviors, including vomiting; high rates of other substance use; and psychological concerns, including body dissatisfaction and depressive symptomatology. These results suggest that NMUPS for weight loss is associated with a variety of negative consequences and users are not well-informed regarding medication knowledge. The SEM provided adequate overall fit to the data; two of the four social norms and both PBC factors were significantly associated with NMUPS for weight loss. This study extends the literature on the utility of the TPB in examining NMUPS, and provides the first research on utilizing the TPB to examine NMUPS for weight loss. Methods aimed at increasing PBC regarding stimulant use and weight loss, and emphasizing healthful and sustaining weight loss strategies, improving mental health, and educating about polysubstance use are potential intervention targets.

This thesis discusses the evolution of the role of the pharmacist in U.S. health care delivery from its early origins to modern day practice. Public policy, education and licensing requirements, and technological advances have substantially shaped the role of the pharmacist and what health care services they provide. Where pharmacists once provided direct patient care when formal modes of pharmacist professionalization did not exist, post-WWII mass production of pharmaceuticals confined pharmacists to dispensing and distribution duties that did not fully utilize their drug knowledge. Consequently, pharmacy educators and leaders have pushed pharmacy practice into an era of “pharmaceutical care,” emphasizing direct patient care activities and the employment of pharmacists’ drug expertise. Pharmacists today have moved back into clinical roles, participating in patient care activities alongside other health care professionals—sometimes even providing primary care services. Due to the U.S.’s growing dependence of prescription drugs and the American public’s continuous demands for high quality care, greater access to health care services, and containment of health care costs, pharmacists will likely acquire greater responsibilities in direct patient care.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.