Young adults using prescription drugs nonmedically

Preface 9
List of figures and tables 11
Introduction 13
Literature review 15
1. What is the nonmedical use of prescription drugs? 15
2. Types of medicines 16
2.1 Analgesics 16
2.2 Tranquillisers, sedatives and hypnotics 17
2.3 Central nervous system stimulants 17
3. Context of use 17
3.1 Motives for use 17
3.2 Initiation and trajectory 21
3.3 Profiles of nonmedical users 22
3.4 Effects and outcomes 25
3.5 Use patterns 27
3.6 Polysubstance use 28
3.7 Attitudes and social acceptability 29
3.8 Sources of information 32
4. Supply 32
4.1 Sources of supply 33
4.2 Diversion 34
4.3 Availability and accessibility 35
5. The European and national context 35
5.1 Epidemiology of NMUPD in Europe 35
5.2 Epidemiology of NMUPD in Belgium 44
5.3 Belgian policy and legislation regarding psychoactive medication 51
5.4 Prescribing practices in Belgium 56
6. The international legal context 58
Methods 61
1. Conceptual framework and operationalisation 61
2. Data collection and analysis 62
2.1 Online survey 62
2.2 In-depth interviews 63
2.3 Online forums 64
3. Ethical considerations 66
4. Limitations 67
Results 69
1. An overview of our sample 69
1.1 Sociodemographic characteristics 69
1.2 Medical and nonmedical prescription drug use 72
1.3 Medical conditions and healthcare 74
1.4 Psychoactive substance use 74
2. Initiation 76
2.1 Initiation age 77
2.2 Supply channels 78
2.3 Reasons for initial use 81
3. Motives for use 86
3.1 Performance enhancement 88
3.2 Self-medication 90
3.3 Recreational use 92
3.4 Intertwined motives 96
4. Use patterns 97
4.1 Type of nonmedical use 97
4.2 Frequency of use 98
4.3 Dose 101
4.4 Administration methods 103
4.5 Concurrent substance use 106
4.6 Setting of use 109
4.7 Problematic use 111
5. Effects 113
5.1 Desired effects 114
5.2 Side effects 117
6. Supply 120
6.1 Sources of supply 120
6.2 Diversion 127
6.3 Prices 130
6.4 Perceived availability and accessibility 131
7. Evolution 132
7.1 Transitions in NMUPD 132
7.2 Stopping NMUPD 137
8. Attitudes and perceptions 139
8.1 Acceptability and users’ justifications 139
8.2 Risk perceptions 143
8.3 Opinions on access and regulation 148
8.4 Perceptions about future use 151
8.5 Social acceptability and peer use 152
9. Risk management strategies 154
9.1 Use and conditions for use 155
9.2 Disclosure to other people 158
9.3 Informing oneself 160
9.4 Supply source 160
10. Information 161
10.1 Information-seeking behaviour: types of information 162
10.2 Channels or sources of information 163
11. Rapid analysis of online discussion forums 166
11.1 Online forums in interviews/survey results 167
11.2 Explorative analysis of online forums 168
12. The effect of COVID-19 on NMUPD 178
12.1 Access and availability 178
12.2 Patterns of use 180
12.3 Impact on the use of illicit drugs 182
Conclusions 183
1. Young adults’ perceptions of their nonmedical use practices, associated risks and social acceptability 184
2. Information needs and sources 188
3. Discussions about NMUPD in online communities of (potential) users 189
4. Policy recommendations to prevent or reduce NMUPD and related harms among young people 191
4.1 Policy area: society 191
4.2 Policy area: education 196
4.3 Policy area: household 201
4.4 Policy area: healthcare 202
4.5 Policy area: online communication 206
4.6 Policy area: recreational contexts of use 208
4.7 Policy area: future research 209

References 213
About the authors 231