Salient Beliefs and Social Influence on Intentions to Misuse Prescription Opioid Pain Relieving Drugs for Recreational Purposes: An Application of the Theory of Planned Behavior

Purpose: The purpose of the proposed study was to evaluate the utility of the Theory of Planned Behavior (TPB) in predicting intentions to use prescription opioid pain relieving drugs for recreational purposes among a sample of college students, while identifying salient beliefs that underlie recreational use in order to inform future intervention efforts among this population. Methodology: A cross-sectional electronic survey design was used to evaluate the direct measures of TPB constructs, salient beliefs, substance use, and individual characteristics of a random sample of university students. Results: Among our sample (N=776) more than 20% reported lifetime use of prescription opioids for recreational purposes, with 13.5% reporting recreational use within the past 6 months. Recreational use of alcohol, marijuana, cocaine, ecstasy, methamphetamine, and non-opioid prescription drugs within the past six months were all associated with increased odds of recreational prescription opioid use. A hierarchical logistic regression model examined the relationship between theory constructs and intention to use prescription opioids for recreational purposes. In this model, descriptive norm was associated with the greatest increase in odds of intention to misuse prescription opioids for recreational purposes (OR=1.37, 95% CI: 1.23 – 1.54, p\u3c.001), folloby subjective norm (OR=1.33, 95% CI: 1.20 – 1.48, p\u3c.001), and finally attitude (OR=1.13, 95% CI: 1.09 – 1.17, p\u3c.001). Additionally, Attitude was hypothesized to moderate the relationship between the additional theory constructs and intention. This hypothesis was upheld only with regard to descriptive norms (p=.006). Slope analysis revealed attitude to exert a protective effect against perceptions of peer opioid use behavior. Conclusion: We recommend interventions among this population focus changing perceptions of peer behavior, as well as, changing attitudes toward recreational use of prescription opioids as this is shown to have a direct impact on intentions as well as moderate the effect of perceptions of peer behavior on intentions. Additionally, it is advised that future studies, move away from solely using terminology such as “nonmedical use” or “misuse” to describe this behavior as these definitions produce a degree of ambiguity when attempting to understand the determinants of this behavior, determinants which are necessary for behavior change interventions