Non-Medical Prescription Opioid Use Was High Among Ontario Students, With Cannabis Use as a Key Predictor | Research

The takeaway

In Ontario, 15.5% of students and 5.9% of adults reported non-medical prescription opioid use, with cannabis use independently associated with opioid misuse in male adults.

Read this if you want to understand the relationship between cannabis use and prescription opioid misuse.

15.5% of Ontario students reported non-medical prescription opioid use

What the researchers found

Two representative surveys in Ontario examined non-medical prescription opioid use (NMPOU): 4,023 adults and 3,266 secondary school students. NMPOU prevalence was notably high, especially among students (15.5%) compared to adults (5.9%).

Multivariate analyses revealed different predictors by sex and age group. For male students, other drug use was the strongest independent predictor. For female students, rural residence, subjective social status, other drug use, and suicidal ideation were all independently associated. Among male adults, marital status and cannabis use were independent predictors. Among female adults, binge drinking was the key factor.

Why it matters

The finding that NMPOU was three times higher in students than adults signals that adolescence is a particularly high-risk period for prescription opioid misuse. The association between cannabis use and opioid misuse in adults raises questions about polysubstance use patterns.

The numbers in context

Students: 15.5% past-year NMPOU. Adults: 5.9% past-year NMPOU. Independent predictors varied by sex. Cannabis use independently associated with NMPOU in male adults. Suicidal ideation associated in female students.

How the study worked

Two population surveys: the Centre for Addiction and Mental Health Monitor (CM), a random-digit-dialing telephone survey of 4,023 adults (2010-2011 cycles), and the Ontario Student Drug Use and Health Survey (OSDUHS), a school-based questionnaire of 3,266 students in grades 7-12 (2011). Logistic regression identified independent predictors.

What this study cannot tell us

Cross-sectional design cannot establish causal direction between cannabis use and opioid misuse. Self-reported data may underestimate true prevalence. The telephone-based adult survey may miss certain populations. Ontario-specific findings may not generalize to other regions.

How to read the evidence

Two large representative surveys with multivariate analysis; moderate evidence for prevalence and predictors.

When this study was published

Published in 2013, during the early recognition of the opioid epidemic. The opioid crisis has since intensified dramatically.

The bigger picture

This study contributed to the growing evidence that prescription opioid misuse was reaching epidemic levels, particularly among young people. The sex-specific predictor patterns suggest prevention strategies need to be tailored rather than one-size-fits-all.

Questions still open

Does cannabis use precede, follow, or occur alongside opioid misuse? Would addressing cannabis use reduce opioid misuse risk? Why is NMPOU so much higher in students than adults?

Common questions

Does cannabis use lead to opioid misuse?

This study found cannabis use was independently associated with prescription opioid misuse in male adults, but the cross-sectional design cannot determine which came first. People who use one substance are generally more likely to use others, and this association could reflect shared risk factors rather than a direct causal pathway.

Why is prescription opioid misuse higher in students than adults?

At 15.5% versus 5.9%, student NMPOU was nearly three times the adult rate. Adolescents may have easier access through household medicine cabinets, less awareness of addiction risk, more peer influence, and developing impulse control. This age disparity highlights the need for school-based prevention.

Read the original research

Prevalence and key covariates of non-medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada.

Drug and alcohol review, 32(3), 276-87

View on PubMed ↗Publisher’s paper ↗

Citation

Fischer, Benedikt; Ialomiteanu, Anca; Boak, Angela; Adlaf, Edward; Rehm, Jürgen; Mann, Robert E. (2013). Prevalence and key covariates of non-medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada.. Drug and alcohol review, 32(3), 276-87. https://doi.org/10.1111/dar.12025