Medical Use and Misuse of Addictive Prescription Drugs and Mental Health Among Adolescents in Estonia

Aims This study aimed to describe the prevalence and characteristics (sources, motivations, perceived health risks, accessibility) of medical use and misuse of addictive prescription drugs (APDs), and the prevalence of poor mental wellbeing and self-harm among adolescents in Estonia. In addition, this study examined associations between APD use status (non-use, medical use, misuse) and mental health indicators (mental wellbeing, self-harm). Methods Data came from the nationally representative 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey of 15–16-year-olds in Estonia ( n = 2,019). Respondents were classified as non-users, medical users, or misusers based on lifetime APD use. Motivations, sources, perceived health risks, accessibility, mental wellbeing, and self-harm were assessed. Multivariable logistic regression examined associations between APD use status and mental health indicators. Results Overall, 27.8% of adolescents reported APD medical use and 18.3% misuse, with higher prevalence among girls. Sedatives and sleeping pills were the most commonly medically used and misused APDs. Most misused APDs were obtained from home, and self-treatment motives predominated. Poor mental wellbeing (44.4%) and self-harm (17.6%) were most prevalent among misusers. APD misuse (. non-use) was associated with poor mental wellbeing, self-harm and female gender; misuse (vs. medical use) with self-harm; and APD medical use (vs. non-use) with self-harm and female gender. The strongest association was found between APD misuse (vs. non-use) and self-harm (adjusted odds ratio = 2.78). Conclusions APD medical use and misuse are common among Estonian adolescents. APD misuse co-occurred with poor mental wellbeing and self-harm, highlighting the importance of integrating APD misuse prevention into broader adolescent mental health and substance use strategies.