This article is one of the first to describe and compare the factors related to nonmedical use of benzodiazepines in immigrant and native-born adolescents residing in Spain.

During the study decade, around 3% of the student population made nonmedical use of these drugs (2.81% native-born vs. 3.36% immigrant adolescents). Consumption increased 4% during this decade, although only among native-born students. Our values are higher than the 1.6% found in a recent study performed with data from the American National Survey on Drug Use and Health in an adolescent population [15], but lower than the 7.5% of benzodiazepine nonmedical use found in McCabe’s research on U.S. high school seniors [4]. Furthermore, they are lower than results of the study by Kokkevi et al. undertaken with data from the ESPAD survey for adolescent students from 31 European countries, showing a 5.6% prevalence of nonmedical use of tranquilizers and sedatives [16].

The results show that, in Spain, the patterns of benzodiazepine nonmedical use among immigrant and native-born adolescents are similar. Gender and socioeconomic status had an effect on nonmedical use of these drugs. Adolescent females were twice as likely to make nonmedical use of these drugs as males, coinciding with the results from other studies that indicated that female gender was associated with nonprescription use of tranquilizers/sedatives [17,18]. Females use legal and socially accepted psychoactive drugs such as psychotropics. Due to the double aspect of psychotropic drugs (being substances for both legal and illegal consumption), they are an atypical substance when compared to other drugs. The fact that benzodiazepines are legal psychoactive substances entails the possible consequence that females are more likely to opt for this type of substance.

In our study, adolescents from low socioeconomic status families due to parental unemployment were at greater risk for recreational use of these drugs [19,20]. Adolescents living in poorer socioeconomic conditions face greater problems when making decisions about drug use, as they may have fewer opportunities, less parental supervision, and more stressful events in their lives.

Just as in other studies [14,21], we found that, in Spain, benzodiazepine nonmedical use among immigrant and native-born adolescents was associated with tobacco and alcohol consumption. The present study also found adolescents using tobacco to be at higher risk for nonmedical use of benzodiazepines. This is not surprising because most of these individuals abuse substances and are thus less likely to perceive nonmedical use as being as harmful as the abuse of other substances.

Regarding the use of other psychoactive substances, such as marijuana, our results show that native-born adolescents who made nonmedical use of benzodiazepines were more likely to use marijuana (aOR = 1.48; 95% CI 1.30–1.69) than immigrant adolescents. A recent study performed on a North American school population found that 59% of the adolescents who made nonmedical use of tranquilizers also participated in marijuana co-ingestion [22]; furthermore, this concomitant use often continues into young adulthood, further aggravating the public health problem [23]. Novak et al., in their study based on data from a cross-national investigation of nonmedical prescription drug use in five European countries, found that 28% of those who had misused sedatives in the previous year had also consumed illicit drugs including marijuana [24].

The “immigrant paradox”, whereby immigrants report better health results when compared to native-born persons during their first years in their destination country, did not apply for adolescent immigrants residing in Spain. The nonmedical use of benzodiazepines in immigrant adolescents, which was higher than that of native-born adolescents, may be explained, the disadvantaged socioeconomic position of their parents notwithstanding, by factors derived from the migration process when it is imposed on them by parents, reflecting disaffection because of the time of separation and the changes in social and economic status resulting from the multiple sharp edges of migration [25].

When the low risk perception associated with nonmedical use of benzodiazepines is added together with the ease with which students are able to obtain these drugs, according to statements made by Spanish adolescents, a really disturbing scenario unfolds. Given this situation, it would seem to be essential to identify the factors that favor this low perception of risks and the consequent increase in rates for this addictive behavior among adolescents [26,27]. Adolescents report that benzodiazepines are very easy to acquire. Patients should be informed of the risks of sharing a prescription for tranquilizers and sedatives with other members of the family. Pharmacists can also play an important role in preventing the nonmedical use of these substances by educating people about the exclusivity of prescriptions and the problem of inadequate storage of medicines at home.

Additionally, it should be noted that such similarity in nonmedical use patterns among immigrant and native-born adolescents could be associated with the acculturation of immigrant adolescents, who assimilate the norms, values, and cultural practices of the host country and tend to adopt consumption patterns similar to those that predominate in their new country [28].

In Spain, there are few studies describing benzodiazepine nonmedical use patterns among immigrant and native-born adolescents with a representative sample at the national level; this is the strength of this investigation.

However, our study is limited by the nature of the ESTUDES surveys. The biases of this study are the ETUDES surveys’ cross-sectional character and self-declared data, which could undervalue the answers provided by the study adolescents. This is because the information obtained during interviews was subjective and may be subject to recall errors or the tendency of subjects to give socially desirable responses in interviews.