ANN ARBOR—Young people who misuse asthma inhalers are seven times more likely to use illegal drugs and nearly three times more likely to use alcohol than their peers.

In a study of 5th through 10th graders in an ethnically diverse public school district in metro Detroit, University of Michigan researchers found that using an asthma inhaler in any way other than how it’s prescribed—sharing it with friends or family, using it to increase alertness or get high, for example—is strongly correlated with other substance use.

“If kids think it’s OK to pass around asthma inhalers, that may be a precursor to other kinds of substance use behaviors,” said Carol Boyd, lead author on a paper due out in Addictive Behaviors in November and a research scientist at U-M’s Substance Abuse Research Center.

“Asthma inhaler abuse appears to be a proxy for other drug use among younger adolescents even if they aren’t using the inhaler to get high. It is possible that these teens have a comfort level with breaking the rules and using other people’s drugs.”

Boyd and co-authors Sean Esteban McCabe and Christian Teter found:

• Asthma inhaler abuse spikes in 8th grade. While just 6 percent of 5th and 6th grade study participants reported having ever misused an inhaler, 9 percent of 7th graders said they had and 15 percent of 8th graders reported misuse.

• There were no gender or racial differences in asthma inhaler abuse—it was equally prevalent among males and females as well as white and black children.

• Inhaler abuse is correlated with smoking cigarettes, drinking alcohol, binge drinking and using illicit drugs.

• The correlation is even stronger among those young people who only misuse inhalers—that is, they do not have a prescription themselves but they borrow, buy or steal one prescribed to someone else. That group is 10 times more likely to use illicit drugs, nearly eight times more likely to drink and about 3.5 times more likely to report binge drinking within the two weeks prior to the survey.

“Nobody has talked about this. It’s been completely off many health professionals’ radar,” said Boyd, who is also a U-M professor of nursing and women’s studies.

So much so that parents often encourage their children to share inhalers, not recognizing that it could be setting a bad example, she said.

“Parents may be sending a message that it is OK to share prescription asthma inhalers but in truth, it is illegal and could be dangerous,” Boyd said.  

Since there are many different kinds of inhalers, what works for one person might be dangerous for another, so sharing might put children at risk, she says.

Based on these results, Boyd and McCabe hope to build a Web-based tutorial for 7th and 8th graders focusing on asthma inhalers as a way to talk about abuse of many common prescription drugs.

Boyd noted that asthma inhalers are easier to abuse because youngsters need to have immediate access to them if they should have an asthma attack, in which passages in the lungs constrict making it difficult to breathe. Many schools allow children to carry and administer their own asthma inhalers. By contrast, many school rules typically require students to leave drugs that are often abused like Ritalin and Adderall with an adult, and request just enough for a prescribed dose when it’s needed.  

“We aren’t teaching the appropriate use of prescription medications,” Boyd said. “Our focus on asthma inhalers in the curriculum is our segue into teaching kids about prescription drugs.”

Boyd has done extensive research on a whole range of substance use and abuse issues, including binge drinking and drug use in college students. She is a former director of the Substance Abuse Research Center, and currently serves as director of the Institute for Research on Women and Gender.

McCabe is a research scientist at the Substance Abuse Research Center. Teter was a U-M   graduate student   during the research, and now is an assistant professor and clinical research pharmacist at the Northeastern University School of Pharmacy in Boston.

Carol J. Boyd, PhD, MSN, RN, FAAN

U-M Substance Abuse Research Center