Misuse of prescribed psychotropic medication and drug crime offending:a follow-up case-control study of former adolescent psychiatric inpatients

Abstract Background: Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. Aims: Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13–17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. Methods: Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. Results: 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders’ purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. Conclusions: Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions