Teens who misuse prescription medications are more likely to have sex and engage in risky sexual behavior, a new study concludes.

Researchers from the Centers for Disease Control and Prevention found teens who misused prescription drugs were more likely than their peers who didn’t use prescription drugs for recreational reasons to be sexually active, not use a condom, use drugs or alcohol before sex, and have more sexual partners. The more teens misused prescription drugs, the more likely they were to engage in all of these risky behaviors, the study found.

Teens in the study misused drugs such as the prescription painkillers OxyContin, Vicodin, Percocet or codeine; sedatives such as Xanax or Ativan, or stimulant drugs such as Ritalin or Adderall, HealthDay reports.

The study of more than 29,000 high school students appears in Pediatrics.

“About one out of every five high school students reported non-medical use of prescription drugs,” said study author Heather Clayton. “This behavior is very concerning, as overdoses and deaths related to non-medical use of prescription drugs is on the rise.” She added, “Non-medical use of prescription drugs and sexual risk behaviors are likely to be part of a constellation of risk-taking behaviors.”

She noted deaths from prescription painkillers have quadrupled since 1999. More than 16,000 people died due to prescription painkillers in the United States in 2013.