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Background: Rhode Island (RI) ninth graders report lifetime nonmedical use of prescription opioids (NMUPO) of 8.9%. NMUPO is associated with transition to heroin use, opioid overdose, and death.

Objectives: Measure changes in 9th grade students' knowledge, confidence, perceptions of opioid use disorder prevention, overdose response with naloxone, treatment, and recovery, following the delivery of an interactive substance use disorder curriculum.

Methods: Eight RI public high schools were recruited to participate. Freshman in each school were administered identical surveys that collected demographic data, substance use and misuse knowledge, students' perceptions of substance misuse harm, reported drug use, and risk and protective behaviors before and after the curriculum.

Results: Among 969 pre-intervention survey respondents, 19% reported use of marijuana, 3% heroin use, and 21% nonmedical use of prescription opioids. Between the pre-intervention to the post-intervention survey, significantly more students identified that addiction is a chronic brain disease (79%–83%, p = 0.05), drug users are not responsible for their addiction (81%–88%, p = 0.001), and that non-medical use of a prescription medication is use without a prescription (81%–88%, p = 0.001). Improved confidence was also reported in identifying opioid withdrawal symptoms (26%–45%, p < 0.0001), identifying signs of an opioid overdose from 29% to 46% (p < 0.0001), and knowing when to administer naloxone (17%–45%, p < 0.0001). Confidence to refer someone to treatment improved from 31% to 45% (p < 0.0001). Logistic regression showed associations between mental health, peer use, parental affection, and academic performance factors as related to NMUPO.

Conclusions: Students reported significant NMUPO prevalence. Ninth grade students' knowledge and confidence of opioid misuse, overdose response, and recovery resources increased following the delivery of a multi-modal interactive substance use disorder curriculum. Community, school, and student-level interventions are needed to reduce NMUPO.

Buchanan_RxAddiction_2018_SupplTable.docx (34 kB)
Supplementary Table


Emily Patry, Jeffrey P. Bratberg, Ashley Buchanan and Kelly L. Matson are in the Department of Pharmacy Practice.

Andrea L. Paiva and Sara Balestrieri are in the Department of Psychology and the Cancer Prevention and Research Center.