Document Type : Research Article (s)


Department of Health Policy and Community Health, Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA. 30458


Background: Given the current public health crisis caused by prescription opioid misuse among
adolescents across the United States, this study analyzed factors in the school environment
associated with prescription opioid misuse in adolescents in the United States.
Methods: Using a cross-sectional quantitative study design, multivariable analysis was
performed on data from the 2019 National Youth Risk Behavior Surveillance survey
Results: The study results showed that the odds of current and lifetime opioid misuse in
adolescents were 3 times higher for the students who carried weapons at least one day at school
(Adjusted odds ratios, AOR, 3.03; CI, 2.13-4.33) compared to students who did not carry
weapons. Other significant risk factors included physical fighting at school, safety concerns at
school, and perception of being threatened at school.
Conclusion: The school can be a critically important stakeholder in the implementation of
policies and programs to tackle the current opioid epidemic in America.


1. Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription Opioid Use and Misuse among Adolescents and Young Adults in the United States: A National Survey Study. PLoS Med. 2019;16(11):e1002922. doi: 10.1371/journal.pmed.1002922. PubMed PMID: 31689290; PMCID: PMC6830740. ## 2. Centers for Disease Control and Prevention. Drug Overdose Deaths in the United States,1999-2020. [Retrieved January 15, 2022]. Available from: ## 3. National Institute on Drug Abuse. Opioid Overdose Crisis. [Retrieved October 11, 2021]. Available from: ## 4. Uchitel J, Scott EH, Raman SR, McClellan MB and Wong CA. The Opioid Epidemic: A Needed Focus on Adolescents and Young Adults. Health Affairs Blog. [Retrieved October 11, 2022]. Available from: ## 5. Substance Abuse and Mental Health Services Administration. Rise in Prescription Drug Misuse and Abuse Impacting Teens. [Retrieved January 16, 2022]. Available from: ## 6. Seamans MJ, Carey TS, Westreich DJ, Cole SR, Wheeler SB, Alexander GC, et al. Association of Household Opioid Availability and Prescription Opioid Initiation Among Household Members. JAMA Intern Med. 2018;178(1):102-109. doi: 10.1001/jamainternmed.2017.7280. PubMed PMID: 29228098; PubMed Central PMCID: PMC5833498. ## 7. Miech R, Johnston L, O'Malley PM, Keyes KM, Heard K. Prescription Opioids in Adolescence and Future Opioid Misuse. Pediatrics. 2015;136(5):e1169-77. doi: 10.1542/peds.2015-1364. PubMed PMID: 26504126; PubMed Central PMCID: PMC4834210. ## 8. Monnat SM, Rigg KK. Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents. J Rural Health. 2016;32(2):204-18. doi: 10.1111/jrh.12141. PubMed PMID: 26344571; PubMed Central PMCID: PMC4779738. ## 9. Nargiso JE, Ballard EL, Skeer MR. A Systematic Review of Risk and Protective Factors Associated with Nonmedical Use of Prescription Drugs among Youth in the United States: A Social Ecological Perspective. J Stud Alcohol Drugs. 2015;76(1):5-20. J Stud Alcohol Drugs. 2015;76(1):5-20. PubMed PMID: 25486389. ## 10. Bhatia D, Mikulich-Gilbertson SK, Sakai JT. Prescription Opioid Misuse and Risky Adolescent Behavior. Pediatrics. 2020;145(2):e20192470. doi: 10.1542/peds.2019-2470. PubMed PMID: 31907292. ## 11. Clayton HB, Bohm MK, Lowry R, Ashley C, Ethier KA. Prescription Opioid Misuse Associated With Risk Behaviors Among Adolescents. Am J Prev Med. 2019;57(4):533-539. doi: 10.1016/j.amepre.2019.05.017. PubMed PMID: 31443955. ## 12. Murphy SM, McPherson S, Robinson K. Non-medical Prescription Opioid Use and Violent Behaviour among Adolescents. J Child Adolesc Ment Health. 2014;26(1):35-47. doi: 10.2989/17280583.2013.849607. PubMed PMID: 25391569. ## 13. Huang KY, Cheng S, Theise R. School Contexts as Social Determinants of Child Health: Current Practices and Implications for Future Public Health Practice. Public Health Rep. 2013; Suppl 3:21-8. doi: 10.1177/00333549131286S304. PubMed PMID: 24179275; PubMed Central PMCID: PMC3945445. ## 14. Centers for Disease Control and Prevention. YRBSS Data & Documentation. [Retrieved April 13, 2022] Available from: ## 15. Pontes NMH, Pontes M. Sex Differences in the Relationship between Prescription Opioid Misuse and Gun and other Weapon-carrying Behaviors. Drug Alcohol Depend. 2021;221:108596. doi: 10.1016/j.drugalcdep.2021.108596. PubMed PMID: 33684773. ## 16. Griesler PC, Hu MC, Wall MM, Kandel DB. Assessment of Prescription Opioid Medical Use and Misuse Among Parents and Their Adolescent Offspring in the US. JAMA Netw Open. 2021;4(1):e2031073. doi: 10.1001/jamanetworkopen.2020.31073. PubMed PMID: 33410876; PubMed Central PMCID: PMC7791357. ## 17. Edlund MJ, Forman-Hoffman VL, Winder CR, Heller DC, Kroutil LA, Lipari RN, Colpe LJ. Opioid Abuse and Depression in Adolescents: Results from the National Survey on Drug Use and Health. Drug Alcohol Depend. 2015;152:131-8. doi: 10.1016/j.drugalcdep.2015.04.010. PubMed PMID: 25981310. ## 18. Veliz P, Boyd CJ, McCabe SE. Nonmedical Prescription Opioid and Heroin Use Among Adolescents Who Engage in Sports and Exercise. Pediatrics. 2016;138(2):e20160677. doi: 10.1542/peds.2016-0677. PubMed PMID: 27456508; PubMed Central PMCID: PMC4960731. ## 19. Veliz P, Epstein-Ngo Q, Austic E, Boyd C, McCabe SE. Opioid Use among Interscholastic Sports Participants: An Exploratory Study from a Sample of College Students. Res Q Exerc Sport. 2015;86(2):205-11. doi: 10.1080/02701367.2014.983219. PubMed PMID: 25514090; PubMed Central PMCID: PMC4430342. ## 20. Outlaw KR, Carpenter-Aeby T, Aeby V. Opioids and Athletes: A Growing Problem and a Deadly Combination. Sport Exerc Med Open J. 2018;4(3):63-65. doi: 10.17140/SEMOJ-4-163. ## 21. Young A, McCabe SE, Cranford JA, Ross-Durow P, Boyd CJ. Nonmedical Use of Prescription Opioids among Adolescents: Subtypes Based on Motivation for Use. J Addict Dis. 2012;31(4):332-41. doi: 10.1080/10550887.2012.735564. PubMed PMID: 23244552; PubMed Central PMCID: PMC3531808. ## 22. McCabe SE, Schulenberg J, McCabe VV, Veliz PT. Medical Use and Misuse of Prescription Opioids in US 12th-Grade Youth: School-Level Correlates. Pediatrics. 2020;146(4):e20200387. doi: 10.1542/peds.2020-0387. PubMed PMID: 32913134; PubMed Central PMCID: PMC7546090. ## 23. Nalven T, Spillane NS, Schick MR. Risk and Protective Factors for Opioid Misuse in American Indian Adolescents. Drug Alcohol Depend. 2020;206:107736. doi: 10.1016/j.drugalcdep.2019.107736. PubMed PMID: 31765857; PubMed Central PMCID: PMC6980750. ##