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Some young adults who receive prescription painkillers for acute pain, such as that from a dental procedure or a broken bone, might have enough medication to both overuse it and divert to others, a new study suggests.

The study of 192 young adults found that 58 percent followed their doctor’s instructions for using their prescription painkiller; 27 percent underused their medication, and 16 percent overused it. The researchers found that 27 percent of all those studied diverted their medication. Of those who overused their medication, 63 percent diverted some—they were almost five times as likely to share, sell or trade their medication as those who used their medication as prescribed. Overusers were eight times as likely as underusers to divert their medication, the researchers report in the journal Pain Medicine.

“We are concerned that these individuals might have had enough medication from the prescription to both overuse it and divert it,” says study lead author Amelia M. Arria, PhD, Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health in College Park. “The research underscores the importance of ‘judicious dosing’ for managing acute pain conditions similar to what has been advised for chronic pain management.”

While much is already known about people who misuse prescription painkillers, less is known about the characteristics of individuals who divert this type of medication, says Dr. Arria, who is also the Scientific Director of the Parents Translational Research Center at the Treatment Research Institute. “This research shows that non-adherence to a medication regimen for acute pain conditions might be a risk factor.”

Dr. Arria and her colleagues explored the alternative idea that young adults who underused their medication would be more likely to divert it since they had extra unused doses. “We found instead that underusers were the least likely to divert medication, perhaps because they might be more risk averse,” she says.

Because many doctors are not initiating conversations with patients about medication diversion, parents of high school and college-age young adults should consider taking the lead, Dr. Arria advises. “When teens are prescribed an opioid analgesic, parents should initiate a conversation with their teen and/or with the doctor about the dangers of diverting the medication.”

Physicians also need practical ways to accurately assess which patients might be more at risk for diverting medication, she says. “We need an easy tool that doctors can use when they are prescribing opioid analgesics, which includes a few questions and talking points about medication diversion.” She adds that specific prescribing guidelines for dentists, who write opioid analgesic prescriptions for tooth extractions, and for orthopedic surgeons, who write them for sports injuries, might be useful.

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