Assessing Risk and Protective Factors of Pain Reliever Misuse in US Adolescents: Results from a National Survey

Background: The U.S. Department of Health and Human Services highlighted pain relievers as the most abused substance after marijuana. Pain reliever misuse (PRM) promotes other substance use (SU) disorders, organ dysfunction, overdose, death, family conflicts, and harmful risk-taking behaviors. Investigating adolescent PRM is critical to combatting overdose-related deaths, however, current evidence remains insufficient. Materials and Methods: We employed the Health Belief Model and Social Learning Theory framework to investigate PRM-related proximal risk (substance use risk perceptions, deviance, alcohol use, and depression) and protective (religiosity, mental health service utilization, emotional support, and negative substance use attitudes) factors in a sample of adolescents (NSDUH 2019, n = 13,397, 51% males). Data on PRM, risk, and protective factors were collected using validated scales. Data analysis examined variable distribution, multicollinearity across key predictors, impact of PRM risk, and protective factors using adjusted binary logistic regression. Results: Our results showed that greater levels of substance use risk perceptions (p = 0.013), religiosity (p = 0.044), and negative substance use attitudes (p = 0.0065) were associated with lower likelihood of engaging in PRM. Deviant behaviors (p < .0001), alcohol use (p < .0001), experiencing ≥1 major depressive episode (MDE) (p = 0.038), female (p = 0.0017), and family income below $20,000 (p = 0.036) significantly associated with PRM. Conclusion: Our findings demonstrate that adolescents with greater risk perception and negative attitudes towards SU are less prone to PRM. Conversely, adolescents who engaged in deviant behaviors, alcohol, and experienced ≥1 MDE were more inclined to PRM. Targeting at-risk adolescents, risk perceptions, and attitudes in PRM prevention interventions may mitigate SU and future PRM.